University of Makati

College of Allied Health Studies

J.P. Rizal Extension West Rembo, Makati City

ACUTE GASTROENTERITIS

A Case Study
Presented to Prof. Noel A. Dichosa ,RN,MAN
Instructor, College of Allied Health Studies, AY 2010-2011

Presented by:

II-AN

Agne, Yuki L.
Aldevera, Kaira R.
Almara, Edrianne Paul A.
Alsol, Lawrenz H.
Arizo, Jamil Carlo G.
Awit, Rendel Mark M.
Barranda, Florabel V.
Benavides, Rogienette A.
Bon, Bernard M.
Bustalinio, Mariane Jhenica I.
Bustillo, Ann Marie Carmela R.
Coronado, Jordan O.

May 13, 2011

 Table of Contents

I. INTRODUCTION

II. OBJECTIVES

III. BIOGRAPHICAL DATA

IV. CHIEF COMPLAINT

V. HISTORY OF PRESENT ILLNESS

VI. PAST MEDICAL HISTORY

VII. FAMILY MEDICAL HISTORY

VIII. PERSONAL AND SOCIAL HISTORY

IX. COURSE IN THE WARD

X. REVIEW OF SYSTEMS

XI. PHYSICAL ASSESSMENT

XII. DIAGNOSIS

XIII. DIFFERENTIAL DIAGNOSIS

XIV. ANATOMY AND PHYSIOLOGY

XV. PATHOPHYSIOLOGY

XVI. LABORATORY RESULT

XVII. NURSING CARE PLAN

XVIII. DRUG STUDY

XIX. DISCHARGE PLANNING

I. Introduction

Gastroenteritis is the infection or irritation of the digestive tract, particularly the

stomach and the intestines. It is also known as gastric flu/ stomach flu, although it is not
related to influenza. It is usually consist of mild to severe diarrhea that may be
accompanied by loss of appetite, nausea, vomiting, cramps and discomfort in the
abdomen. Although Gastroenteritis usually is not serious for healthy adults, it can cause
life-threatening dehydration and electrolyte imbalance in very ill, the very young and the
very old. (Merck Manual)

Gastroenteritis is a very common disease; most people are at some risk to

encounter the wide-spread causes (mainly viral and bacterial). This risk is due to poor
hygiene of a few people with the disease that may be encountered frequently in daily
living (for example, infants, children, or some food handlers). Some people have higher
risk for infection; for example, individuals on cruise ships or those that live or work in
crowded conditions like child care centers, dorms, or barracks, because of the higher
chance that an infected person will come in contact with many other people, and rapidly
spread the causative agent. (www.medicinenet.com)

According to the then NSO survey, 572, 259 infants, young and old were affected
by diarrheal diseases during 2006. Because of severe dehydration and diarrhea, 914 case
of Acute Gastroenteritis specifically infants hospitalize and eventually die. ) Locally, In
July 22, 2004, the Department of Health (DOH), Philippines declared an epidemic
(outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns in
Central Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily
caused by ingestion of spoiled or bacterial contaminated water or
food.(www.census.gov.ph)
II. Objectives

A. General Objectives

To understand the underlying disease of the patient and identify the significant
physiological, psychological and socioeconomic needs to provide appropriate care.

B. Specific Objectives

1. To know the anatomy of the G.I. tract and pathophysiology of Acute

Gastroenteritis.

2. To learn about the major etiologic agent of AGE.

3. To determine the previous and present medical history of the patient.

4. To perform physical assessment with special attention on the systems focus.

5. To show the laboratory examination results with the corresponding normal

values, actual result from the patient, and its interpretation

6. To learn the basic principle of medical management of AGE.

7. To gain information through Nurse-Patient interaction, identify problems

from the client and provide the appropriate nursing care plan.

8. To understand the pharmacological management set on the client and

provide nursing interventions.

9. To identify the discharge plan for the patient’s rehabilitation to conduct an

evaluation of the client’s condition from admission to present.
III. Biographical Data

Patient’s Name : SMP

Age : 1 year old

Gender : Male

Status : Single

Date of Birth : May 9, 2010

Place of Birth : La Union (lying-in)

Nationality : Filipino

Religion : Roman Catholic

Address : Makati City

Date of Admission : April 25, 2011 (11:12AM)

Hospital : Ospital ng Makati

Informant : Mother

Percentage of Reliability: 80%

IV. Chief Complaint

“Masyado na kasing liquid yung tae na lumalabas sa colostomy bag niya” as verbalized
by the mother

V. History of Present Illness

The patient is a known case of intussusception, s/p exploratory laparotomy, ileal

resection with ileostomy, appendectomy. (December 19, 2010)
 History revealed that 10 days prior to admission, patient was discharge for acute
gastroenteritis. Prior to discharge, the consistency of the stool was soft, non-bloody, and
the patient was active, no fever and vomiting.

On the 9th day until the 2nd day prior to admission, the patient didn’t experience
any signs of further symptoms of acute gastroenteritis.

One day prior to admission, patient had loose watery yellowish stools via
ileostomy bag. He had fever of 39oC, 3-4 episodes of vomiting of milk amounted 2-3 tbs.

Symptoms persisted until few hours prior to admission; patient was noted to be
irritable. Thus patient brought to Ospital ng Makati for re-admission.

VI. Past Medical History

The patient was delivered NSD at one of the lying-in at La Union and was fully
immunized. He had previous case of intussusceptions, s/p exploratory laparotomy, ileal
resection with ileostomy, appendectomy last December 19, 2010.

VACCINE Age of Vaccination

BCG At birth

Hepa B At birth

Vit. K At birth

DPT 6 weeks

OPV 6weeks

AMV 9 months
VII. Family Medical History

No significant family medical history.

VIII. Personal and Social History

A. Health Perception and Health Management Pattern

The mother considers the patient’s health so important. She assures that
the patient receives enough nutrition and is alert to any abnormal condition his
son is experiencing. Whenever her son has cough, she gives him home remedies
in which if does not alleviate makes her decide to bring him on private clinics.
She ensures that she is focused on the patient’s health.

B. Nutritional and Metabolic Pattern

Patient SMP is exclusively breastfed from birth up to 6 months old. When
he is 6 months old, he started to eat solid foods like rice and biscuits such as
wafer, eggnog, breadstick and bravo. His appetite is good. He is not eating salty
foods yet fond of eating fruits like orange and banana. Her mother then gave him
formula milk and its brand is Pediasure. He drinks a lot of water. When he was
hospitalized, this routine was changed since he’s no longer fond of eating fruits
and drinking water but is still given formula milk.

C. Elimination pattern
The mother changes his diaper three times a day. According to the mother,
the patient defecates three times a day with yellow colored stool. The consistency
of his stool is condensed, soft and slightly formed. When he was hospitalized, her
mother then changes his diaper two times a day and his stool is watery.

D. Activity and Exercise Pattern

According to the mother, he wants to walk but needs assistance. He plays
many toys but he loses eagerness and gets easily tired and plays another toy.
E. Sleep and Rest Pattern
He sleeps in the morning up to lunch, two naps in the afternoon and sleeps
in the whole night. When he was hospitalized, his sleep pattern changed. He
sleeps on and off for about every two hours at night and just take naps if not
disturbed.

F. Cognitive and Perceptual Pattern

The patient is active and is oriented with the people around him. He could
recognize his mother and father.

G. Role and Relationship Pattern

According to the mother, he is a very active child and does not cry easily.
He recognizes the people around him and play with them. He has one elder
brother and they kept on playing with each other when he was around. He can
cope easily with other person.

H. Sexuality and Reproductive Pattern

Not applicable to age

I. Coping and Stress Tolerance

Patient SMP copes up to his condition very well. He is not easily irritated
and is even a jolly kid. He is fond of playing with people around him. He reduces
his stress by entertaining himself with the different things around him. He has also
good appetite despite of his condition.

J. Value and Belief Pattern

Their religion is Roman Catholic.

K. Self-Perception and Self-Concept Pattern

Not applicable to age
IX. Course in the Ward

DATE &TIME DATA ACTION RESPONSE / RESULT

Monday-May 9, 2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

sleeping on bed recorded. CR: 130cpm
with his mother RR: 34bpm
on the bedside.
 8:30 am  Provided with bedside care.  Established rapport.
 Nurse-patient interaction,
done.

 11:00 am  The ileostomy  Assisted the mother in

bag of the emptying the ileostomy bag.
patients is  Noted the appearance of the  Beefy red stoma.
about two- stoma.
thirds.  Noted the consistency, and  Fluid condense-like effluent.
odor of the effluent.

 12:00 noon  Vital signs taken and  Temp: 36.5oC

recorded. CR: 135cpm
RR: 30bpm
 Intake and Output was  Intake: Breast feeding and 120 ml
documented. of water
Output: 90 ml ( 1 diaper changed)
Tuesday- May 10,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

awake and recorded. CR: 135ccpm
playing with RR: 30bpm
her mother.  Due medications are given.  Ferrous sulfate 150mg/10.6
ml/2ml, PO, OD
Probiotics plus prebiotics 1
sachet, OD
 Provided with bedside care
and done with nurse-patient
interaction.
 9:00 am  Physical assessment done.

 11:00 am  Scheduled time  Assisted the mother in  Fluid condense-like effluent

for ileostomy ileostomy bag emptying.
bag emptying. Noted the appearance of the
stoma.
 12:00 noon  Vital signs taken and  Temp: 36.5oC
recorded. CR: 134 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breast feeding and 60 ml
output. of water
Output: 90 ml (1 diaper change)
Wednesday- May 11,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

eating cerelac recorded. CR: 136 cpm
 for breakfast, RR: 30 bpm
with his mother
feeding his son.
 Due medications given.  Ferrous sulfate 150mg/10.6
 Bedside care done, nurse- ml/2ml, PO, OD
patient interaction done. Probiotics plus prebiotics 1
sachet, OD
 9:00 am  CBG monitored.  68 mg/dl

 11:00 am  With beefy red

stoma on the
lower right
quadrant of the
abdomen.
 Scheduled time  Assisted the mother in  Fluid condense-like effluent
for ileostomy ileostomy bag emptying.
bag emptying.

 12:00 noon  Vital signs taken and  Temp: 36.5oC

recorded. CR: 136 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breastfeeding and 60 ml
output. of water
Output: 90 ml ( 1 diaper change)
Thursday-May 12,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

sleeping with recorded CR: 136 cpm
his parents on RR: 30 bpm
 the bedside. .

 Bedside care done, with

nurse-patient interaction.

 11:00 am  With beefy red

stoma on the
lower right
quadrant of the
abdomen.
 Scheduled time  Assisted the mother in  Fluid condense-like effluent
for ileostomy ileostomy bag emptying.
bag emptying.
 Scheduled time  Assisted the mother in
for ileostomy providing ileostomy care.
care.
 12:00 noon

 Vital signs taken and  Temp: 36.5oC

recorded. CR: 134 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breastfeeding and 50 ml
output of water
Output: 90 ml ( 1 diaper change)
X. Review of Systems

General

(+) altered sleeping pattern

Integumentary System

(+) pruritus around the skin barrier of ileostomy bag

Gastrointestinal System
Stool from ileostomy bag was yellowish in colour, ~ half of plastic cup as amount and drain
twice a day

XI. Physical Assessment (MAY 10, 2011)

GENERAL APPEARANCE Awake, conscious, active and looks as an

infant (1 yr old).

 CEPHALOCAUDAL EXAMINATION

Findings Reference Value

Height : 69 cm Height : 71 -81 cm
Anthropometric Weight : 8.5 kg Weight : 8.6-12.2kg
measurement Weight Percentile Rank: 9% Weight percentile Rank : 5%-
Height Percentile Rank: 95%
<5% Height percentile Rank : 5%-
95%
Head circumference : 46 cm
Chest Circumference : 44 Chest Circumference generally
cm < 2 cm than Head
Abdomen circumference : 45 circumference.
cm
Abdomen circumference :
protuberant abdomen

Initial Vital Signs Heart rate : 130 bpm Heart rate : 120-160 bpm
Respiratory rate : 34 cpm Respiratory rate : 20-40 cpm
Temperature : 36.5 C Temperature : 36.5-37.5C
 Organ/ Techniques of Findings Reference findings
system physical
examination
Head (Facial Inspection  (-) lesions  (-) lesions
features )  (-) areas of deformity  (-) areas of deformity
 Symmetric facial  Symmetric facial
features features

Palpation  (-) palpable masses or  (-) palpable masses or

lesions lesions
 (+) temporal pulse  (+) temporal pulse

Hair Inspection  Evenly distributed  Evenly distributed

black hair black hair
 (-) infestations  (-) infestations
 normal texture  normal texture

Eyes Inspection  Eyebrows  Eyebrows

symmetrically aligned symmetrically aligned
 Eyelashes equally  Eyelashes equally
distributed distributed
 (+) Sunken eyes  (-) Sunken eyes
 Anecteric sclera  Anecteric sclera
 White sclera  White sclera
 Pinkish Conjunctivae  Pinkish Conjunctivae
 Dark brown iris  Black iris
 (+) PERRLA (2-3  (+) PERRLA (2-3 mm
mm diameter of iris diameter of iris)
 (-) discharge  (-) discharge

 Symmetrically  Symmetrically aligned

aligned  Intact tymphanic
Ears Inspection  Intact tymphanic membrane
membrane  (-) masses
 (-) masses  (-) discharge
 (-) discharge  (-) lesions
 (-) lesions

 Pinna immediately  Pinna immediately

recoil after it is folded recoil after it is folded
Palpation
 Pink nasal mucosa  Pink nasal mucosa
 (-) nose flaring  (-) nose flaring
Nose Inspection  Teeth (+) central and  Teeth (+) central and
lateral incisor on lateral incisor on upper
upper and lower and lower
Mouth and Inspection  Gums and Mucosa  Gums and Mucosa
Throat (-) swelling (-) swelling
(-) bleeding (-) bleeding
(-) infection (-) infection
(-) white patches (-) white patches
 Gums are pink  Gums are pink
 normal Pharynx and  normal Pharynx and
Tonsillar Fossa Tonsillar Fossa
 Pink and moist oral  Pink and moist oral
mucosa mucosa
 (-) swelling and  (-) swelling and
lesions lesions
 (-) lips are pinkish  (+) lips are pinkish and
and moist moist
 Tongue is pink, moist  Tongue is pink, moist
and at midline and at midline position
position  (-) lesions
 (-) lesions

 Supple  Supple
 (-) vein engorgement  (-) vein engorgement

Neck Inspection  Thyroid: non-palpable  Thyroid: non-palpable

lymph nodes lymph nodes
(-) postauricular (-) postauricular
Palpation (-) occipital (-) occipital
(-) superficial cervical (-) superficial cervical
(-) posterior cervical (-) posterior cervical
(-) tonsilar (-) tonsilar
(-) anterior cervical (-) anterior cervical
(-) supraclavicular (-) supraclavicular
(-) preaucular (-) preaucular
(-) submental (-) submental
(-) submaxillary (-) submaxillary
 (-) masses or lesions  (-) masses or lesions
present present
 Suprasternal Notch:  Suprasternal Notch:
 (-) pulsation  (-) pulsation

Thorax and Inspection  (+) symmetrical  (+) symmetrical

Lungs expansion with expansion with
 respiration respiration

Palpation  (+) Tactile fremitus  (+) Tactile fremitus

Percussion  (+) resonant sound  (+) resonant sound

Auscultation  (+) normal vesicular  (+) normal vesicular

breathing sounds breathing sounds
 (-) added or  (-) added or
adventitious sound adventitious sound
Heart Inspection  (+) not visible PMI  (+) not visible PMI

Palpation  (+) regular rhythm  (+) regular rhythm

 Precordium:  Precordium:
(-) parasternal (-) parasternal
impulse impulse
(-) thrills (-) thrills
 PMI- palpable in 5th  PMI- palpable in 5th
ICS, apical area ICS, apical area

Auscultation  S1- heard best at  S1- heard best at apex,

apex, normal intensity normal intensity
 S2- heard best at  S2- heard best at base,
base,  Extra Sounds- (+) S3,
 Extra Sounds- (+) S3, S4
S4  (-)murmurs
 (-)murmurs
Abdomen Inspection  (+) protuberant  (+) protuberant
 (-) scars, striae  (-) scars, striae
 (+) Ileostomy on  (-) Intact on Right
Right lower Quadrant lower Quadrant
(+) beefy red  Ileostomy should:
(+) moist (+) beefy red
(+) redness around (+) moist
the skin barrier (-) redness around the
skin barrier

Auscultation  (+) pinging sounds

(bowel sounds) 5-10  (+) pinging sounds 5-
secs. 10 secs.
Palpation  (-) bruit  (-) bruit

 Umbilicus  Umbilicus
Facial ring ~2cm Facial ring ~2cm
 (-) hernia (-) hernia
 Right & left Kidney:  Right & left Kidney:
(+) palpable as size as (+) palpable as size as
walnut walnut
Extremities Inspection  Upper extremities:  Upper extremities:

(-) pallor (-) pallor

(+) slightly cyanosis (-) cyanosis
(-) rashes (-) rashes
(+) 3 major creases on (+) 3 major creases on
the palms the palms
(+) pink nails (+) pink nails

Palpation (+) hard masses on the (-) masses

right antecubital area
and carpal region
Palms normal in texture Palms normal in texture
(-) nails are hard and (+) smooth and convex
clubbing
(-) warm to touch (-) warm to touch
(-) slightly moist (-) slightly moist
(+) skin pinch goes back (+) skin pinch goes back
rapidly rapidly
Radial pulse normal and Radial pulse normal and
symmetric symmetric
(+) capillary refill (+) capillary refill

 Lower Extremities
Inspection (bilaterally):
(-) pallor
(-) cyanosis (-) pallor
(-) rashes (-) cyanosis
(-) edema (-) rashes
(+) nails are convex (-) edema
(-) nails cyanosis and (+) nails are convex
Clubbing (-) nails cyanosis and
clubbing
Pulse of Dorsalis pedis
and Posterior tibia was Pulse of Dorsalis pedis
Palpation normal and symmetric and Posterior tibia was
(-) palpable popliteal normal and symmetric
nodes (-) palpable popliteal
(+) capillary refill nodes
within 2 secs. (-) cold (+) capillary refill within
and clammy extremities 2 secs. (-) cold and
 clammy extremities
Genitalia Inspection  Penis:  Penis:
(+) Uncircumcised (+) Uncircumcised
(-) lesions and normal for his age
deformities (-) lesions and
deformities

 Urethral meatus:  Urethral meatus:

(-) discharge (-) discharge
(+) slit like and (+) slit like and
centered at penis tip centered at penis tip

Inspection and  Scrotum & testes :  Scrotum & testes :

palpation (+) normal size for his (+) normal size for his
age age
(+) left testes was (+) left testes was
slightly lower slightly lower than right
than right
 Inguinal area:  Inguinal area:
(-) bulging (-) bulging
(-) palpable Femoral (-) palpable Femoral
Lymph nodes Lymph nodes

XII. Diagnosis

Acute Gastroenteritis with some signs of dehydration

XIII. Differential Diagnosis

XIV. Anatomy and Physiology

The Gastrointestinal System

 If a human adult’s digestive tract were
stretched out, it would be 6 to 9 m (20 to 30 ft) long.
In humans, digestion begins in the mouth, where both
mechanical and chemical digestion occurs. 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 down) starch—a
carbohydrate manufactured by green plants. 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 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 toward the stomach.

 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

the alimentary canal by means of rhythmic muscle contractions (tightenings) known as

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.

Food travels the length of the esophagus in two to three seconds.

 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

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

into the duodenum, the first portion of the small intestine.

 Small Intestine

Most digestion, as well as absorption of digested food, occurs in the small

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 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 arecapillaries (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
 A watery residue of indigestible food and digestive juices remains unabsorbed.

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) of the alimentary canal. The

rectum stores the feces—waste material that consists largely of undigested food,

digestive juices, bacteria, and mucus—until elimination. Then, muscle contractions in

the walls of the rectum push the feces toward the anus. When sphincters between the

rectum and anus relax, the feces pass out of the body.

FLUIDS & ELECTROLYTES

Electrolytes are minerals in your body that have an electric charge. They are in

your blood, urine and body fluids. Maintaining the right balance of electrolytes helps

your body's blood chemistry, muscle action and other processes. Sodium, calcium,
 potassium, chlorine, phosphate and magnesium are all electrolytes. You get them from

the foods you eat and the fluids you drink.

Levels of electrolytes in your body can become too low or too high. That can

happen when the amount of water in your body changes. Causes include some

medicines, vomiting, diarrhea, sweating or kidney problems. Problems most often

occur with levels of sodium, potassium or calcium.

XV. Pathophysiology

XVI. Laboratory Result

MAY 8, 2011

Hematology

Component Result Normal Values Interpretation

Hgb 11.3 14-18g/L Iron Deficiency
Hct 0.35 0.40-0.54 Iron Deficiency
WBC Count 18.6 4-11x109/L Infection
RBC Count 4.3 5.0-6.4 Iron Deficiency
Different Count
Eosinophils 0.02 0.02-0.04 Normal
Neutrophil
Segmenters 0.49 0.50-0.70
Lymphocytes 0.48 0.20-0.40 Infection
Monocytes 0.01 0.02-0.05 Release of toxins in
the blood; infection
Platelet Count 288 150-450x Normal

Remarks: Pricked

MAY 4, 2011
Macroscopic Examination

Examination Result Interpretation

Color Dark Yellow Normal
Consistency Watery Increased peristaltic
movement

Occult Blood

Examination Result Interpretation

WBC None Normal
RBC None Normal

*No intestinal parasite seen

MAY 4, 2011

Chemical Chemistry Section

Test Name SI Unit Range Cony Unit Interpretation

Result Result Range
Total 2.01 mmol/L 2.12- 8.04 8.50- Vitamin D
Calcium 2.52 mg/dL 10.10 deficiency,
over
consumption
of phosphates
Sodium 139 mmol/L 136-145 139.00 136-145 Normal
meq/L
Potassium 3.6 mmol/L 3.5-5.1 3.60 3.5-5.1 Normal
meq/L
Chloride 103 mmol/L 98-107 103.00 98-107 Normal
 meq/L

APRIL 30, 2011

Component Result Normal Values Interpretation

Hgb 10.4 14-18g/L Iron Deficiency
Hct 0.32 0.40-0.54 Iron Deficiency
WBC Count 8.3 4-11x109/L Normal
RBC Count 3.9 5.0-6.4 Iron Deficiency
Different Count
Eosinophils 0.01 0.02-0.04 Normal
Neutrophil
Stab Cells 0.01
Segmenters 0.42 0.50-0.70
Lymphocytes 0.52 0.20-0.40 Infection
Monocytes 0.04 0.02-0.05 Normal
Platelet Count 262 150-450x Normal

APRIL 28, 2011

Specimen Blood Right Arm

Initial result: No growth after 2 days of incubation

APRIL 27, 2011

Macroscopic Exam

Examination Results Interpretation

Color White Lack of bile, problem in biliary
tract or liver
Consistency Watery Increased peristaltic movement
Occult Blood

Examination Results Interpretation

WBC 0-1 Normal
RBC None Normal

Remarks

*No intestinal parasite seen

Examination Results Interpretation

Yeast Cells Occasional Infection

APRIL 27, 2011

Chemical Chemistry Section

Test Name SI Unit Range Cony Unit Interpretation

Result Result Range
Total 2.40 mmol/L 2.12- 8.04 8.50- Normal
Calcium 2.52 mg/dL 10.10
Sodium 133 mmol/L 136-145 139.00 136-145 Prolonged
meq/L sweating,
vomiting and
diarrhea
Potassium 4.2 mmol/L 3.5-5.1 3.60 3.5-5.1 Normal
meq/L
Chloride 90 mmol/L 98-107 103.00 98-107 Loss of body
meq/L fluid due to
 prolonged
vomiting and
diarrhea

Remarks: Pre- extracted; Ionized Calcium: Not available

APRIL 25, 2011

Macroscopic Examination

Examination Results Interpretation

Color Light Yellow Normal
Transparency Clear Normal
Sugar (-) Normal
Protein (-) Normal
pH 6.0 Normal
S.G. 1.020 Normal

Microscopic Examination

Examination Result Interpretation

WBC o-1/HPF
RBC 0-1/HPF
Epithelial Cells Occasional Normal
Crystals
Amorphous Few Normal
Urates/Phosphates
Others
Bacteria Few Infection
APRIL 25, 2011

Component Result Normal Values Interpretation

Hgb 11.2 14-18g/L Iron Deficiency
Hct 0.34 0.40-0.54 Iron Deficiency
WBC Count 17.6 4-11x109/L Infection
RBC Count 4.2 5.0-6.4 Iron Deficiency
Different Count
Neutrophil
Segmenters 0.51 0.50-0.70 Normal
Lymphocytes 0.46 0.20-0.40
Monocytes 0.03 0.02-0.05 Normal
Platelet Count 428 150-450x Normal

APRIL 25, 2011

Chemical Chemistry Section

Test Name SI Unit Range Cony Unit Interpretation

Result Result Range
Total 2.34 mmol/L 2.12-2.52 8.04 8.50- Normal
Calcium mg/dL 10.10
Sodium 121 mmol/L 136-145 139.00 136-145 Prolonged
meq/L sweating,
vomiting and
diarrhea
Potassium 2.9 mmol/L 3.5-5.1 3.60 3.5-5.1 Vomiting
meq/L
Chloride 79 mmol/L 98-107 103.00 98-107 Loss of body
meq/L fluid due to
prolonged
vomiting and
diarrhea
APRIL 24, 2011

Chemical Chemistry Section

Test Name SI Result Unit Range Cony Unit Interpretation

Result Range
Total 2.23 mmol/L 2.12-2.52 8.04 8.50- Normal
Calcium mg/dL 10.10
Sodium 132 mmol/L 136-145 139.00 136-145 Prolonged
meq/L sweating,
vomiting and
diarrhea
Potassium 2.9 mmol/L 3.5-5.1 3.60 3.5-5.1 Vomiting
meq/L
Chloride 97 mmol/L 98-107 103.00 98-107 Loss of body
meq/L fluid due to
prolonged
vomiting and
diarrhea

GLUCOSE MONITORING SHEET

APRIL 25, 2011

12pm 342 mg/dL
8pm 123 mg/dL
APRIL 26, 2011
4am 126 mg/dL
12pm 101 mg/dL
8pm 96 mg/dL
APRIL 27, 2011
4am 110mg/dL
12pm 104mg/dL
8pm 110mg/dL
APRIL 28, 2011
4am 121mg/dL
12pm 96mg/dL
8pm 90mg/dL
APRIL 29, 2011
4am 102mg/dL
12pm 91 mg/dL
APRIL 30, 2011
4am 98 mg/dL
12pm 97 mg/dL
8pm 84 mg/dL
MAY 1, 2011
4am 90 mg/dL
12pm 135 mg/dL
8pm 123 mg/dL
MAY 2, 2011
4am 104 mg/dL
12pm 117 mg/dL
8pm 89 mg/dL
MAY 3, 2011
4am 100 mg/dL
12pm 119 mg/dL
8pm 120 mg/dL
MAY 4, 2011
4am 89 mg/dL
12pm 277 mg/dL
8pm 132 mg/dL
MAY 5, 2011
4am 66 mg/dL
12pm 102 mg/dL
8pm 92 mg/dL
MAY 6, 2011
4am 88 mg/dL
12pm 81 mg/dL
8pm 124 mg/dL
MAY 7, 2011
4am 40 mg/dL
12pm 98 mg/dL
8pm 105 mg/dL
MAY 8, 2011
4am 88 mg/dL
12pm 70 mg/dL
8pm 102 mg/dL
MAY 9, 2011
4am 100 mg/dL
12pm 100 mg/dL
8pm 98 mg/dL
MAY 10, 2011
4pm 100 mg/dL
XVII. Nursing Care Plan
XVIII. Drug Study

DRUG NAME CLASSIFICATION INDICATION ACTION DOSAGE / NURSING EVALUATION

ROUTE/ CONSIDERATION
FREQUENCY

Generic:
Analgesics / Relief of mild to Decreases Dosage: 7mg -assess patients -The client
acetaminophen anti-pyretics moderate pain; fever fever or pain: type of decreases the
paracetamol treatment of Route: TIV location, intensity, fever.
fever. Inhibiting the duration,
effects of Frequency: temperature.
pyrogens on every 4 hours.
the -assess allergic
Brand: hypothalamic reactions: rash,
heat urticaria; if these
regulating occur drug may
center. have to discontinue

A -check input and

hypothalamic output ratio:
action decrease output
may indicate renal
Leads to failure
sweating and
vasodilation. -inform the relatives
of the patient that
the urine may
become dark brown
as a result of
phenacetin
(metabolite of
acetaminophen)
-monitor liver and
renal functions.

AST, ALT, bilirubin,

BUN, CREA.

-tell the family of the

patient to avoid
taking more than
one product
containing
paracetamol at one
time; can cause
toxicity.

-teach the family of

the patient,
recognize of signs
of chronic overdose:
bleeding, bruising,
malaise, fever, sore
throat.

-tell parent to notify

prescriber for fever
lasting for more than
3 days.
 DRUG CLASSIFICATION INDICATION ACTION DOSAGE / NURSING EVALUATION
NAME ROUTE/ CONSIDERATION
FREQUENCY

Generic:
Anti - infectives Treatment of Interferes with Dosage: 170 -obtain patient -control of
ampicillin respiratory tract cell wall mg history of infection infection
infection and soft synthesis of before and during manifested by
tissue infections, susceptible Route: TIV therapy to assess absence of
bacteria, organisms. response. signs/
meningitis, Frequency: symptoms of
septicaemia and Preventing every 6 hours -assess history of infection.
Brand: gonococcal bacterial previous sensitivity
infections caused multiplication. reactions to
by susceptible penicillins or other
microoorganisms. Renders the cephalosporins.
cell wall
osmotically -assess for allergic/
unstable. hypersensitivity
reactions: chills,
Burst due to fever, joint pain
osmotic pruritus and rash.
pressure.
-monitor renal
Deactivated function: urine
due by beta- output, urinalysis:
lactamase, an protein and blood,
enzyme BUN.
produced by
resistant -assess for
bacteria. overgrowth of
infection: perineal
itching, fever,
malaise, redness,
pain, swelling, rash
and diarrhea.

-instruct the family

of the patient to take
all medications
prescribed for the
length of time
period.

-instruct the family

of the patient to
monitor adverse
reactions.

-instruct the family

of the patient if
diarrhea with blood
or pus occur
immediately to the
notify physician.
 DRUG CLASSIFICATION INDICATION ACTION DOSAGE / NURSING EVALUATION
NAME ROUTE/ CONSIDERATION
FREQUENCY

Generic:

Gentamicin Anti-infectives Short-term Interferes Dosage: 17 mg - assess patient for -absence of signs
treatment of with the previous sensitivity and symptoms of
serious protein Route: TIV reaction. infection
infections synthesis in (WBC<10,000/mm,
caused by the bacterial Frequency: -assess for the Absence of red,
susceptible cell. every 8 hours allergic reactions: draining wounds.
Brand: strains of rash, urticaria,
microorganisms binding to pruritus, chills,
especially gram ribosomal fever. Joint pain
(-) bacteria. unit. may occur a few
days after therapy
Causing begins.
misreading
of genetic -identify urine
code. output; if
decreasing, notify
physician. Also
Inaccurate increased BUN,
peptide creatinine, urine.
sequence
forms in -monitor
protein electrolytes: patient
chain. is in long-term
therapy.

Bacterial -advise the patient

death. to to take drug
directly as exactlyas
directed when
prescribed.

-advise the patients

to drink adequate
amounts of water
(2-3 L/day) unless
instructed to restrict
fuild intake.

-inform the family of

the patient might
experience of GI
upset, loss of
appetite.

-instruct the family

of the client
changes in urine
pattern and
respiratory difficulty.
 DRUG CLASSIFICATION INDICATION ACTION DOSAGE / NURSING EVALUATION
NAME ROUTE/ CONSIDERATION
FREQUENCY

Generic:

Naphazoline/ Ophthalmic Relief of eye Sympathomimetic Dosage: 1-2 -assess patient’s -patient
Zinc drops preparations irritation, or w/ alpha receptor drops condition before experiences
congestion activity. therapy and improvement of
secondary to Route: eye regularly thereafter vision w/
eye strain, to monitor drug medication.
exposure toto Causes Frequency: effectiveness.
smoke or air constriction of every 4 hours
pollutants. blood vessels of -assess patient for
Brand: the eye and nasal narrow angle
VasoClear-A mucosa. glaucoma/
increased
intraocular pressure.
Decongestion
-monitor for possible
drug induced
adversed reactions:
Papillary dilatation,
increased
intraocular pressure.

-assess patient’s
and family
knowledge on drug
therapy.
 DRUG CLASSIFICATION INDICATION ACTION DOSAGE / NURSING EVALUATION
NAME ROUTE/ CONSIDERATION
FREQUENCY

Generic:

Ferrous Dietary/ nutritional Prevention and Provides/ Dosage: 15mg/ -obtain a baseline -decreased of
sulfate preparations treatment of replaces 10.6 ml/ 2ml assessment of iron feeling fatigue
iron-deficiency elemental iron deficiency before and weakness.
anemia. essential Route: Oral starting therapy.
component in -improvement in
formation of Frequency: -evaluate hgb, Hct, results of Hct,
haemoglobin once a day and reticulocyte Hgb and
Brand: on RBC count during reticulocytes on
development. therapy. follow-up
examination.
-monitor adverse
Contains 37% reactions: nausea,
elemental diarrhea.
iron. Ferrous
gluconate. -assess bowel
12%, ferrous elimination, increase
sulphate- 20% water,bulk and
ferrous activity if
sulphate constipation occurs.
dessicated-
30% -assess diet and
nutrition: amount of
iron in diet.

-instruct the family

of the client not to
substituteone iron
salt for another
because they have
different elemental
iron content.

-remind the family of

the patient that
poisoning may
occur if increased
beyond
recommended level.

-instruct the family

of the client to
swallow the whole
tablet do not crush
or chew.
XIX. Discharge Planning

M- edications

 Instruct the mother to administer the following medications to the client as

prescribed by the physician:

o Zinc drops 1 ml OD x 14 days

o Probiotics + Prebiotics 1 sachet OD to be mixed with milk
o Paracetamo 170 mg q4 for fever ≥ 37
o Ferrous Sulfate 2 ml OD

 Inform the parents on the side effects of the following drugs given
 Instruct the mother to properly comply on the following medications
 Give emphasis on the right time and right dose of every drug to be given.

E- xercise

 Inform the mother the need of the client to have a daily exercise
 Encourage the mother to have some walk with her child especially early
morning.
 If possible, advice the mother to let her child to play
 Encourage to have a stretching of the hands and feet.

T- reatment

 Advice the mother to visit their barangay health center for further
observations
 Instruct the mother to routinely check the client’s colostomy for signs of
infection
 Instruct the mother to have a regular colostomy care to the client
 Teach the mother to keep an eye on the appearance of the client’s stool

H- ealth teaching

 Teach the mother the proper hand washing as well as to the family and most
especially to the client
 Instruct the SO’s to observe proper hygiene such as taking a bath everyday
 Teach the proper food handling
 Teach the family the susceptible microorganism that can cause diseases to the
GI tract including where, when and how to get these kinds of microorganism.
  Teach the parents the best nutrition that fits to the client’s needs at the same
time the appropriate time and number of hours for time and rest.

O- PD

 Instruct the client to comply on the following scheduled check-ups to the OPD
 Give emphasis on the need and the benefits to get when conforming to the
following check-ups.

D- iet

 Follow the BRAT diet

 Avoid eating street foods
 Start eating cooked vegetables and fruits
 Dairy products must not be taken
 Increase fluid intake

S- piritual

 Encourage the family as well as the patient to go to church every Sunday and
to keep on believing and praying.