Transcript Case Presentation - DR.Ahmed Abanamy Hospital

Acute Gastro
Enteritis
(A.G.E)
PREPARED BY: MARIAMMA JOHN
STAFF NURSE, PEDIA WARD
Name:
Case no.2
MR No.:
195077
Diagnosis: Acute Gastroenteritis
Age:
1 year
Gender:
Female
D.O. A:
23/01/2013
D.O.D:
25/01/2013
General Assessment:

Chief complaint: Febrile,
Lethargic and decreased Activity

Genitourinary: Redness of the
perineal area, urine concentrated
and dark color

Skin: Dehydrated, Dry, Pale and
mottled, Cold extremities,
capillary refill > 3 sec

Gastrointestinal: Abdomen is
hyperactive and distended. Loose
stools more than 7 times per day

Head and Neck: Neck Veins
Flattened, Sunken Eyes, Fontanel  Musculoskeletal: No deformities
Sunken
Noted. No joint or muscle pain
noted during examination

Thorax: Normally symmetrical in
size
 Neurology: Growth and
development is normal according
Cardiovascular: Tachycardia
to Erikson’s Psychosocial Stage
present, no tachypnoea

Past Medical History :
There is no past medical history of any
illness
Present Medical History:
Now the baby is admitted with the
complaints of loose stool, vomiting and
fever
CHILD’S AGE and MASTERED SKILLS
1 MONTH

Lifts head when lying on tummy. Respond to
sound. Stares at faces.
2 MONTHS

Vocalizes: gurgles and coos. Follows objects
across field of vision. Notices his hands. Holds
head up for short periods.
3 MONTHS

Smiles, laughs. Can bear weight on legs. Coos
when you talk to him.
5 MONTHS


Distinguishes between bold colors. Plays with
his hands and feet.

Turns toward sounds and voices
Imitates sounds
Rolls over in both directions
Says ‘mama’ or ‘dada’ to parents. Passes
objects from hand to hand.
9 MONTHS

Stands while holding onto something. Jabbers
or combines syllables. Understands object
permanence.
10 MONTHS

Waves good bye. Picks things up with pincer
grasp. Crawls well, with belly off the ground.
11 MONTHS

6 MONTHS

Sits without support. Drags objects toward
herself.
8 MONTHS
Recognizes your face and scent. Holds head
steady. Visually tracks moving objects.
4 MONTHS

7 MONTHS
Says ‘mama’ or ‘dada’ to the correct parent.
Plays patty- cake and peek-a-boo. Stands
alone for a couple of seconds.
12 MONTHS

Imitates others activities. Indicates wants with
gestures.
GASTROENTERITIS
Definition;
Gastroenteritis is an upset
stomach. It causes nausea and
vomiting. It is sometimes called
stomach flu, caused by viruses
and bacteria.
The gastrointestinal tract is a
muscular tube made by
epithelial cells. The individual
components of the
gastrointestinal system are oral
cavity, salivary glands,
esophagus, stomach, small
intestine and large intestine.

ORAL CAVITY: Mechanical breakdown of food occurring in mouth.
Insalivations and absorption of small molecules such as glucose and
water are the functions of oral cavity

SALIVARY GLANDS : 3 pairs of salivary glands present ,which
produce saliva

ESOPHAGUS : It is a muscular tube which extend from pharynx to
stomach .It acts as a transport medium between compartments.

STOMACH : Stomach is a “j” shaped bag located just left of the
midline between the esophagus and small intestine. Its functions are
• The short term storage of ingested food
• Mechanical breakdown of food
• Chemical digestion of proteins by acids, enzymes
 VIRAL:
E.g.; Rotavirus ,
Adenoviruses, Norovirus , Parvovirus
and Astroviruses

BACTERIAL; E.g.; Salmonella,
Shigella, E- coli, Clostridium deficit
 PARASITES
AND PROTZOANS: E.g.;
Giardia, Cryptosporidium
PATHOPHYSIOLOGY
Predisposing Factors
- Age
- Malnutrition
Direct Invasion of the
bowel wall
Excessive gas formation
GI Distention
ACUTE GASTROENTERITIS
Precipitating Factors
- Contaminated
Food and Water
Ingestion of fecally
contaminated food and
water
Endotoxins are released
Stimulation and
Destruction of mucosal
lining of the bowel wall
Attempted Defecation
Digestive and
Absorptive Malfunction
Secretion of food and
electrolytes in the
intestinal lumen
Increase Peristaltic
Movement
Mild Diarrhea
Fluid and Electrolytes
Imbalance
Increased Protein in the
Lumen
LI is overwhelmed and
unables to reabsorb
the lost food
Intense diarrhea >10times
watery stool
Serious Fluid Volume
Deficit
Hypovolemic Shock
Death
Book Based
Patient Manifested
 Diarrhea
 Nausea
 Nausea
 Diarrhea
 Crampy
abdominal
pain
 Vomiting
 Vomiting
 Fever
 Dehydration
 Tachycardia

Maintain hydration

Promoting intake of nutrients

Reduce hyperthermia

Monitoring and preventing potential complications

Promoting family knowledge
BOOK BASE







PATIENT TREATMENT
A.G.E is usually an acute and
 Treated with
self limiting disease that does not
 IV Fluids,
require medication
 ORS solution,
The preferred treatment in
those with mild to moderate
 Inj. Perfalgan 200mg iv
dehydration is oral rehydration
prn,
therapy, metaclopromide or
 Voltaren suppository
ondansteron if needed
12.5mg prn
If it is viral :
soft anti diarrheal diet
Oral rehydration
IV Fluids
Bacterial: Antibiotics
 Pseudomembraneous
enterocolitis ( usually only
seen in those who are taking antibiotics)
 Gastro intestinal bleeding
 Dehydration
 Electrolyte Imbalance (Hypokalemia,
Hypernatremia)
 Shock
 Sepsis ( secondary bacterial infection )

Altered fluid volume deficit due to diarrhea and
vomiting

Altered electrolyte imbalance due to diarrhea and
vomiting

Imbalanced nutrition less than body requirement due to
less food intake

Hyperthermia related to infection

Lack of skin integrity due to severe loose stool
ASSESSMENT
SUBJECTIVE
Patient’s Mother
Complaints Of
Increase No Of Loose
Stools And Vomiting
OBJECTIVE
Loose Stool More Than
7 Times Per Day
1.
Dry Skin
2.
Cracked Lips
NURSING
DIAGNOSIS
Altered fluid volume
deficit related to
active fluid loss
PLANNING
Within 12hrs of
nursing intervention
patient will

Hydrated

Normal lips
No vomiting
IMPLEMENTATION
1.
2.
3.
4.
5.
6.
Encouraged oral
intake of fluids
Given
nutritionally
enrich drinks
with more taste
enrich with
electrolyte (e.g.
Pedialyte)
Administered IV
Fluids 5% dex in
½ NS + 5 ml kcl
at 60ml / hour
Provided rest
with calm and
quiet
environment
Monitored
intake and
output chart
Provided soft
Anti-Diarrheal
diet
RATIONALE
1.
2.
3.
4.
5.
6.
Helps to
promote
hydration
To avoid
dehydration
Helps to provide
fluids , calories
and electrolytes
To maintain
electrolyte
imbalance
Will determine
if output
exceeds input
Fiber and solid
food may cause
gastric irritation
EVALUATION
After 12 hours of
nursing
intervention the
goals was partially
met as evidenced
by :

Frequency of
diarrhea
decreased

Still
dehydration

No fatigue

No vomiting
ASSESSMENT
SUBJECTIVE
Patient mother
complaints baby feel
hot while touching
OBJECTIVE
Fever ( 39 – 40 c)
Drowsy
Tachycardia
Weakness
NURSING
DIAGNOSIS
PLANNING
IMPLEMENTATION
1.
Hyperthermia
Within 24 hours
related to infection patient will
completely
2.
relieved from fever
3.
4.
5.
Removed
excessive
clothing
Provided tepid
sponge bath
Encouraged
fluid intake
Administer IV
Fluids 5% dex in
½ NS + 5 ml kcl
at 60ml / hour
Administered
Antipyretics
(e.g.
Inj.perfalgan
200mg IV PRN,
Rofenac
suppository
12.5mg PRN )
RATIONALE
1.
2.
3.
4.
5.
Excessive
clothing may
elevate
temperature
High
temperature
causes
coagulation
of cell protein
and cell die.
High
temperature
leads to brain
damage
To prevent
dehydration
To prevent
electrolyte
imbalance
To reduce
body
temperature
EVALUATION
After 2 days of
nursing
intervention the
goals are fully
met.

No fever

No weakness

Fully
nourished
 Encourage
the mother to feed the baby
with a nutritious diet which is not harmful
to the stomach
 Advise to increase the activities gradually
 Advise the mother to prepare the food in a
hygienic manner
 Advise the mother to maintain the
personal hygiene of the baby
 Encourage rest to the baby
Patient relieved from signs
and symptoms. Discharge
medications: Pedialyte and
voltarin suppository 12.5mg
prn. Review after 1 week

Brunner
& Suddarth’s. Test book of
Medical Surgical Nursing. 12thEdition.
Lippincott
Manual of Nursing
Practice. 9th Edition.
KHALAS
Shukran for listening…