I.

INTRODUCTION

Acute Gastroenteritis (AGE) Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications such as dehydration. Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that has spoiled may also cause illness. Certain medications and excessive alcohol can irritate the digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms of gastroenteritis include diarrhea, nausea and vomiting, and abdominal pain and cramps. Sufferers may also experience bloating, low fever, and overall tiredness. Typically, the symptoms last only two to three days, but some viruses may last up to a week. A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medical treatment is essential if symptoms worsen or if there are complications. Infants, young children, the elderly, and persons with underlying disease require special attention in this regard. The greatest danger presented by gastroenteritis is dehydration. The loss of fluids through diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially lifethreatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydration increases as symptoms are prolonged. Dehydration should be suspected if a dry mouth, increased or excessive thirst, or scanty urination is experienced. If symptoms do not resolve within a week, an infection or disorder more serious than gastroenteritis may be involved. Symptoms of great concern include a high fever (102 F [38.9 C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or swelling. These symptoms require prompt medical attention. Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort and convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve the symptoms. These medications work by altering the ability of the intestine to move or secrete spontaneously, absorbing toxins and water, or altering intestinal microflora. Some over-the-counter medicines use more than one element to treat symptoms.

II.

Patients Profile S.Q. is a female, 11/12 months old, residing at P2 Blk1 L38 Pabahay Nanadero, Calamba City, Laguna. Her mother is J.Q., works part time in a shop and her father is R.Q., factory worker. She has one sibling older than her, K.Q., 3 years old. S.Q. was born on March 6, 2009, and born at Calamba, Laguna, Filipino in nationality. Their whole family is Born Again in religion. She weighs 8.7 kg. Shes admitted on January 30, 2010 at room 103-C, pedia ward with chief complaint of high fever for 2 days with emesis and has a diagnosis of Acute Gastroenteritis. And she was discharged on January 6, 2010, Saturday at 1:30 pm. Their attending physicians were Campos, Angelie, M.D. and Bonagua, Aireen, M.D.

III.

Health History & Chief Complain

Chief Complaint She was admitted for having high fever for 2 days with vomiting. Present Illness S.Q. was only admitted to the hospital due to gastrointestinal problem now and was also suspected of urinary tract infection by Dra. Campos. Aside from the diagnosis, no other disease or complication was seen or diagnosed. Past Health History Mrs. Q says eto first time nya ma-admit after nya ipanganak. S.Q. gets seasonal cough and colds at times but never serious because it usually last only for a few days. They always consult their doctor once sick. She is complete in her vaccinations except those which would be taken on her 1 year of age. Family Health History No one in the family had any respiratory illness or allergies. On her fathers side, almost all have hypertension. One member of their family died on a heart attack. IV. Gordons Pattern Health Perception As Mrs Q. stated, lagi naman kami nagpapacheck up ni stephani. Napunta talaga kami kay Dra. Campos. Malikot lang talaga yan pero inaalagaan yan sa bahay.

S.Q. has a mannerism of sticking anything on her mouth. Whatever she touches she directs it toward her mouth. Although, she doesnt practice hand washing every now and then. There are some medications she takes easily but there are also those medications which is hard for her because of the taste. Nutritional-Metabolic S.Q. weighs 8.7 kg. She eats soft foods. She drinks 6-7 bottles of milk in a day. Mrs. Q provides her daughter milk and food in accordance to age and doctors advise. She drinks formula milk. She stop being breastfed when she was 10 moths. She has no allergy. Elimination She defecates once or twice a day in her usual days. She changes diaper 3-5 times in a day when full or had defecated. She was advise to use Lactacid for her perennial wash and calmoseptin ointment on her diaper rash. Activity-Exercise S.Q. is a very playful and active girl. She has lots of energy but cries when she doesnt like something. She smiles and laughs a lot. Her coordination, gait, balance is not yet stable due to age. Her daily living activities were provided by her parents. There is no musculoskeletal impairment. She usually plays after she wakes up in the morning. Sleep-Rest She sleeps at 8 P.M. in the evening and usually gets up 7 A.M. 8 A.M. in the morning. After playing or eating she takes a nap. She has straight undisturbed sleep at night. Cognitive Perceptual S.Q. has no sensory deficits. She response well to verbal stimulus by looking at you or having facial expressions. Bibo nga yan bata nay an, makulit pero mabilis mo naman makuha attention, as her mother stated. Self-Perception S.Q. is not afraid of new people around her. She is friendly and is easy to accommodate. Sexual-Reproduction Prior to age, S.Q. is not yet oriented with any sexual matters.

Coping Stress In her age, she usually cries when something is wrong about her. Simple smile or cry is a sign of her comfort, distress or feelings. She is familiarized to her family members and long for them when she doesnt want the situation like giving of medications or other procedures. Role-Relationship She doesnt know the concept of death yet due to age. Forms words like dede and dada. She knows her family members and can easily familiarize the people around her. Value-Belief The family is Born Again. They regularly attend church together with all the members of the family. They dont usually believe in hilot. Once one is sick in the family, they go immediately to the hospital or for check-up.

V.

Head-to-Toe Assessment General Assessment: Playful and active, neat Initial Vital Sign: T=36.4C RR=27 PR=118

Area Assessed Skin Color Lips, nail beds, soles and palms Moisture Temperature Texture Turgor

Technique Inspection

Normal Findings Light brown, tanned skin (vary according to race) Lighter colored palms, soles, lips and nail beds Skin normally dry Warm to touch Smooth, soft and flexible palms and soles (thicker) Skin snaps back

Actual Findings brown skin Lighter colored palms, soles, lips and nail beds Skin normally dry 36.4 o C, warm to touch Smooth, soft and flexible palms and soles (thicker) Skin snaps back

Evaluation Normal

Inspection Inspection/ Palpation Palpation Palpation Palpation

Normal Normal Normal Normal Normal

immediately Skin appendages a. Nails Inspection Transparent, smooth and convex cut and clean Pinkish Firm White color of nail bed under pressure should return to pink within 2-3 seconds Evenly distributed Black Smooth Parallel to each other

immediately 1-2 seconds Transparent, smooth and convex Uncut and dirty Pinkish Firm White color of nail bed under pressure returned to pink within 2-3 seconds Poor grooming Normal Normal Normal

Nail beds Nail base Capillary refill

Inspection Inspection Inspection/ Palpation

b. Hair Distribution Color Texture Eyes Eyes Visual Acuity

Inspection Inspection Inspection/ Palpation Inspection Inspection (penlight) Inspection

Evenly distributed Black Smooth and curly Parallel to each other but slightly sunken

Normal Normal Normal May be a sign of dehydration Normal

Eyebrows

Eyelashes Eyelids

Inspection Inspection

PERRLA- Pupils PERRLA- Pupils equally round equally round react to react to light and light and accommodation accommodation Symmetrical in Symmetrical in size, size, extension, extension, hair texture hair texture and and movement movement Distributed evenly Distributed evenly and curved and long curved outward outward Same color as the Same color as the skin skin Blinks involuntarily and bilaterally up to 20 times per minute Blinks involuntarily and bilaterally up to 16 times per minute Do not cover the

Normal

Normal Normal

Normal

Conjunctiva Sclera Cornea Pupils Iris Ears Ear canal opening

Inspection Inspection Inspection Inspection Inspection Inspection

Do not cover the pupil and the sclera, lids normally close symmetrically Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible Free of lesions, discharge of inflammation Canal walls pink Client normally hears words when whispered Smooth, symmetric with same color as the face Close to midline, thicker anteriorly than posteriorly Oval, symmetric and without discharge

pupil and the sclera, lids normally close symmetrically

Normal

Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible Free of lesions, discharge of inflammation Canal walls pink Client normally hears words when whispered Smooth, symmetric with same color as the face Close to midline, thicker anteriorly than posteriorly Oval, symmetric and without discharge

Normal Normal Normal Normal Normal Normal

Normal Normal

Hearing Acuity Nose Shape, size and skin color Nasal septum

Inspection

Inspection

Normal

Inspection

Normal

Nares

Inspection

Normal

Mouth and Pharynx Lips Buccal mucosa

Inspection Inspection

Pink, moist symmetric Glistening pink soft moist

Pink, moist symmetric Glistening pink soft moist

Normal Normal

Gums

Inspection

Tongue

Inspection

Teeth Hard and soft palate Neck Symmetry of neck muscles, alignment of trachea Neck Rom Thyroid gland Trachea Thorax and Lungs Abdomen

Inspection Inspection

Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny Hard palatedome-shaped Soft Palate- light pink

Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny No tooth decay, milk tooth present Hard palate- domeshaped Soft Palate- light pink

Normal

Normal Normal

Normal

Inspection Inspection Palpation Inspection Auscultatio n Inspection

Bowel sounds

Auscultatio n

Neck is slightly Neck is slightly hyper hyper extended, extended, without without masses or masses or asymmetry asymmetry Neck moves Neck moves freely, freely, without without discomfort discomfort Rises freely with Rises freely with swallowing swallowing Midline Midline Clear breath Clear breath sounds sounds Skin same color Skin same color with with the rest of the rest of the body the body Clicks or gurling Clicks or gurling sounds occur sounds occur irregularly and range irregularly and from 5-35 per minute range from 5-35 per minute Fully conscious, Fully conscious, respond to respond quickly to questions quickly, stimulus perceptive of events Unstable gait, balance

Normal Normal Normal Normal Normal Normal

Normal

Neurology system Level of consciousness

Inspection

Normal

and coordination Behavior and appearance Inspection Makes eye contact with examiner, hyperactive expresses feelings with response to the situation Makes eye contact with examiner, hyperactive expresses feelings with response to the situation

Normal for age (11 months) Normal

VI.

Anatomy & Physiology

Digestion is the process by which food is broken down into smaller pieces so that the body can use them to build and nourish cells and to provide energy. Digestion involves the mixing of food, its movement through the digestive tract (also known as the alimentary canal), and the chemical breakdown of larger molecules into smaller molecules. Every piece of food we eat has to be broken down into smaller nutrients that the body can absorb, which is why it takes hours to fully digest food. The digestive system is made up of the digestive tract. This consists of a long tube of organs that runs from the mouth to the anus and includes the esophagus, stomach, small intestine, and large intestine, together with the liver, gall bladder, and pancreas, which produce important secretions for digestion that drain into the small intestine. The digestive tract in an adult is about 30 feet long. Mouth and Salivary GlandsDigestion - begins in the mouth, where chemical and mechanical digestion occurs. Saliva or spit, produced by the salivary glands (located under the tongue and near the lower jaw), is released into the mouth. Saliva begins to break down the food, moistening it and making it easier to swallow. A digestive enzyme (called amylase) in the saliva begins to break down the carbohydrates (starches and sugars). One of the most important functions of the mouth is chewing. Chewing allows food to be mashed into a soft mass that is easier to swallow and digest later. Esophagus - Once food is swallowed, it enters the esophagus, a muscular tube that is about 10 inches long. The esophagus is located between the throat and the stomach. Muscular wavelike contractions known as peristalsis push the food down through the esophagus to the stomach. A muscular ring (called the cardiac sphincter) at the end of the esophagus allows food to enter the stomach, and, then, it squeezes shut to prevent food and fluid from going back up the esophagus. Stomach - a J-shaped organ that lies between the esophagus and the small intestine in the upper abdomen. The stomach has 3 main functions: to store the swallowed food and liquid;

to mix up the food, liquid, and digestive juices produced by the stomach; and to slowly empty its contents into the small intestine. Small Intestine - Most digestion and absorption of food occurs in the small intestine. The small intestine is a narrow, twisting tube that occupies most of the lower abdomen between the stomach and the beginning of the large intestine. It extends about 20 feet in length. The small intestine consists of 3 parts: the duodenum (the C-shaped part), the jejunum (the coiled midsection), and the ileum (the last section). The small intestine has 2 important functions. First, the digestive process is completed here by enzymes and other substances made by intestinal cells, the pancreas, and the liver. Glands in the intestine walls secrete enzymes that breakdown starches and sugars. The pancreas secretes enzymes into the small intestine that help breakdown carbohydrates, fats, and proteins. The liver produces bile, which is stored in the gallbladder. Bile helps to make fat molecules (which otherwise are not soluble in water) soluble, so they can be absorbed by the body. Second, the small intestine absorbs the nutrients from the digestive process. The inner wall of the small intestine is covered by millions of tiny fingerlike projections called villi. The villi are covered with even tinier projections called microvilli. The combination of villi and microvilli increase the surface area of the small intestine greatly, allowing absorption of nutrients to occur. Undigested material travels next to the large intestine. Large intestine - forms an upside down U over the coiled small intestine. It begins at the lower right-hand side of the body and ends on the lower left-hand side. The large intestine is about 5-6 feet long. It has 3 parts: the cecum, the colon, and the rectum. The cecum is a pouch at the beginning of the large intestine. This area allows food to pass from the small intestine to the large intestine. The colon is where fluids and salts are absorbed and extends from the cecum to the rectum. The last part of the large intestine is the rectum, which is where feces (waste material) is stored before leaving the body through the anus. The main job of the large intestine is to remove water and salts (electrolytes) from the undigested material and to form solid waste that can be excreted. Bacteria in the large intestine help to break down the undigested materials. The remaining contents of the large intestine are moved toward the rectum, where feces are stored until they leave the body through the anus as a bowel movement.

VII.

Pathophysiology

VIII. Course in the Ward On day 1, January 30, 2010, at 8:40 am S.Q. is for check up with her attending physician due to high fever for 2 days associated with vomiting. She was seen and examined by Dra. Campos and was advised to be admitted for further test and treatment due to suspected UTI. She was diagnosed with Acute Gastroenteritis. An IVF D5 INM 500 ml x 10cc/hr is hooked and CBC was done. She was brought to pedia ward at around 11:00 am and received by nurse on charge. Monitoring of input and output was ordered by the doctor with increase fluid intake. Medications were Paracetamol drops 1 ml every 4 hours for fever. 1 dose was given on admission and following doses for every 4 hours was given. On the second day, January 31, 2010, IVF was changed to #2 D5 INM 500 ml x 10cc/hr at 9:50 am. She was seen by Dra. Campos at 10:15 am and given an order of urinalysis and fecalysis. She was prescribed with Omeprazole (Omepron) 5mg IV once a day, 1st dose is given at 8:00 am the next morning. Also, Zinc Sulfate (E-Zinc) drops (0.6 ml) once daily was ordered. Her fever decreases gradually unitl there administration of paracetamol every 4 hours for fever was discontinued. She is being given Ceftriaxone (Xtenda) 750 mg IV once a day side drip every 12 noon. She was playful all through out the day. The laboratoty results was followed up. On the third day, February 1, 2010, Monday, she was crying when received. She has fever of 37.9 C and administration of Paracetamol drops 1 ml every 4 hours was resumed. She has been irritable all day. 10:40 am Dra. Campos, examined S.Q. and was refered to Dr. Zablan due to decreased results of urinalysis. All laboratory results were seen by Dra. Campos. During the afternoon, her fever subsides to 37.2 C . IVF #3 D5 INM 500 ml x 10 cc/hr was hooked at 1:00 pm. All medications were given. On the fourth day, February 2, 2010, Tueasday, she has no fever, negative vomiting and playful. Dra. Campos had her round at 4:50 pm and checked S.Q. she ondered continue all medications and treatment and wait for Dr. Zablans assessment. IVF #4 D5 INM 500 ml x 10 cc/hr was hooked at 11:30 am. On the fifth day, February 3, 2010, Wednesday, Dr. Zablan had his round at 11:30 am. Findings were with positive diaper rash, decrease laboratory results and afebrile, no vomiting. He ordered repeat UA from AM (clear catch), urine culture and sensitivity, use of Lactacid pink for perennial wash, and apply Calmoseptin ointment to diaper rash 3x a day. IVF #5 INM 500 ml x 10cc/hr was hooked at 12:15 nn. On the sixth day, February 4, 2010, Thursday, Dra. Campos ordered continue all medications and follow order of Dr. Zablan. IVF #6 INM 500 ml x 10cc/hr was hooked at 11:00 am. S.Q. is received active, playful but cries at times. All medications were given on time. Dr. Zablan saw laboratory results and advise client to increase fluid intake and replace loses with PLRS. Follow up urine culture and sensitivity. Repeat

urinalysis and notify him when WBC is 1-3. IVF #7 INM 500 ml x 10cc/hr was hooked at 1:00am. On the seventh day, February 5, 2010, Friday, Dra Campos ordered continue all medeications and treatments. Proceed to Dr. Zablans orders. All 8:00 am medications were given. S.Q. is taking a bath, playful and laughing when received. IVF was regulated. IVF was ordered to shift to D5 IMB L x 20 cc/hr. IVF #8 IMB L x 20 cc/hr was hooked at 11:30 am. Dr. Zablan had his round at 11:45, he checked S.Q. and the laboratory test. He said all test were now stabilized and normal. He ordered follow up of urine culture and sensitivity and advised periodic complete emptying of urinary bladder. On the eighth day, February 6, 2010, Saturday, all findings were on normal range. S.Q. is afebrile, no vomiting, diminished diaper rash, and was active and playful. All morning medications were given. IVF #9 imb l X 20 cc/hr was hooked at 10:45 am. Dra. Campos, advised that they may go home. S.Q. was discharge at 1:30 pm.

IX. Urinalysis

Laboratory Results

01/30 /10 Color Transparenc y Reaction Specific Gravity Albumin Sugar WBC
Yellow SI turbid 5.5 1.025 Traces (#) 7-10

Int.
Normal increased urine concentrati on Decreased Normal Normal Increase sugar Infection

01/31/ Int. 10
Yellow SI turbid 6.0 1.010 Traces (-) 15-20 Normal increased urine concentrat ion Normal Normal Normal Normal Infection

02/03/ 10
yellow Clear

Int.
Normal Normal

02/05 Int. /10

Light Yello w Clear Normal Normal

6.0 1.025 +1 (-) 28-30

Normal Normal UTI Normal Infection

8.0 1.010 (-) (-) 1-3

Normal Normal Normal Normal Normal

Fecalysis Color Consistency Parasites Hematology 01/30/10 Hemoglobin Hematocrit RBC WBC Neutrophils Lymphocytes Platelets MCV MCH MCHC Blood Chemistry 01/30/10 BUN Creatinine Results 11 0.3 Normal Value 7-17 0.52-1.04 Interpretation Normal Decrease,indirectly proportional to glomerular filtrate rate Results 123 0.38 4.98 19.1 0.77 0.23 297 77.3 26.7 31.9 Normal Value 120-150 0.37-0.45 4.6-5.2 5-10 x 10/L 0.55-0.65 0.25-0.35 140-340 x 10/L 86-100 26-31 31-37 Interpretation Normal Normal Normal Increase, infection Increase, acute bacterial infection Decrease, may cause severe malnutrition Normal Normal Normal Normal 01/31/10 Green Soft No OVA or parasites seen Interpretation Sign of diarrhea Sign of diarrhea Normal

X. Generic

Drug Study Brand E-Zinc Classification Indication Vitamins & Minerals Nsg. Responsibilities To prevent Participate in > Explain need individual trace synthesis & for zinc element stabilization administration deficiencies in of protein & to patient & patient nucleic acids family receiving long- in term total subcellular > Report signs parenteral & membrane of nutrition transport hypersensitivity system promptly Gastrointestinal Inhibits > Sodium disturbaces and activity of restricted diet irritations acid (proton) should be pumps & cautious binds to hydrogen> take 30 potassium minutes before adenosine meals triphosphate at secretory surface of gastric parietal cells to block formation of gastric acid Action

Zinc-Sulfate Drops (0.6 ml) OD

Omeprazole 5mg IV OD

Omepron

Proton Pump Inhibitor

XI.

Nursing Care Plan Nsg. Diagnosis Risk for Infection Planning The client will be able to demonstrate no signs of infection (fever) until discharge Intervention >Demonstrate & teach proper handwashing technique and stress its importance Rationale > first-line of defense against infection/ crosscontamination (NANDA 10th Ed. Pg. 323) > first-line defense and eliminate rough edges or long nails, which can harbor microorganism (Kozier 8th Ed. Vol I pg. 682) > to prevent exposure of client (NANDA 10TH Ed. Pg. 323) > same > Advise to avoid opening of door or going out the room too much > Instruct mother to neglect her child from putting hands or objects on Evaluation Goal Met AEB afebrile until discharged

Assessment S > Oo, mahilig nga yan magsubo ng kahit anong mahawakan nya, as stated by mother > sa halos 1 week naming na stay ditto sa ospital, 3-4 times ko sya pinaliguan ditto, as stated by mother O > very playful > does not wash often > age = 11/12 moths old > dirty nails

> Instruct in daily bath/ shower, regular cutting of nails

> Limit visitors

> One source of fecal-oral route mode of transmission of pathogens (Kozier 8th Ed) >To avoid

mouth > Suggest techniques for safe food preparation and presentation Assessment S> Sadyang malikot nga yan, maliksi kumilos, as stated by mother O > Tantrums at times > Age= 11/12 months old > Unstable gait, balance and coordination >Unfamiliar environment > Active and playful Nsg. Diagnosis Risk for Fall Planning The client will be able to maintain safety measure with free from injury within hospitalization Intervention > Provide assistive device or safety device like side rails

microbial growth (NANDA 10TH Ed.)

Rationale > Prevent from falling onto one side or the other, also helps stabilize balance (Kozier 8th Ed) > Supervision helps one child to be safe as well as gain courage to be independent on activity (Kozier 8th Ed.) > helps mucle and bones to stabilize and gain balance on coordination (Kozier 8th Ed.)

Evaluation Goal Met AEB free from injury upon discharge

> Encourage family for proper supervision

> Practice walking with support / exercise of legs and extremities

> Discuss safety measures that should be in > To avoid precautions injury and

lessen the risk (Kozier 8th Ed) Assessment S> Hinuhugasan ko naman kamay nya pag nadudumiha n sya. Ganun sabi nung nurse, pero hindi ko na minamayat maya ang hugas, pag madumi lang, as stated by mother O > client has a habit of putting everything to mouth > hands are always wet with saliva > nails uncut and dirty > Unorganized bed & bed side table > No bed linens Nsg. Diagnosis Deficient Knowledge (Infection Control) R/T information misinterpretatio n AEB verbalized data Planning The client will be able to practice understandin g of teaching after 1-2 hours of teaching Intervention Evaluatio n > Describe > to prevent Goal Met ways to possible cross- AEB manipulate the contamination mother bed, room & (Kozier 8th Ed. performed other facilities Vol I pg. 682) hygiene care for > Instruct to > to induce self and rinse soiled death of child and cloth in cold microorganis cleaning water, wash in m of place hot water if (Kozier 8th Ed. possible & add Vol I pg. 682) a cup of bleach or phenolbased disinfectant > Perform & teach hand hygiene (before & after handling/eatin g of foods, or toileting) > first-line defense against infection/ crosscontamination (NANDA 10th Ed. Pg 323) Rationale

> Promote nail care > eliminate rough edges or long nails, which can harbor microorganis m (Kozier 8th Ed. Vol I pg. > Instruct not 682) share personal

items

> Infections can be transmitted from shared personal items through fomites (Kozier 8th Ed. Vol I pg. 682)

XII.

Prognosis

Medications Upon discharge client was advised to continue intake of Zinc-Sulfate (Ezinc) drops 0.6 ml once a day. Economics Advised client to buy foods within the budget. The client, prior to admission present a health insurance card, ( + ) HMO. They had discount on S.Q.s hospitalization and also to the doctors fee. Treatment S.Q. was still advised for increase fluid intake, periodic complete emptying of urinary bladder, use of lactacid for perinial wash, and keep hands clean. She still have a follow up check up after 1 week after discharge. Health Teaching Proper hygiene of both child and parent are very important as defense from infection. Proper and strict supervision of child until balance, gait, and coordination is gained. Advise to restrict child from handling items or objects especially if unfamiliar and not edible. Emphasize importance of hand washing and nail care. Out Patient Client was discharge on January 6, 2010. Last advises and follow up check ups were reminded. Other treatments were elaborated. Diet Client was ordered with diet for age, with increase fluid intake.

CASE STUDY (ACUTE GASTROENTERITIS)