Introduction

Numerous things may cause acute gastroenteritis. Bacterial infection is

frequently a factor, and infection by parasites like giardia can
cause acute gastroenteritis to last for several weeks. Viruses can also cause
lengthy stomach flu, particularly rotaviruses and nor viruses. Accidental
poisoning or exposure to toxins may also instigate acute gastroenteritis as well.

When a person does not recover from stomach flu symptoms within a day or so,
it is usually a good idea to see a doctor. Some types of acute gastroenteritis will
not resolve without antibiotic treatment, especially when bacteria or exposure to
parasites are the cause. Physicians may want to diagnose the cause by
analyzing a stool sample, when stomach symptoms remain problematic.

Another reason to seek medical treatment is that some forms

of acute gastroenteritis mimic appendicitis, which may require emergency
treatment. As well, young children run an especially high risk of becoming
dehydrated during a long course of the stomach flu. One should receive
directions regarding how to help affected kids or adults get more fluids.
Sometimes children, those with compromised immune systems, and the elderly
may require hospitalization and intravenous fluids. Dehydration can actually
cause greater nausea, and can begin to cause organ shut down if not properly
addressed.

Even through causes for acute gastroenteritis vary, methods of transmission from
one person to another usually remain the same. Generally, contact with the fecal
matter of a person with the condition and then improperly washing or not washing
the hands causes’ acute gastroenteritis to be quite contagious. Proper hand
washing for both the ill person and well people in the family is always
encouraged.

Other methods of transmission of acute gastroenteritis can include eating food or

drinking liquids contaminated with bacteria or parasites. For example, poorly
cooked hamburger might result in a very severe case of acute gastroenteritis due
to exposure to E. coli, a sometimes lethal bacterial infection in young children.
Drinking improperly treated water, or drinking from streams and lakes can
expose one to giardia, which can leave one ill for many weeks, without treatment.
Definition

Gastroenteritis is a general term for infection or irritation of the digestive tract,

particularly the stomach and intestine. It is frequently referred to as stomach or
intestinal flu, although the influenza virus does not cause this illness. Major
symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fever and
overall weakness sometimes accompany these symptoms. Gastroenteritis
typically lasts about three days. Adults usually recover without problem, but
children, the elderly, and persons with an underlying disease are more vulnerable
to complications such as dehydration.

Gastroenteritis (also known as gastro, gastric flu, tummy bug in some countries,
and stomach flu, although unrelated to influenza) is inflammation of
the gastrointestinal tract, involving both the stomach and the small intestine (see
also gastritis and enteritis) and resulting in acute diarrhea. The inflammation is
caused most often by an infection from certain viruses or less often by bacteria,
their toxins, parasites, or an adverse reaction to something in the diet or
medication. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million
people per year,[1] and is a leading cause of death
among infants and children under 5.
At least 50% of cases of gastroenteritis due to food borne illness are caused
by norovirus.[3]Another 20% of cases, and the majority of severe cases in
children, are due to rotavirus. Other significant viral agents include adenovirus
and astrovirus.
Different species of bacteria can cause gastroenteritis,
including Salmonella, Shigella,Staphylococcus, Campylobacter
jejuni, Clostridium, Escherichia coli, Yersinia, and others. Some sources of the
infection are improperly prepared food, reheated meat dishes, seafood, dairy,
and bakery products. Each organism causes slightly different symptoms but all
result in diarrhea. Colitis, inflammation of the large intestine, may also be
present.
Risk factors include consumption of improperly prepared foods or contaminated
water and travel or residence in areas of poor sanitation. It is also common for
river swimmers to become infected during times of rain as a result of
contaminated runoff water.
Classification

Viral Gastroenteritis

Gastroenteritis is usually caused by infection with one of these viruses: rotavirus,

adenovirus, astrovirus, calicivirus, and small round-structured viruses (SRSVs).
These viruses are found all over the world and are particularly problematic where
sanitation is poor. Typical exposure to these viruses occurs through the fecal-to-
oral route, by ingesting food that is contaminated with fecal material or by coming
in contact with an infected person's vomit or diarrhea and then inadvertently
bringing the contaminant to the mouth. Other routes of transmission are quite
likely, because exposure to as few as 100 virus particles can cause an infection.

Typically, children are more vulnerable to rotaviruses—the most common cause

of acute watery diarrhea. It is estimated that each year rotaviruses cause
800,000 deaths worldwide in children younger than age five. For this reason,
much research has gone into developing a vaccine to protect children from this
virus. Adults can be infected with rotaviruses, but these infections typically have
minimal or no symptoms.

Adenoviruses and astroviruses are minor causes of childhood gastroenteritis,

and children may become infected with caliciviruses and SRSVs. Adults
experience illness from astroviruses as well, but the major causes of adult viral
gastroenteritis are the caliciviruses and SRSVs. The SRSVs are a type of
calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses.
SRSVs are the most likely to produce vomiting as a major symptom.

Bacterial Gastroenteritis

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe

drinking water, or contaminated food—conditions that are common in developing
nations. Natural or man-made disasters can worsen underlying sanitation and
food-safety problems. In developed nations, modern food production, handling,
and distribution systems and methods may expose millions of people to disease-
causing bacteria. Common types of bacterial gastroenteritis can be linked to
Salmonella and Campylobacter bacteria; however, Escherichia coli 0157
and Listeria monocytogenesare creating increased concern in developed nations.
Cholera and shigella remain two diseases of great concern in developing
countries, and research to develop long-term vaccines against them is underway.
Causes & Symptoms

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites.

Spoiled food 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, vomiting,
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 typical bout of gastroenteritis should not 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.

Dehydration is the greatest danger presented by gastroenteritis. The loss of

fluids through diarrhea and vomiting can upset the body's electrolyte balance,
leading to potentially life-threatening problems, such as heart beat abnormalities
(arrhythmia). The risk of dehydration increases the longer that symptoms are
present. Signs of dehydration include a dry mouth, increased or excessive thirst,
or scanty urination.

Symptoms that do not clear up within a week may point to an infection or

disorder more serious than gastroenteritis. Symptoms of great concern include a
fever of 102°F (38.9°C) or above, blood or mucus in the diarrhea, blood in the
vomit, and severe abdominal pain or swelling. Persons experiencing these
symptoms should seek prompt medical attention.

Diagnosis

A usual bout of gastroenteritis should not require a visit to the doctor. However,
medical treatment is essential if symptoms worsen or if the child has any
symptoms of dehydration.

A physician makes the diagnosis of gastroenteritis based on the presence of

symptoms and after performing a medical examination. Unless there is an
outbreak affecting several people or complications are encountered in a
particular case, identifying the specific cause of the illness is not a priority.
However, if identification of the infectious agent is required, a stool sample will be
collected and analyzed for the presence of rotavirus, disease-causing
(pathogenic) bacteria, or parasites.
When symptoms continue even after treatment or to rule out the presence of
other illnesses with similar symptoms, the diagnostic evaluation may include
blood tests, a hydrogen breath test, or an x ray of the bowel, called a barium
enema. Endoscopic tests such as a colonoscopy or sigmoidoscopy may be
performed. An endoscopic test is an internal examination of the colon using a
flexible instrument (sigmoidoscope or colonoscope) inserted through the anus.
When symptoms persist, a nutritional assessment, performed by a
registered dietitian, may be included in the child's diagnostic evaluation.

Epidemiology

Every year worldwide rotavirus in children under 5 causes 111 million cases of
gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the
world's poorest nations.
In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with
most of these occurring in the third world. Lack of adequate safe
water and sewage treatment has contributed to the spread of infectious
gastroenteritis. Current death rates have come down significantly to
approximately 1.5 million deaths annually in the year 2000, largely due to the
global introduction of oral dehydration therapy.
The incidence in the developed world is as high as 1-2.5 cases per child per year
and is a major cause of hospitalization in this age group.
Age, living conditions, hygiene and cultural habits are important
factors. Aetiological agents vary depending on the climate. Furthermore, most
cases of gastroenteritis are seen during the winter in temperate climates and
during summer in the tropics.
Patient’s Profile

Name: Patient “X”

Age: 1yr old

Address: Huyo,Silang Cavite

Sex: Male

Religion: Catholic

Past Illness: Diarrhea

Chief Compliant: Vomiting

Admitting Diagnosis: Age which signs and symptoms of dehydration

Brief Clinical History: Patient noted to have loose bowel movement watery

Non-odor, non-bloody (5) which vomiting previously ingested food ilk (4x)

Laboratory:

Cbc: 10.2

Rbc: 3.9

Hct: .36

Hgo: 12.1
 VI. Pathophysiology with Anatomy & Physiology

Predisposing Factors: Precipitating Factors:

 Environment ~ Age(6 Months)

 Hygiene ~ Gender(Male)
 Stress

Ingestion of E. Coli

Invasion of gastric
mucosa

Penetration of Gastric
mucosa

Signs & Symptoms:

Toxins producing
Watery stool
pathogens cause watery,
Fever
large volume diarrhea
 Irritation of the Gastric Signs & Symptoms:
Lining Vomiting

Fluid and Electrolyte imbalance too much Na+

and H2O are expelled from the body

Increased fluid loss

Signs & Symptoms:
Decrease skin turgor
Dehydration Sunken Eyes
 VII. MEDICAL MANAGEMENT
a. Medical Orders and Rationale
b.
DOCTOR’S ORDER RATIONALE

 Please admit to pedia ward  For further management and

under the service of Dr. X treatment of condition
 At par with age regular diet  To provide easy digestion of food
without experiencing pain upon
digestion
 Start D5 0.3NaCL 500ml @  To provide access for intravenous
100cc/hr medications.

 Labs:  To screen the patient’s blood

• CBC component and to detect any
abnormalities. This also serves as a
baseline data to evaluate
effectiveness of blood transfusions.

• Urinalysis  To screen the patient’s urine

components and to detect any
abnormalities.

• SE  To screen the patients feces & to

detect any abnormalities

 I & O q shift  To measure daily I & O of the client

 v/s q4H  To have baseline data and for

comparison of future data / for
monitoring of patient’s condition.

 IVF with D5 0.3NaCl 500ml @

 To provide access for intravenous
 100cc/hr
 Continue medications
 For billing today
 IVF with D5 0.3 NaCl500cc @  Preparation for going home
SR
 Continue medications
 IVF D5 0.3 NaCl 500cc @ SR
medications.
 To help for fast recovery
 To provide access for intravenous
medications.
 To help for fast recovery
 To provide access for intravenous
medications.
 “nagtatae kc sya. Verbalized by the patient’s mother.
S
• Hyperactive bowel sounds
O • 3-5 loose liquid stools per day

A Diarrhea related to irritation of the GI tract

P Short Term: at the end of 8 hours, the patient will reestablish and
maintain normal pattern of bowel functioning.

1. Weighed infant’s diaper.

• To determine the amount of output and fluid
replacement needs
2. Encouraged oral fluid intake containing electrolytes.
• To maintain fluid and electrolyte balance
3. Provided prompt diaper changes and gentle cleansing
• Because, skin breakdown can occur quickly when

I diarrhea is present
4. Did auscultation of abdomen.
• To check for presence, location, and characteristics of
bowel sounds.
Dependent:
5. Administered antidiarrheal medications as prescribed.
• To treat infectious process and decrease motility and
minimize fluid losses

Goals were not met

E At the end of 8 hours, the patient was unable to manifest signs of

decrease fluid volume.
S “nagsusuka kc sya, verbalized by the patients’ mother.

• Cool extremities
• Sunken eyes
• Dry skin
• Watery stool
• Persistent vomiting
O • Weight (Before = 7 kgs; Now = 6.5 kgs)
Fluid volume deficit related to excessive losses through GI tract secondary to
A diarrhea
Short term: At the end of 8 hours, the patient will be able to restore fluid and
P electrolyte imbalances

• Encouraged the mother to give oral fluid intake.

• To increase fluid intake
2. Monitored intake and output balance.
• To ensure accurate picture of fluid status
3. Observed for excessively dry skin and mucous membranes, decreased
skin turgor, slowed capillary refill.
• Indicates excessive fluid loss/resultant dehydration

I 4. Weighed daily
• Indicator of overall fluid and nutritional status

5. Monitored vital signs

• To note the changes in heart rate and respiration
Dependent:
6. Provided supplement fluids as indicated D5LR 500cc @ 28cc/hr
• Fluids may be given in this manner if patient is unable to take
oral fluid

Goal has been met; at the end of 8 hours, the patient was able to restore fluid
E and electrolyte imbalances
Brand Name: Erceflora
Classification: Antidiarrheals
Suggested Dose:
Adults 2-3 vials of 2 billion/5 mL susp
Children 2-11 years 1-2 vials of 2 billion/5 mL susp
Infants >1 month 1-2 vials of 2 billion/5 mL susp.
Administration: May be taken with or without food (Dilute contents of vial in
sweetened water, milk, tea or orange juice.).
Mode of Action:
Contributes to the recovery of the intestinal microbial flora altered during the
course of microbial disorders of diverse origin. It produces various vitamins,
particularly group B vitamins thus contributing to correction of vitamin disorders
caused by antibiotics & chemotherapeutic agents. Promotes normalization of
intestinal flora.
Indication:
Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons.
Chronic or persistent diarrhea with duration of >14 days.
Contraindication:
Not for use in immunocompromised patients (cancer patients on chemotherapy,
patients taking immunosuppressant meds)
Drug Interaction:
No known drug interactions.
Side Effects/Adverse Reactions:
No known side effects.
Adverse Effects:
No known adverse effects.
Nursing Responsibility:
1.) Shake drug well before administration.
Allows equal distribution of the drug in the fluid it is in.
2.) Monitor patient for any unusual effects from drug.
Monitoring allows detection of possible side effects of the drug since there has
been no known side effect of the drug.
3.) Administer drug within 30 minutes after opening container.
To avoid contamination of the drug.
4.) Dilute drug with sweetened milk, orange juice or tea.
To allow easy administration of the drug.
5.) Administer drug orally.
Proper administration allows better effects of the drug and prevent possible
complications.
 Case Analysis

“Acute Gastroenteritis”

By:
John Gregory Calanog