Professional Documents
Culture Documents
General Objectives
After an hour and a half of case presentation:
The presenters, the audience, and the clinical
instructors will be acquainted with the vital
information; patients health history; normal
anatomy and physiology of gastrointestinal
system; pathophysiology of the disease; clinical
manifestations; medical and surgical
managements; diagnostic tests; nursing care
plan; and discharge plan of a client with
gastroenteritis.
Specific Objectives
For the presenter
The presenter will be able to:
INTRODUCTION
Gastroenteritis, or enteritis, is an
inflammation of the stomach and small
intestine. Enteritis may be caused by
bacteria, viruses, parasites, or toxins.
Upper GI manifestations such as
anorexia, nausea, and vomiting are
common. Diarrhea of varying intensity
and abdominal discomfort are nearly
universal features of gastroenteritis.
(LeMone, 2010)
MANIFESTATIONS
Gastrointestinal Effects:
General Effects:
COMPLICATIONS
Electrolyte and acid-base imbalances may
result from gastroenteritis. Extensive vomiting
can lead to metabolic alkalosis due to the
loss of hydrochloric acid from the stomach.
When diarrhea predominates, metabolic
acidosis is more likely. Potassium is lost in
either case, leading to hypokalemia.
Hyponatremia may develop if fluids are
replaced with pure water. Headache, cardiac
irregularities, changes in respiratory rate and
pattern, malaise and weakness, muscle aching,
and signs of neuromuscular irritability are the
possible manifestations of these disturbances
in homeostasis. (LeMone, 2010)
MANAGEMENTS (http://www.patient.co.uk)
Fluid management
Continue breast-feeding and other milk
feeds
Encourage fluid intake
Discourage the drinking of fruit juices and
carbonated drinks, especially in those at
increased risk of dehydration
Offer oral rehydration salt (ORS) solution
as supplemental fluid to those at
increased risk of dehydration
Nutritional management
During rehydration therapy:
Continue breast-feeding
Do not give solid foods
In children with mild cases, do not routinely
give oral fluids other than ORS solution;
however, consider supplementation with the
child's usual fluids (including milk feeds or
water but not fruit juices or carbonated drinks)
if they consistently refuse ORS solution
In children with severe cases, do not give oral
fluids other than ORS solution
Drugs
Antibiotic therapy should not be used routinely but
should be given:
PREVENTION
DEFINITION OF TERMS
1. Borborygmi- a rumbling or gurgling
sound caused by the movement of gas
in the intestines.
2. Norwalk Virus- A family of small
round viruses that are an important
cause of viral gastroenteritis (viral
inflammation of the stomach and
intestines). Norwalk disease is a
significant contributor to illness in the
US.
VITAL INFORMATION
Structures
The tube that comprises the GI tract
is continuous with the external
environment, opening at the mouth
and again at the anus. Because of this
GI tract contains many foreign agents
and bacteria that are not found in the
rest of the body.
Accessory Organs
Pancreas
Deposits digestive enzymes and sodium
bicarbonate into the beginning of small intestine
to neutralize acid from the stomach and to
further facilitate digestion
Gallbladder
When gallbladder is stimulated to contract by
the presence of fats, all of the nutrients
absorbed from the small intestine pass into the
liver
Liver
Produces bile (very important in the digestion of
fats), which stored in the gallbladder.
Adventitia Layer
The adventitia is the outer layer of
the GI tract. It serves as a supportive
layer and helps the tube maintain its
shape and position.
Secretions
The GI tract secretes various compounds to
aid the movement of the food bolus through
the GI tube, to protect the inner layer of the
GI from injury and to facilitate digestion and
absorption of nutrients.
Absorption
Absorption is the active process of removing
water, nutrients and other elements from
the GI tract and delivering them to the
bloodstream for use by the body.
Digestion
Digestion is the process of breaking food
into usable and absorbable nutrients.
Motility
Motility is the movement of food and
secretions through the system. The basic
movement seen in the esophagus is
peristalsis, a constant wave of contraction
that moves from the top to the bottom of
the esophagus. The act of swallowing, a
response to a food bolus in the back of the
throat, stimulates the peristaltic movement
that directs the food bolus into the stomach.
Gastric Lavage
Gastric Lavage and catharsis- in effect, washing
outthe stomach and intestines- may be
performed to remove unabsorbed toxin from GI
tract if botulism is suspected. The patient with
botulism is closely observed for signs of
respiratory distress. Respiratory support with
endotracheal intubation or tracheostomy and
mechanical ventilation may be required.
Plasmapheresis
Plasmapheresis (plasma exchange therapy) may
be performed to remove circulating toxins for
hemorrhagic colitis caused by E-coli. Potential
complications include those associated with
intravenous catheters, shifts in fluid balance, and
altered blood clotting.
Dialysis
Acute tubular necrosis and renal
failure associated with hemorrhagic
colitis may necessitate dialysis to
remove wastes and prevent severe
fluid and electrolyte imbalances and
metabolic acidosis. Although acute
renal failure often resolves
spontaneously and renal function
resumes, dialysis can be lifesaving.
Either hemodialysis or peritoneal
dialysis may be used, generally as a
temporary measure.
Special Instructions:
Hand washing
Increase fluid intake
Health teachings:
Instruct the mother to clean the bottles or any containers used in feeding
the baby.
Encourage the parents to do hand washing before and after giving the milk
to the baby.
Instruct them to comply religiously the medication with their baby to the
period of time as prescribed.
Demonstrate to the parents the different ways of burping for the baby.
Diet:
Milk Formula for age
Spiritual care:
Be grateful for all the things that God has been given to us. For He never
forget to bless and shower His graces. Humbly we bow ourselves unto Him
and give respect for He is the King of kings and Lord of all lords. All things
are made because of His will, thank God for His protection and guidance in
PROGNOSIS
The prognosis for complete recovery
is excellent in most people infected
with viral and bacterial caused by
gastroenteritis, as long as the person
keeps well hydrated. Their prognosis
depends on how dehydrated they
become and how effective are the
attempts to rehydrate the patient.
Prevention of the recurrence of the
disease is also important.
BIBLIOGRAPHY
Doenges, M. et. al. (2009) Nurses Pocket Guide 12 th
edition. Philadelphia. C&E Publishing, Inc.
Karch, A. (2011) Focus on Nursing Pharmacology 5th
edition. Philadelphia. Lippincott Williams & Wilkins
LeMone et.al. (2010) Medical-Surgical Nursing
Critical Thinking in Patient Care 5th edition. Pearson,
C&E Publishing, Inc.
McFarland, M. (2014) Nursing Implications of
Laboratory Tests 2nd Edition. Delmar Publishers Inc.
MIMS 140th edition 2014
Nurses Quick Check Diagnostic Tests
Nursing 2006 Drug Hand Book 26 th edition.
Philadelphia. Lippincott Williams & Wilkins
Schull, P.D. (2006) Nursing spectrum Drug Hand
Book. New York. McGraw-Hill Companies, Inc.