Professional Documents
Culture Documents
INTRODUCTION
intestinal flu, although the influenza virus is not associated with this illness. Major
symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These
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
Natural or man-made disasters can make underlying problems in sanitation and food
safety worse. In developed nations, the modern food production system potentially
Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria
Shigella remain two diseases of great concern in developing countries, and research to
threatening in the United States and other developed nations. However, an estimated
220,000 children younger than age five are hospitalized with gastroenteritis symptoms
in the United States annually. Of these children, 300 die as a result of severe diarrhea
diarrheal illness.
1
infection with bacteria, viruses, or other parasites, or less commonly reactions to new
crippling), diarrhea and/or vomiting, with non-inflammatory infection of the upper small
'gastro'. It is often called the stomach flu or gastric flu even though it is not related to
influenza. If inflammation is limited to the stomach, the term gastritis is used, and if the
small bowel alone is affected it is enteritis. As such, this has a relationship on the
concept fluids and electrolyte. Because dehydration the most common complication of
A case of patient KA, 3-year old, Filipino child, from Macasandig, Cagayan de
Oro City, was admitted for the second time in Oro Doctor’s Hospital due to Loose Bowel
In the morning prior to the patient’s admission, the patient had an onset of loose
accompanied by abdominal discomfort and vomiting for two consecutive episodes. The
patient was negative for fever, and was given Flagyl for relief; however, due to
From the patient’s presenting signs and symptoms, along with the aid of some
laboratory studies, the physician arrived with a diagnosis of Acute Gastroenteritis with
2
b. General Objectives:
After 2 weeks of case study on Patient AR, the group will be able to acquire
knowledge about Gastroenteritis with some dehydration especially Amoebiasis and their
complications; gain proficiency on nursing interventions which are essential and suitable
for the patient and significant others with the above mentioned disease condition.
Furthermore, provide support and encouragement on the patient and the family in
c. Specific Objectives:
This case study specifically aims to do the following after 2 hours of case
presentation:
1. Discuss the Anatomy and Physiology of the organs interconnected to the client’s
disease condition.
3. Itemize the predisposing and precipitating factors that lead to Gastroenteritis with
4. List the ideal medical and nursing intervention appropriate to the disease condition
5. Present the formulated and prioritized nursing care plan for the client
6. Provide a study of the medications ordered for the client and the rationale for its
prerequisite
3
7. Convey additional information that is necessary for the improvement of care given
This study includes the collection of information specifically to the patient’s health
condition. The study also includes the assessment of the physiological and
psychological status, adequacy of support systems and care given by the family as well
a. Data collected via assessment, interviews with the patient, family members
b. Actual and ideal problems for 3 days including the initial assessment and its
appropriate nursing intervention that would be applied within his stay in the hospital at
PGH hospital.
complications.
d. Coordinating and delegating interventions within the plan of care to assist the
b. The interaction, assessment and care were only limited to a total of 16 hours
(2 days clinical duty, 1 day assessment) with actual nursing intervention done.
4
c. The lack of complete family history obtained was due to lack of laboratory
5
II. ASSESSMENT
A. Client Profile:
Name: KA
Age: 3
Current Medications:
Furoate hystolitica
Domperidone 3ml TID Vomiting
Zinc Sulfate 5ml OD PO Zinc deficiency
Past hospitalization, if any: twice, because of Amoeba. First at Sabal clinic then 2 nd at
Apperance: weak & pale, poor skin turgor, appears restless; thin & small for age; poor
6
Grooming: well groomed, appropriately dressed, neat & clean without any foul/bad
body odor.
Posture: erect
Child is fully immunized when he was 9 mos. Old according to his mother
(February 2007).
Skin-Color: brownish
Hair-Color: black
Lesions: none
Condition: clean
Breakfast/Lunch/Dinner: his meal varies; he only eats rice & viand once in a day
either during breakfast, lunch or dinner. Other meals consist of biscuit or milk and/or
juice.
Vitamins taken: Ener 4 plus & Pro-zinc but for only 2 months
7
III. ELIMINATION
Bowel-Habits:
Bladder Habits:
Daily activities: upon waking up, he eat his meal, watch tv or play; he sleeps at noon
V. SLEEP-REST PATTERN
Hearing: good but do not pay attention most of the time when called by his name
Smell: N/A
8
VII. COGNITIVE PATTERN
Ability to express:
When he wants to eat he grabs a plate , when he wants to pee he takes off his
shorts. If he wants to sleep he lies on bed. If he wants something but cant express it
verbally he cries out loud. He cannot speak properly and mother admitted that her child
(the Patient) has special needs and has a developmental delay in speech.
Primary caregiver of client: mother, but he was taken care by a nanny when he was
B. Laboratory Results
Hematology
Date: 2/15/2010
9
CBC
Increases in the RBC count are most commonly seen in polycythemia vera,
Differential Count
Fecalysis
Date: 2/16/2010
10
Color: Yellow usually found in milk-fed children
Urinalysis
Date: 2/16/2010
Physical Characteristics
or calcium oxalate
Specific gravity: 1.030 Urine with a high specific gravity is associated with
nephrosis
Chemical Tests
Cells
Others
Crystals
11
Amorphous Phosphate: Few may be found in urine that has stool at room
C. Developmental Stages
12
a. Developmental Task Theory of Robert Havighurst
A developmental task is a task which arises at or about a certain period in the life
of an individual. Havighurst has identified six major age periods: infancy and early
childhood (0-5 years), middle childhood (6-12 years), adolescence (13-18 years), early
adulthood (19-29 years), middle adulthood (30-60 years), and later maturity (61+).
Basing on Havighurst’s Theory, the patient belongs in the infancy and early
childhood stage. According to the patient’s mother the patient learned to walk when he
was already almost 2 years old and started to talk just recently. The patient has control
on his elimination but is not able to relate emotionally to his parents and cannot
distinguish right from wrong when in fact according to Havighurst these things should
periods during which the individual seeks pleasure from different areas of the body
Anal 2 to 3years
Phallic 4 to 5years
Latency 6 to 12years
Genital 13 and Up
Basing on this theory, the patient belongs to the anal stage the time wherein the
experience. According to the mother when a child wants to void or defecate he takes off
13
Erik Erickson envisioned life as a sequence of levels of achievement. Each
stage signals a task that must be achieved. He believed that the greater the task
achievement, the healthier the personality of the person. Failure to achieve a task
influences the person’s ability to progress to the next level. Stages of Erikson’s
Basing on this theory, the patient belongs to late childhood stage with the central
task of “initiative vs. guilt.” The mother verbalized that her son has a developmental
delay and depends on her in most of his activities of daily living. According to Erikson a
child in this stage must develop initiative in doing things without the help of other
people; failure to do so may indicate a negative resolution for this stage such as having
a poor self-esteem, lack of self-confidence and pessimism which are apparent to the
understanding of his or her world through the interaction and influence of genetic and
14
Sensorimotor Phase Birth to 2 years
The child in this stage according to Piaget has rapid language development and
associates words with objects but in the case of the patient he has a developmental
D. Body Map
regulated @ 55 ml/hr
2)Vomiting, developmental
delay in speech
3 Loss of appetite
bowel movement
4
1
15
III. ANATOMY AND PHYSIOLOGY
30 ft) long. In humans, digestion begins in the mouth, where both mechanical and
chemical digestion occur. The mouth quickly converts food into a soft, moist mass. The
muscular tongue pushes the food against the teeth, which cut, chop, and grind the food.
Glands in the cheek linings secrete mucus, which lubricates the food, making it easier to
chew and swallow. Three pairs of glands empty saliva into the mouth through ducts to
moisten the food. Saliva contains the enzyme ptyalin, which begins to hydrolyze (break
Once food has been reduced to a soft mass, it is ready to be swallowed. The
tongue pushes this mass—called a bolus—to the back of the mouth and into the
pharynx. This cavity between the mouth and windpipe serves as a passageway both for
food on its way down the alimentary canal and for air passing into the windpipe. The
16
epiglottis, a flap of cartilage, covers the trachea (windpipe) when a person swallows.
This action of the epiglottis prevents choking by directing food from the windpipe and
Mouth
The mouth plays a role in digestion, speech, and breathing. Digestion begins
when food enters the mouth. Teeth break down food and the muscular tongue pushes
food back toward the pharynx, or throat. Three salivary glands—the sublingual gland,
the submandibular gland, and the parotid gland—secrete enzymes that partially digest
food into a soft, moist, round lump. Muscles in the pharynx swallow the food, pushing it
into the esophagus, a muscular tube that passes food into the stomach. The epiglottis
Esophagus
The presence of food in the pharynx stimulates swallowing, which squeezes the
food into the esophagus. The esophagus, a muscular tube about 25 cm (10 in) long,
passes behind the trachea and heart and penetrates the diaphragm (muscular wall
between the chest and abdomen) before reaching the stomach. Food advances through
peristalsis. The process begins when circular muscles in the esophagus wall contract
and relax (widen) one after the other, squeezing food downward toward the stomach.
A circular muscle called the esophageal sphincter separates the esophagus and
the stomach. As food is swallowed, this muscle relaxes, forming an opening through
which the food can pass into the stomach. Then the muscle contracts, closing the
opening to prevent food from moving back into the esophagus. The esophageal
sphincter is the first of several such muscles along the alimentary canal. These muscles
act as valves to regulate the passage of food and keep it from moving backward.
Stomach
The stomach, located in the upper abdomen just below the diaphragm, is a
saclike structure with strong, muscular walls. The stomach can expand significantly to
17
store all the food from a meal for both mechanical and chemical processing. The
stomach contracts about three times per minute, churning the food and mixing it with
gastric juice. This fluid, secreted by thousands of gastric glands in the lining of the
stomach, consists of water, hydrochloric acid, an enzyme called pepsin, and mucin (the
main component of mucus). Hydrochloric acid creates the acidic environment that
pepsin needs to begin breaking down proteins. It also kills microorganisms that may
have been ingested in the food. Mucin coats the stomach, protecting it from the effects
of the acid and pepsin. About four hours or less after a meal, food processed by the
stomach, called chyme, begins passing a little at a time through the pyloric sphincter
Liver
The liver is the largest internal organ in the human body, located at the top of the
abdomen on the right side of the body. A dark red organ with a spongy texture, the liver
is divided into right and left lobes by the falciform ligament. The liver performs more
than 500 functions, including the production of digestive liquid called bile that plays a
role in the breakdown of fats in food. Bile from the liver passes through the hepatic duct
into the gallbladder, where it is stored. During digestion bile passes from the gallbladder
through bile ducts to the small intestine, where it breaks down fatty food so that it can
be absorbed into the body. Nutrientrich blood passes from the small intestine to the
liver, where nutrients are further processed and stored. Deoxygenated blood leaves the
Small Intestine
intestine. This narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most of the
lower abdomen, extending about 6 m (20 ft) in length. Over a period of three to six
hours, peristalsis moves chyme through the duodenum into the next portion of the small
intestine, the jejunum, and finally into the ileum, the last section of the small intestine.
During this time, the liver secretes bile into the small intestine through the bile duct. Bile
18
breaks large fat globules into small droplets, which enzymes in the small intestine can
act upon. Pancreatic juice, secreted by the pancreas, enters the small intestine through
the pancreatic duct. Pancreatic juice contains enzymes that break down sugars and
starches into simple sugars, fats into fatty acids and glycerol, and proteins into amino
acids. Glands in the intestinal walls secrete additional enzymes that break down
starches and complex sugars into nutrients that the intestine absorbs. Structures called
Brunner’s glands secrete mucus to protect the intestinal walls from the acid effects of
digestive juices. The small intestine’s capacity for absorption is increased by millions of
fingerlike projections called villi, which line the inner walls of the small intestine. Each
villus is about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a single layer of
cells. Even tinier fingerlike projections called microvilli cover the cell surfaces. This
combination of villi and microvilli increases the surface area of the small intestine’s
lining by about 150 times, multiplying its capacity for absorption. Beneath the villi’s
single layer of cells are capillaries (tiny vessels) of the bloodstream and the lymphatic
system. These capillaries allow nutrients produced by digestion to travel to the cells of
the body. Simple sugars and amino acids pass through the capillaries to enter the
bloodstream. Fatty acids and glycerol pass through to the lymphatic system.
Large Intestine
This residue leaves the ileum of the small intestine and moves by peristalsis into the
large intestine, where it spends 12 to 24 hours. The large intestine forms an inverted U
over the coils of the small intestine. It starts on the lower right-hand side of the body and
ends on the lower left-hand side. The large intestine is 1.5 to 1.8 m (5 to 6 ft) long and
about 6 cm (2.5 in) in diameter. The large intestine serves several important functions. It
absorbs water— about 6 liters (1.6 gallons) daily—as well as dissolved salts from the
residue passed on by the small intestine. In addition, bacteria in the large intestine
promote the breakdown of undigested materials and make several vitamins, notably
vitamin K, which the body needs for blood clotting. The large intestine moves its
remaining contents toward the rectum, which makes up the final 15 to 20 cm (6 to 8 in)
19
of the alimentary canal. The rectum stores the feces—waste material that consists
Then, muscle contractions in the walls of the rectum push the feces toward the anus.
The Urinary System performs the functions of producing and excreting urine from
the body. The constancy of body fluid volumes and the level of many important
functions and eliminates the dissolved organic waste products generated by the body’s
cells. It is also responsible for regulating blood volume and blood pressure by adjusting
the volume of water lost in the urine and releasing the hormones erythropoietin and
chloride and other ions by controlling the quantities lost in the urine; stabilizes blood pH
by controlling the loss of ions in the urine; and conserves valuable nutrients by
20
The body takes nutrients from food and converts them to energy. After the body
has taken the food that it needs, waste products are left behind in the bowel and in the
blood. Thus, the urinary system keeps the chemicals and water in balance by removing
a type of waste called urea from the blood. Urea is produced when proteins, found in
function is to:
cells.
• The kidneys remove urea from the blood through tiny filtering units called
called a glomerulus and a small tube called a renal tubule. Urea, together with
water and other waste substances, forms the urine as it passes through the
• Ureters: narrow tubes that carry urine from the kidneys to the bladder. Muscles
in the ureter walls continually tighten and relax forcing urine downward, away
from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection
can develop. About every 10 to 15 seconds, small amounts of urine are emptied
located in the lower abdomen is held in place by ligaments that are attached to
other organs and the pelvic bones. The bladder's walls relax and expand to store
urine and contract and flatten to empty urine through the urethra.
• Sphincter muscles: circular muscles that help keep urine from leaking by
closing tightly like a rubber band around the opening of the bladder.
21
• Nerves in the bladder: alert a person when it is time to urinate, or empty the
bladder.
signals the bladder muscles to tighten, which squeezes urine out of the bladder.
At the same time, the brain signals the sphincter muscles to relax to let urine exit
the bladder through the urethra. When all the signals occur in the correct order,
22
IV. PATHOPHYSIOLOGY
A. Narrative
production.
absorption. This produces an increased luminal fluid content that cannot be adequately
• Inflammatory (or mucosal), when the mucosal lining of the intestine is inflamed
The small intestine is the prime absorptive surface. The colon then absorbs
additional fluid, transforming a relatively liquid fecal stream in the cecum to well-formed
Disorders of the small intestine result in increased amounts of diarrheal fluid with a
generated by bacteria (ie, enterotoxigenic Escherichia coli, Vibrio cholera) that act
directly on secretory mechanisms and produce typical, copious watery (rice water)
diarrhea. No mucosal invasion occurs. The small intestines are primarily affected, and
23
Cytotoxin production by bacteria (ie, Shigella dysenteriae, Vibrio
destruction that leads to bloody stools with inflammatory cells. A resulting decreased
inflammatory diarrhea. Similarly, Salmonella and Yersinia species also invade cells but
do not cause cell death. Hence, dysentery does not usually occur. However, these
bacteria invade the bloodstream across the lamina propria and cause enteric fever such
as typhoid.
defenses. A large inoculum may overwhelm the host capacity to mount an effective
defense. Normally, more than 100,000 E coli are required to cause disease, while only
10 Entamoeba or Giardia cysts may suffice to do the same. Some organisms (eg, V
cholera, enterotoxigenic E coli) produce proteins that aid their adherence to the
intestinal wall, thereby displacing the normal flora and colonizing the intestinal lumen.
factors can lead to infection. An alteration of normal bowel flora can create a biologic
void that is filled by pathogens. This occurs most commonly after antibiotic
administration, but infants are also at risk prior to colonization with normal bowel flora.
proximal small bowel, where motility is the major mechanism in the removal of
24
diphenoxylate and atropine [Lomotil], loperamide) or anomalous anatomy (eg, fistulae,
mellitus or scleroderma.
although serotonin release has been postulated as a cause, stimulating visceral afferent
input to the chemoreceptor trigger zone in the lower brainstem. Preformed neurotoxins
produced by Staphylococcus aureus and Bacillus cereus, when ingested, can cause
severe vomiting.
• Trophozoite
• Cyst
The motile trophozoites feed on bacteria and tissue, reproduce, colonize the lumen
and the mucosa of the large intestine, and sometimes invade tissues and organs.
Trophozoites predominate in liquid stools but rapidly die outside the body. Some
trophozoites in the colonic lumen become cysts that are excreted with stool.
environment. They may spread directly from person to person or indirectly via food or
E. histolytica trophozoites can adhere to and kill colonic epithelial cells and PMNs
and can cause dysentery with blood and mucus but with few PMNs in stool.
Trophozoites also secrete proteases that degrade the extracellular matrix and permit
invasion into the intestinal wall and beyond. Trophozoites can spread via the portal
circulation and cause necrotic liver abscesses. Infection may spread by direct extension
25
from the liver to the right lung and pleural space or, rarely, through the bloodstream to
When cyst is swallowed, it passes through the stomach unharmed and shows no
activity while in an acidic environment. When it reaches the alkaline medium of the
intestine, the metacyst begins to move within the cyst wall, which rapidly weakens and
tears. The quadrinucleate amoeba emerges and divides into amebulas that are swept
down into the cecum. This is the first opportunity of the organism to colonize, and its
success depends on one or more metacystic trophozoites making contact with the
mucosa.
Mature cyst in the large intestines leaves the host in great numbers (the host
remains asymptomatic). The cyst can remain viable and infective in moist and cool
environment for at least 12 days, and in water for 30 days. The cysts are resistant to
levels of chlorine normally used for water purification. They are rapidly killed by
The metacystic trophozoites of their progenies reach the cecum and those that
come in contact with the oral mucosa penetrate or invade the epithelium by lytic
digestion.
The trophozoites burrow deeper with tendency to spread laterally or continue the
lysis of cells until they reach the sub-mucosa forming flash-shape ulcers. There may be
From the primary site of invasion, secondary lesions maybe produced at the
Progenies of the initial colonies are squeezed out to the lower portion of the
bowel and thus, have the opportunity to invade and produce additional ulcers.
26
E. histolytica has been demonstrated in practically every soft organ of the body.
lymphatics or walls of the mesenteric venules in the floor of the ulcers, and are carried
If thrombi occur in the small branches of the portal veins, the trophozoites in
thrombi cause lytic necrosis on the wall of the vessels and digest a pathway into the
lobules.
Next to the liver, the organ which is the frequent site of extra-intestinal amoebiasis is
27
28
29
30
V. MEDICAL MANAGEMENT
31
infection. Only effective against the
trophozoite forms and not the cyst
form.
8. Diloxanide furoate Luminal amebicide; acts primarily in
(Furamid, bowel lumen because it is poorly
Entamizole, absorbed. Used to eradicate cysts of
PERFORMED
Furamide) E histolytica after treatment of
invasive disease. Not available in
the United States.
B. Supplemental /
Dietary
1. Supplemental Zinc More recent advances in the science
Therapy of diarrhea treatment include
recognition for the role of zinc
supplementation in reducing disease
severity and occurrence, and
development of an oral rehydration
PERFORMED
solution of lower osmolarity for
global use. The combination of oral
rehydration and early nutritional
support promises to safely and
effectively assist a patient through
an episode of diarrhea.
2. Moderate Oral rehydration therapy is as
Dehydration effective as intravenous therapy in
rehydrating and replacing
• Oral electrolytes in children with mild to
rehydration moderate dehydration and therefore
solutions contain should be the therapy of first choice.
glucose plus
electrolytes.
PERFORMED
• Rehydration
protocols
(Moderate):
100cc/kg of ORS
plus replacement
over 4 hours
32
the severity or duration of diarrheal
illnesses among children, including
diarrhea caused by rotavirus or
associated with antibiotic use. These
products have included various
species of lactobacilli or
bifidobacteria or the nonpathogenic
yeast Saccharomyces boulardii. The
mechanism of action might include
competition with pathogenic bacteria
for receptor sites or intraluminal
nutrients, production of antibiotic
substances, and enhancement of
host immune defenses
C. Diagnostic
Procedures
1. Imaging Studies
a. Chest May reveal an elevated right
radiography hemidiaphragm and a right-sided
pleural effusion in patients with
amebic liver abscess.
b. Ultrasonography Preferred for the evaluation of
amebic liver abscess because of its
low cost, rapidity, and lack of
adverse effects. A single lesion is
usually seen in the posterosuperior
aspect of the right lobe of the liver.
Multiple abscesses may occur in
some patients.
c. CT May be slightly more sensitive than
ultrasonography. In cerebral
amebiasis, CT shows irregular
lesions without a surrounding
capsule or enhancement.
d. MRI Reveals high signal intensity on T2-
weighted images. Perilesional
edema and enhancement of rim are
noted after injection of gadolinium
(86%).
2. Invasive Studies
a. Rectosigmoidosc Provides valuable materials for
opy and diagnostic information in intestinal
colonoscopy with amebiasis. Small mucosal ulcers
biopsy covered with yellowish exudates are
observed. The mucosal lining
between ulcers appears
normal. Rectosigmoidoscopy and
colonoscopy should be considered
before using steroids in patients in
whom inflammatory bowel disease is
suspected. Biopsy results and a
scraping of ulcer edge may reveal
trophozoites.
b. Aspiration of the Occasionally required to rule out a
liver abscess pyogenic abscess. Aspiration
amebic liver abscess yields an
33
anchovy-pastelike material that lacks
WBCs due to lysis by the parasite.
Amebae are visualized in the
abscess fluid in a minority of patients
with amebic liver abscess. Aspiration
of liver is indicated only for large
abscesses (>12 cm), imminent
abscess rupture, failure of medical
therapy, or presence of left lobe
abscesses.
3. Stool cultures Indicated in cases of dysentery or
where the diagnosis of AGE is PERFORMED
unclear.
a. Light Examination of a fresh stool smear
microscopy: for trophozoites that contain
ingested RBCs is rather insensitive.
Routine microscopy cannot
distinguish the E dispar and E
moshkovskii (nonpathogenic
amebae) from E histolytica.
b. An enzyme Specifically detect E histolytica in
immunoassay fresh stool specimens is
kit commercially available.
c. PCR-based Have been developed but are not
diagnostic tests widely available. Field studies that
directly compared PCR with stool
culture or antigen-detection tests for
the diagnosis of E histolytica
infection suggest that these methods
are equally comparable.
4. Serum Should be considered in cases of
electrolytes moderate to severe dehydration,
PERFORMED
when the case is not straightforward,
or when IV fluids are required
a. Antibody tests Serum antibodies against amebae
are present in 70-90% of individuals
with symptomatic intestinal E
histolytica infection. Antiamebic
antibodies are present in as many as
99% of individuals with liver abscess
who have been symptomatic
for longer than a week. Serologic
examination should be repeated a
week later in those with negative test
on presentation.
i. Indirect Detects antibody specific for E
hemagglutinati histolytica. The antigen used in IHA
on antibody consists of a crude extract of
(IHA) test axenically cultured organisms.
Antibody titers of more than 1:256 to
the 170-kd subunit of the galactose-
inhibitable adherence lectin are
noted in approximately 95% of
patients with extraintestinal
amebiasis, 70% of patients with
active intestinal infection, and 10%
of asymptomatic individuals.
34
i. EIA As sensitive and specific as the IHA
test and has replaced IHA in most
laboratories.
ii. Immunodiffusi Simple to perform, making it ideal for
on (ID) the laboratory that has only an
occasional request for amebic
serology. However, it requires a
minimum of 24 hours to complete,
compared with 2 hours for the IHA or
EIA test. ID is slightly less sensitive
than IHA and EIA, but is equally
specific.
B. Dietary
Modifications
35
1. Diet as tolerated Certain foods are known to irritate
with restrictions on the bladder, such as caffeine,
bowel irritants alcohol, tomatoes, spicy foods,
chocolate, and some berries. Clients PERFORMED
should be encouraged to avoid
bladder irritants during the acute
phase of the UTI
2. Cranberry juice Have been used to acidify the urine.
and Ascorbic Acid The use of these dietary measures
(Vitamin C) is under investigation. The tannin
proanthocyanidins is thought to
block bacteria from attaching to the
bladder wall, thus flushing it from the
urinary system.
3. Increase Fluid To treat and prevent UTI, encourage
Intake increased fluid intake, especially
water, if the client is not required to
restrict fluids. The desired amount is
PERFORMED
3 to 4 L/day. Increased fluids flush
the urinary system and are important
in preventing urolithiasis in clients
treated with sulfa drugs.
C. Diagnostic Findings
1. Urine Cultures Useful for documenting a UTI and
can identify the specific organism
present. UTI is diagnosed by a
bacteria in the urine culture. A
colony count of at least 105 colony PERFORMED
forming units (CFU) per millilitre of
urine on a clean-catch midstream or
catheterized specimen is a major
criterion for infection.
2. Cellular Studies Microscopic hematuria is preset in
about half of patients with an acute
UTI. Pyuria (greater than 4 white
blood cells per high-power field) PERFORMED
occurs in all patients with UTI;
however, it is not specific for
bacterial infection.
3. Other Studies
a. Multiple Test Includes testing for WBCs, known as
dipstick the leukocyte esterase test, and
nitrite testing (Griess nitrate
reduction test). If the leukocyte
esterase test is positive, it is
assumed that the patient has pyuria
and should be treated. The Griess
nitrate reduction test is considered
positive if bacteria that reduce
normal urinary nitrates to nitrites are
present.
b. Test for STD May be performed because acute
urethritis caused by sexually
transmitted organisms or acute
vaginitis infections may be
responsible for symptoms similar to
those of UTIs.
36
c. CT scan May detect pyelonephritis and
abscesses
d. Ultrasonography Is extremely sensitive for detecting
obstruction, abscess, tumors and
cysts.
e. Transrectal To assess the prostate and bladder.
ultrasonography It is the procedure of choice for men
with recurrent and complicated UTIs.
f. Intravenous Indicated to visualize the ureters or
Urogram to detect strictures or stones, and it
is necessary for an accurate
diagnosis of reflux nephropathy.
37
C. Drug Study
Name of Patient: Kenneth Amolato Age: 4 years old Room No.: 304 Hospital No.
Diagnosis/Impression: Acute Gastroenteritis with some dehydration Attending Physician: Dr. Red
38
Name of Drug Date Drug Dose, Frequency, Mechanism of Action Specific Contraindication Adverse Effects Nursing Precaution
(Generic &Brand Ordered Classification Route Indication
Name)
paracetamol 2/15/10 Analgesic, Dose: Acts directly on Treatment of • >Hyperse Anemia, >administer with
anti- 250/5 4.5 ml the mild to nsitivity jaundice, food and provide
inflammatory Frequency: hypothalamus to moderate • >Pregnan hypoglycaemic small, frequent
, Antipyretic q4h cause pain,fever cy coma, rash, meals if GI upset
Route: vasodilation and • >Lactation uticaria, occurs
PO sweating which • >Chronic hypersensitivity >ensure that client
will reduce fever alcoholism reaction,headach is well hydrated
• >Hepatic e,liver toxicity, >monitor for
dysfunction chest pain,renal severe reactions
dysfunction, >do not exceed
bone marrow recommended
suppression doses
>do not take drug
for more than 10
days
gentamicin 2/15/10 Anti-infective Dose: Inhibits protein Serious >hypersensitivity >dizziness, >Avoid long-term
25 mg synthesis in infections deafness, therapies because
Frequency: susceptible caused by lethargy, of increased risk
q8h gram (-); appears susceptible hypotension, of toxicity
Route: to disrupt strains of stomatitis, >Ensure adequate
IVTT functional Escherichia hypertension, hydration of
integrity of coli, hepatic toxicity, patient before and
bacterial cell enterobacter, palpitations, during therapy
membrane proteus and increased >Monitor hearing
causing cell staphylococcu salivation, with long term
death s species polyuria, dysuria therapy
>monitor client’s
weight regularly
>watch for signs
and symptoms of
hypersensitivity
reactions
Diloxanide 2/16/10 Anti- Dose: Destroys the Treatment of >children below >flatulence >Follow-up stool
fuorate protozoal 5ml trophozite Entamoeba 2 years of age >nausea exam should be
Frequency: Entamoebe hystolitica and >vomiting done no earlier
TID hystolytica that other >abdominal than 2 weeks after
Route: eventually form protozoal cramps the end of the
PO into cysts. The infections, >pruritis treatment to 39
cysts are intestinal >uticaria determine efficacy
secreted with amoebiasis
asymptomatic
VI. NURSING MANAGEMENT
40
Subjective Cues: Diarrhea related to Short term goals: Independent: To be
As verbalized by the inflammation and At the end of 45- • Discuss with the SO the • Helps identify implemented;
SO: presence of toxins as minutes of effective patient’s recent exposure causative however,
“Sige ra nah siya ug evidenced by: nursing to different/ foreign and environmental interventions are
kalibanga, usahay interventions, the change in drinking water/ factors. directed towards
muabot ug walo (8) sa Increased bowel significant others food intake. the improvement of
isa ka adlaw” sounds/ peristalsis will be able to: the patient’s
“Sige basa iyang tae” • Observe and record frequency during
Frequent watery stools a. Verbalize changes in stool • Helps differentiate elimination and the
understanding of frequency , individual disease promotion of
Changes in stool color causative factors characteristics, amount and assesses comfort.
Objective Cues: of the illness. and precipitating factors. severity of episodes.
41
a. Re-establish as hand.
a more normal • Restrict solid food
stool consistency. intake as indicated.
• Reduces noxious
b. Reduce odors to avoid undue
frequency of client embarrassment.
stools. • Provide for changes in
dietary intake such as low • To allow for
c. Re-establish fiber and low fat diet. bowel rest/
normal pattern of reduced
bowel functioning. • Restart oral fluid, intestinal
gradually offer clear workload.
liquids hourly, and avoid
cold fluids. • To avoid
foods/
substances
that precipitate
diarrhea.
• Provides colon
rest by omitting
Dependent: or decreasing
• Administer anti- stimulus of
diarrheal medications as foods/ fluids.
ordered. Gradual
resumption of
liquids may
• Administer intravenous prevent
fluids as ordered. cramping and
recurrence of
Collaborative: diarrhea,
however, cold
• Consult dietitian for fluids can
42
further assessment and increase
recommendations intestinal
regarding food preferences motility.
and nutritional support.
• To decrease
gastrointestinal
• Monitor laboratory motility and
values for fluid and minimize fluid
electrolyte imbalance. loss.
• Dietitians have
a greater
understanding
of the
nutritional
value of foods
that may be
helpful in
assessing
specific foods.
• Indicates the
need for fluid
and electrolyte
supplements.
43
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE EVALUATION
44
Deficient fluid Volume At the end of 65 Independent:
Subjective Cue: related to active fluid minutes after • Discuss with the • Helps identify To be
As verbalized by volume loss as effective nursing S.O.the factors related causative implemented;
the SO: evidenced by : interventions are to occurrence of deficit environmental however, the
“Usahay ginasuka ra carried out, the S.O as individually factors interventions are
gihapon niya ang iya pallor will be able to: appropriate directed towards
ginainom nga tubig.” diaphoresis the improvement of
frequent vomiting a.) Verbalize • weigh daily and • although the patient’s
restlessness understandin compare with 24-hour weight gain and hydration status
decreased urine g of fluid balance. Mark fluid intake greater and prevent any
output causative /measure edematous than output may complications that
75cc upon factors anal; abdomen, limbs not accurately may arise from
Objective Cues: assessment b.) Verbalize reflect intravascular deficiency of the
pallor delayed capillary understandin volume, these patient’s fluid
diaphoresis refill-3 seconds g of purpose measurement status.
frequent vomiting weight loss of individual provide useful data
restlessness decreased therapeutic for comparison
decreased urine skin/tongue interventions
output turgor and • Ascertain client’s • Relieve thirst
75cc upon dry skin/mucous medications beverage preference. and discomfort of
assessment membranes c.) Demonstrate And set up a 24-hour dry mucous
delayed capillary elevated Hgb and behaviors to schedule for fluid membranes and
refill-3 seconds Hct monitor and intake- encourage augments
weight loss Hgb:187g/dl NV:40- correct foods with high fluid parenteral
decreased 75 deficits as content replacement
skin/tongue Hct: 0.5 g/dl indicted
turgor NV: 0.2 Long term: • Turn frequently,
dry skin/mucous elevated SG- 1.030 Gently massage skin, • Tissues are
membranes NV: 1.010-1.025 Within the time and protect bony susceptible to
elevated Hgb and frame of 8 hours prominences breakdown
Hct after effective because of
Hgb:187g/dl NV:40- nursing vasoconstriction
75 interventions are and increased
45
Hct: 0.5 g/dl carried out, the cellular fragility
NV: 0.2 patient will be able
elevated SG- 1.030 to: • Provide skin and • Skin and
NV: 1.010-1.025 mouth care. Bathe mucous
a.) Demonstrate every other day using membranes are dry
improved fluid mild soap. Apply lotion with decreased
balance as indicated elasticity because
evidenced by of vasoconstriction
individually and reduced
adequate urinary intracellular H2O.
output with normal Daily bathing may
specific gravity. increase dryness
Moist mucous
membranes, good
skin turgor and • Provide safety • Decreased
prompt capillary precautions as cerebral perfusion
refill inidicated: e.g. use of frequently result in
side rails where changes in
appropriate bed in low mentation/ altered
postion thought process
requriung protective
measure to prevent
client injury
Collaborative:
• Monitor Laboratoty
studies as indicated;
e.g. electrolyte,
glucose. Ph/PCO2 and
coagulation studies
46
Dependent:
Administer
IV solutions as • crystalloid
indicated; provide prompt
• Isotonic solutions; circulatory
• e.g. 0.9 NaCl (NS). improvement,
5% Dextrose/ water; Although the
• .45% NaCl ( half benefit may be
NS), Lactated Ringer transit
Solution
• Colloid; e.g. • used to
Dextran; albumin promote both
electrolyte and -----
• administer Sodium H2O of renal
if indicated excretion of
metabolic ---
• corrects
plasma protein
concentration
deficits, thereby
increasing
intravascular
osmotic pressure
and facilitating
return of fluid into
vascular
compartment
• Maybe given to
correct severe
47
acidosis while
correcting fluid
imbalance.
48
Subjective cues: Ineffective Tissue Short term goals: Independent: To be
As verbalized by the Perfusion related to implemented;
SO: mal-absorption of food At the end of 45- • Maintain bedrest. • Decreased however,
“ Ginasuka ra niya nutrients as evidenced minutes of effective myocardial interventions are
iyang mga kinaon mao by: nursing interventions workload and directed towards
wala kayo siya gana the significant others O2 early
mukaon” Changes in stool – will be able to: consumption, manifestations of
“Sige siya ug libang frequent watery stools. maximizing adequate nutrient
dayon basa iyang tae” a. Identify causative effectiveness absorption and
Presence of blood in factors. of tissue improvement in the
the stool. • Elevate head of bed perfusion. condition.
b. Verbalize and maintain head/neck
Objective cues: Abdominal tenderness understanding of on midline or neutral • To promote
condition, therapy position. circulation/ venous
Changes in stool – Altered skin regimen, side effects drainage.
frequent watery stools. characteristics of medications and • Provide for diet
when to contact restrictions, as
Presence of blood in Imbalanced intake/ healthcare provider. indicated, while
the stool. output- decreased providing adequate • Restriction of
output c. Demonstrate calories to meet the protein helps
Abdominal tenderness behaviors to body’s needs such as limit BUN.
improve/ maintain protein restriction.
Altered skin circulation.
characteristics • Encourage quiet,
Long term goals: restful atmosphere.
Imbalanced intake/
output- decreased Within the time
output frame of 8-hours of • Conserves energy/
effective nursing • Provide small/ easily lower tissue O2
interventions, the digested foods as demands.
patient will be able to tolerated.
demonstrate increased • To promote
49
perfusion as • Encourage rest after digestion.
individually appropriate meals.
( skin warm, vital signs
within client’s normal • To maximize blood
range, alert/ oriented, flow to stomach
balanced intake/ Dependent: enhancing digestion.
output)
• Administer vitamin
supplements and vitamin
b12 injections, folate and
calcium as indicated. • Supplements may
be needed for life to
Collaborative: prevent anemia
because absorption is
• Refer to impaired.
multidisciplinary team.
• Provides assistance
in planning
individualized
• Monitor laboratory treatment and
studies such as hgb and support.
hct.
• Provides
information about
circulatory volumes.
50
ASSESSMENT DIAGNOSIS OBJECTIVE IMPLEMENTATION RATIONALE EVALUATION
51
Subjective Cue: Imbalanced nutrition less Short term Goals: Independent: To be
than body requirement At the end of 1 hour implemented;
As verbalized by the related to insufficient with Purposeful and • Encourage Caloric • Diet however,
SO: intake of nutrients effective nursing intake appropriate for change is a interventions are
“ Nagiwang na siya secondary to poor interventions, the body type and lifestyle. complicate directed towards
karon kumpara adtong appetite as evidenced Significant others will d process the improvement
wala pa siya na-admit.” by: be able to: that of the patient’s
“ Lahi na iyang timbang involves metabolic status
karon ug atong sauna” Appears thin and small a. Verbalize at changing and ensure that
for age the same time, patterns adequate nutrition
demonstrates that have is met for the
Unwillingness to eat selection of foods or been firmly patient’s daily
Objective cues: meals that will • Encourage patient to established needs.
Loss of weight with achieve a cessation of be aware of nutritional by family
Appears thin and small inadequate food intake weight loss. habits that may prevent to and
for age under eating: personal
Poor muscle tone b. Verbalize a. To realize the factors.
Unwillingness to eat • BMI -16.98% understanding of time needed for
* Underweight causative factors eating. • Hurried
Loss of weight with * Weight:15kgs when known and eating may
inadequate food intake * Height: 37 in. necessary b. To focus on eating result in
independent and to avoid other under
Poor muscle tone interventions for diversional activities eating
• BMI -16.98% further complications because
* Underweight of the condition. c. To observe for cues satiety is
* Weight: 15Kgs that will lead for the not
* Height: 37 in. c. Suggest client to eat realized
behaviors in relation until 15-20
to the lifestyle d. To eat in a minutes
changes of the patient designated place after
and to regain or ingestion of
maintain appropriate e. To recognize actual foods.
52
weight according to Its hunger versus • This
Age. desire to eat. controls
environme
Long term Goals: • Establish appropriate nt stimuli
short and long range for eating
At the end of 1 goals to the patient and and other
Week with purposeful the significant others by impulse
and effective nursing suggesting ways to obtain eating.
interventions, the proper nutrition and
client will be able to: hydration.
53
anticholinergics, Without
antiemetics and anti- realistic
diarrheals) short term
goals to
provide
tangible
rewards,
c. High-calorie patient
nutrient-rich dietary may lose
supplements, such as interest in
meal replacement addressing
shake. this
problem.
• These may
decrease
appetite
and lead to
Collaborative: early
satiety.
• Consult dietitian for
further assessment and
recommendations • To correct
regarding food preferences deficiencie
and nutritional support. s as well
as to
enhance
food
satisfaction
• Monitor laboratory and
values that indicate stimulate
nutritional well appetite.
being/deterioration:
54
a. Serum albumin • Multivitami
b. Transferrin n pills are
c. RBC and WBC not a
counts replaceme
d. Serum electolyte nt for a
healthy
diet,
however.
Instead,
they are a
supplemen
t to healthy
eating.
• High
calorie
nutrient
rich diet is
indicated
for the
patient to
promote
adequate
nutrition to
the patient.
• Dietitians
have a
greater
55
understand
ing of the
nutritional
value of
foods that
may be
helpful in
assessing
specific
foods.
• This
indicates
degree of
protein
depletion
(2.5g/dl
indicates
severe
depletion;
3.8-4.5g/dl
is normal)
• Decreased
in
malnutritio
n indicates
anemia
and
resistance
to infection.
56
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTION RATIONALE EVALUATION
57
Subjective Cue: Impaired verbal Short term Goals: Independent: To be
As verbalized by the Communication related At the end of 30 implemented;
SO: to a decreased minutes with • Listen for errors in • Provides however, the
“Dugay ra nah siya transmission of purposeful and conversation or provide opportunity to clarify interventions are
nga dili kayo makalitok messages with an effective nursing feedback. content and meaning. directed towards
ug sturya. ‘Mama’ ra absent of ability to interventions, the the assistance of
gyud nah iya receive information Significant others • A test for the client in the
gakahibal-an” secondary to delayed will be able to: • Ask client to follow Receptive aphasia. promotion of
growth and simple commands. verbal/speech
development as a. Verbalize or • This will prevent developments that
evidenced by: indicate increasing the are appropriate for
Objective cues: understanding of • Never talk in front of patient’s sense of the patient’s age.
Age = 4 years old communication patient as though he or frustration and
Age = 4 years old difficulty and she comprehends feelings of
Speak or verbalizes with plans for ways of nothing. And Keep helplessness. And
Speak or verbalizes difficulty handling this distractions such as will keep patient
with difficulty condition. television and radio at a focused, decrease
Difficulty expressing minimum when talking to stimuli going to the
Difficulty expressing thoughts verbally b. Establish patient. brain for
thoughts verbally method of interpretation, and
Problems in receiving communication in enhance the nurse’s
Problems in receiving the type of sensory which needs can ability to listen.
the type of sensory input being sent or be expressed.
input being sent or sending the type of • Talk directly to the • Stimulates harmony
sending the type of input necessary for Long term Goals: patient, speak slowly & and further enhances
input necessary for understanding At the end of 1 distinctly begin with yes word/idea
understanding week with or no questions. Do not association. Loud
Absence of eye contact. purposeful and speak loudly unless talking does not
Absence of eye effective nursing patient is hearing- improve the patient’s
contact. interventions, the impaired. ability to understand
client will be able to: if the barriers are
primary language,
58
a. Participate in aphasia, or a sensory
therapeutic deficit.
communication
properly. • Maintain eye contact • Patients may have
with patient when defect in field of
b. Demonstrate speaking. Stand close, vision or may need to
congruent within patient’s line of see the nurse’s face
verbal and vision (generally midline). or lips to enhance
nonverbal understanding of
communication. what is being
Dependent: communicated.
c. To use a form
of • Check for Doctor’s • Help alleviate
communication order regarding the condition or minimize
to get needs client’s condition. dysfunction
met and to
relate effectively Collaborative: • Fatigue may have
with persons • Consult a speech an adverse effect on
and his or her therapist for additional learning ability.
environment. help. See that patient is
well-rested before each
session with the speech
therapist.
59
VII. DISCHARGE PLANNING
physician.
Exercise >provide safe environment on which the
motion.
promoting cleanliness.
60
persist after the treatment.
the physician.
care provider.
Diet >encourage fluid intake such as water,
61
yogurt, orange juice, or soda should be
nutritious.
Spirituality >establish an environment that promotes
possible.
condition.
VIII. PROGNOSIS
62
having a loose watery foul-smelling,
episodes.
discomfort.
prompted admission.
>The illness is a self limiting process of
healing.
symptoms.
Predisposing >The patient’s condition is not a familial
63
>The patient’s age is a possible factor
causative agents.
>The patient does not comply with
phenomenon.
The family supports him in every
Calculation:
100%
Overall Prognosis:
Acute Gastroenteritis is usually resolved within two to three days and there
are no long term effects. When dehydration occurs, recovery is extended by a few
64
days. So, overall, patient has a good prognosis since he has no longer manifested
any signs and symptom. Also, this illness is a self limiting process which can be
environment.
IX. RECOMMENDATIONS
• For the patient significant others, she should provide good hygiene to the
patient to prevent further infections from occurring. She should have strict
good prognosis. She would be able to identify foods that can precipitate
65
• For the following student nurses, they should continually provide interventions
the mother regarding promotion of proper hydration and nutrition for the
patient. They should also give emphasis on promoting hand washing before
feeding the child. They should also review all their insights regarding the
duty if ever given with a patient who has the same condition.
• For the health care team they should continue to monitor the patient’s
X. CONCLUSION
The patient in this study has under taken both pharmacologic and and non
maintain core vital signs within normal range. Nursing care and administration of
prescribed medications were done to promote patients wellness and prevent further
66
treatments and interventions. All of these were made for the welfare of the patient
XI. Bibliography:
Human Biology, UK
http://www.leeds.ac.uk/chb/lectures/anatomy8.html
http://www.emedicinehealth.com/resources/40933-6.asp
67
• MIMS. Philippines. 08 Feb 2010. http://www.mims.com/Page.aspx?
menuid=mng&name=racecadotril&h=racecadotril&CTRY=PH&searchstring=r
acecadotril
http://www.amspc.org/Knowledge_Objectives/DrugList/GI.asp
Company
97:424-35.
http://pediatrics.uchicago.edu/chiefs/inpatient/AcuteGE.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm
Medicine. http://emedicine.medscape.com/article/996092-treatment
Feb 2009.
• http://www.buzzle.com/articles/diet-for-gastroenteritis.html
www.sfsu.edu/~shs
68
• Gastroenteritis. The Free Dictionary by Farlex. Farlex, Inc. 2010.
http://medical-dictionary.thefreedictionary.com/Acute+gastroenteritis
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm
XII. APPENDIX
A. DOCTOR’S ORDER
69
Meds: Paracetamol 5ml PRN for
fever
ORS as vol/vol replacement, give
dropper by dropper
> Monitor v/s q 4h
> I and O q shift
> Chart amount, frequency and character
of stool
> will inform AP- informed
> refer accordingly
4:00pm > Hydration status q 2h
> Domperidone, 3ml 3x a day, PRN for
vomiting
> Zinc sulfate syrup, 5ml OD PC
> Gentamycin 25mg, q 8h IVTT, ANST
6:10pm > Diet for age
11:00pm > IVTFTF: D5IMB 500cc@ 50cc/hr
2/16/10 12:40pm > IVTFTF 1 D5IMB 500cc @ 52Mgtts
Afebrile > Continue meds
(+) appetite > 1 banana per meal
BNI with soft stool > Diloxamide ferorate ( Dilfur) 5.0ml TID
2/17/10 4am > IVTFT:D51MB 500cc @ 50cc/hr
> Nacecodotril( Hidrasev) 10mg 2 sachet
LBM 2x @ 56-58cc/hr
(+) weak looking > continue meds
> Full diet
> Reassess after 8hrs
> Refer accordingly
11:44pm > IVF: D5LR 1L @ 56-58cc/hr
2/18/10 11:55am > MGH
> IVFTWC and IV meds to consume
Home Meds:
8days
3days
replacement
> Follow-up after 7days
70
B. NURSES NOTES
P = 82 bpm; R = 19 cpm
>bedside care done
>adequate rest periods provided
>back kept dry
6:30pm >above IVF on KSS status
>consumed share with poor appetite
>health teachings reinforced to patients mother with
emphasis on:
a. proper hygiene
c. medication compliance
71
and regulated @ 55cc/hr infusing well on R arm
10:00pm >endorsed with latest signs of T = 37.1 degrees
exam
9:35am >above IVF consumed and followed up with 500cc
72
FREQUENCY AMOUNT
Feb. 15, 10
2-10 0 - - -
10-6 0 0 - -
Feb. 16, 10
6-2 1 130 cc Loose, watery Yellowish
foul smelling
2-10 1 20 cc Watery foul Yellowish
smelling
10-6 2x 250 cc Smelling watery Yellowish
Feb. 17,10
6-2 0 - - -
2-10 5 520 cc Watery Yellowish
73