Davao Medical School Foundation
Medical School Drive, Bajada Davao City
In Partial fulfillment of the Requirements in
NCM-104 RLE
A Case Study on
Acute Enteritis
Submitted To:
Ms. Aysa Amerkhan, RN, MAN
Clinical Instructor
Submitted By:
Cruz, Kristine
Doromal, Gedelene
Egagamao, Jonalyn
Estrada, Zenneth Marie
Famoso, Mellan Joy
Fernando, Nanellen
September 15, 2009
ACKNOWLEDGEMENT
The group would like to stress the fact that the completion of this study would have been
impossible without the help, love and support of the following:
To the Almighty God, the Father, for showering us with so much blessings, in guiding us
to the right path of making this work fruitful and for giving us the strength we need to finish this
noble task.
To our beloved parents, who have been very supportive in all our endeavors, for their
love and encouragement which made us strong and firm.
To our chosen patient and her relative, for the time they’ve allotted in answering our
inquiries, and for treating us kindly whenever we approach them.
To the staff of the Davao Medical School Foundation Hospital – St. Joseph ward, for
their warmest welcome and accommodation during our two-week exposure in their area.
To our mentors and clinical instructors, most especially to Ms. Aysa Amerkihan, R.N.,
for urging us to do things ahead of time, for the fervent encouragement and motivation.
INTRODUCTION
Most of us are questioned why there is such ba need to be healthy. Is health truly essential to
attain the fullness of a good life? Some says they feel just right well in fact there are alterations
already internally. It may not be seen externally but for those who value their health, definitely
there are actions which they put into considerations to easily prevent potential changes in the
state of health. Health in any ways should never be disregarded because it is something that we
value the most. Something which indeed gives us the reason why we work to earn a living, that
is, to achieve and maintain a physical, mental, social, and spiritual harmony and thus upholding a
healthy life. It does not merely mean the absence of such illnesses but also the views the holistic
aspect of an individual.
Gastroenteritis is inflammation of the gastrointestinal tract, involving both the small and
large intestines. Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely lifethreatening 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 and dehydration. In
developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately
three million deaths occurred worldwide as a result of diarrheal illness. Typically, children are
more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Annually,
worldwide, rotaviruses are estimated to cause 800,000 deaths in children below age five. For this
reason, much research has gone into developing a vaccine to protect children from this virus.
Adults can be infected with rotaviruses, but these infections typically have minimal or no
symptoms.
Children are also susceptible to adenoviruses and astroviruses, which are minor causes of
childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major
causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause
illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton,
and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major
symptom.
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking
water, or contaminated food—conditions common in developing nations. Natural or man-made
disasters can make underlying problems in sanitation and food safety worse. In developed
nations, the modern food production system potentially exposes millions of people to diseasecausing bacteria through its intensive production and distribution methods. Common types of
bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however,
Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed
nations. Cholera and Shigella remain two diseases of great concern in developing countries, and
research to develop long-term vaccines against them is underway.
The purpose of this case study is to illustrate and contribute a unique and valuable
method of eliciting phenomena of interest to nursing. The goal of the case study is to describe as
accurately as possible the fullest, most complete description of the case. For the remainder of the
case study, remarks are aimed at implications for future nursing research activities.
OBJECTIVES
General Objectives:
That within our 6 days of exposure at Davao Medical School Foundation-St. Joseph
ward, we will be able to conduct an extensive and comprehensive case study and present the
disease process which could be a way of recognizing and presenting all accompanying
characteristics, factors and information contained in the patient’s condition that would be helpful
for us students and nurses and to the patient’s condition.
Specific Objectives:
Moreover this case study aims to:
1. Establish a good working and therapeutic relationship with the client and significant others to
obtain pertinent information and gain cooperation;
2. Conduct an interview to gather relevant facts about our client’s family, present, and past
health history;
3. Relate the patient’s developmental data in accordance with Erik Erickson and Robert
Havighurst theories;
4. Assess our patient with great emphasis on the observed abnormal bodily functions brought
about by the present condition;
5. Assess our patient in a cephalocaudal manner;
6. Define the complete final diagnosis from three different sources;
7. Present the anatomy and physiology of the affected systems;
8. Trace the pathophysiology of Acute Enteritis;
9. Present and interpret the diagnostic exams done to our patient;
10. Present the actual and possible medical-surgical management;
11. Enumerate the drugs used in the treatment regimen, their action, indications,
contraindications, adverse effects and nursing responsibilities;
12. Formulate actual and potential nursing care plans; and
13. Impart Health teachings to the family and caregivers that are necessary for the betterment of
the client’s condition;
14. Discuss the client’s prognosis with justification;
15. Formulate specific discharge plan concerning recognized needs, projected crisis and deficient
awareness on establishing and maintaining a commendable health condition.
PATIENT’S DATA
NAME
:
Mr. T
AGE
:
62 years old
SEX
:
Male
BIRTHDAY
:
July 07, 1947
BIRTHPLACE
:
Davao City
ADDRESS
:
#1 Zinnia Ave. Ladislawa Vill. Buhangin Davao
City
RELIGION
:
Roman Catholic
NATIONALITY
:
Filipino
CIVIL STATUS
:
Married
CLINICAL DATA
Chief Complaint: LBM
Department: St. Joseph Ward
Admitting Diagnosis: Colon Cancer
Date and Time of Admission: September 01, 2009/ 8:15 am
How Admitted: Per Wheelchair
Admitting Physician: Dr. R. Bandolon
GENOGRAM
Mr. M, T
83 Ψ
Mr. T
62 ♫
B
63
P
38
Mrs. C, T
82 Ψ ♫ Ə
ƏΩ
S
59 Ə
K
P
36 Ω
33Ə
L
56 Ψ
M
54 Ψ
C
53 ♫
P
31
Ə
LEGEND:
♫
-
Arthritis
Ψ
-
Hypertension
Ω
-
Diabetes Mellitus
☼
-
Cancer
Ə
-
Alcoholism
R
40 Ψ
HEALTH HISTORY
FAMILY HISTORY
Our patient is Mr. T, a 62 year-old male. His mother is Mrs. C, 82 years of age. His father
is Mr. T (83), loves to drink alcoholic beverages and has hypertension. His parents has 7 siblings,
namely Mr. T who is our patient (62), B (63) with arthritis, S (59) with asthma, L (56) with
hypertension, M (54) with hypertension, C (53) with arthritis and R (40) with hypertension.
PAST HEALTH HISTORY
Our patient, Mr. T, is the second among seven siblings was born via NSVD. He was
breastfed before he turned one. The patient has completed the immunization like BCG, DPT,
OPV and measles vaccine. In his early years, he still suffered from minor illnesses such as
cough, colds, fever and flu. The patient, prefer to eat vegetables and fishes than meat foods. His
common activities of daily living are cooking, washing the dishes and repairing their appliances.
Our patient is not a known hypertensive, though some of his relatives do have these illnesses. In
1995, he was diagnosed that he had colon cancer.
PRESENT HEALTH HISTORY
One month prior to admission the he developed loose bowel movement and it last
for 1 week and was discharged. 2 days after he developed loose bowel movement, watery, nonbloody, amounting to about 50cc associated with cramping abdominal pain. Patient took hydrite
and crimazole. The patient decided to consult a physician when he still had episodes of LBM and
the pain he felt was already severe. He experienced difficulty in sleeping at night too.
He has been admitted to Davao Medical School Foundation Hospital September 01,
2009.
PHYSICAL ASSESSMENT
September 03, 2009 5pm, an assessment was made done to Mr. T, 62 years old, male with with a
diagnosis of acute enteritis.
I.
GENERAL SURVEY
Mr. T, 62 years old, male, Filipino and married was assessed while lying on bed awake and
coherent with an IVF of PLR at 160cc/˚ infusing well at ® metacarpal vein. Patient appears clean and
neat.
II.
VITAL SIGNS AND ANTHROPOMETRIC MEASUREMENT
36.8˚ C; afebrile
Temperature
Pulse Rate
(Normal: 36.6 – 37.5 ˚ C)
(Normal: 55 – 95 beats per minute)
68bpm
Cardiac Rate
69bpm
(Normal: 80 – 90 beats per minute)
Respiratory Rate
22cpm
(Normal: 16 – 20 cycles per minute)
Blood Pressure
110/80mmHg
(Normal 90-60 – 130/100 mmHg)
III.
SKIN
The patient had fair brown complexion. Skin was warm to touch on upper and lower extremities.
Good skin turgor. No presence of lesion, edema. Nails good capillary refill.
IV.
HEAD
Hair was equally distributed. The scalp was clean with no presence of scars, lesions, dandruffs
and lice noted. Skull and face were symmetrical. Facial features and movement were symmetrical on both
sides.
V.
EYES
Eyebrows were equally distributed, symmetrically aligned and moves equally. Eyelids there are
no blinking reflex. Eyes were symmetrical. Slightly pink palpebral conjunctiva. Pupil sizes were equal.
Eyeball No alignment in a proper position.
VI.
EARS
External pinna had the same tone with facial skin color. Both pinna were symmetrical with each
other, no tenderness and lesions noted. Patient can literally hear to both ears.
VII.
NOSE
Nose skin tone was same with facial skin color. Nose was symmetric and straight. No discharges
from nares. No tenderness noted.
VIII.
MOUTH
Slightly pink lips, gums and oral mucosa. Slightly moist lips. Able to masticate & swallow. Teeth
were complete. No associated pain and tenderness. No bleeding noted.
IX.
NECK
Neck color was same with facial skin color. Carotid arteries are palpable with strong pulsations
on neck. The patient can voluntarily able to flex, extend and turn his head side to side. No lymph nodes
enlargement, problem with ROM.
X.
CHEST and LUNGS
Respiratory rate and rhythm regular. Respiratory rate was 22 cycles per minute. Lung expansion
was symmetrical. No presence of wheezes and crackles during auscultation.
XI.
HEART
Point of maximal impulse is heard at left mid clavicular line, fifth intercostals space with apical
pulse of 78 beats per minute.
XII.
BREAST and AXILLAE
Axillae were free from rashes and few hairs noted. No signs of tenderness noted.
XIII.
ABDOMEN
No signs of infection noted. Tenderness noted when palpation was done. Normoreactive bowel
sounds heard upon auscultation.
XIV.
GENITO-URINARY
The client can void normally without difficulty.
XV.
BACK and EXTREMITIES
Upper and lower extremities were proportional to the body size. Both extremities can
move freely. No swelling noted. Nailbeds were pinkish with normal capillary refill.
NURSING THEORIES
Erik Erikson
The Psychosocial Developmental Stages
Middle Adulthood: Generativity vs. Stagnation (35 to 65 years)
Erik Erikson’s theory of psychosocial development is one of the best-known theories of
personality and development. Similar to Sigmund Freud, Erikson believed that personality
develops in a series of predetermined stages. Unlike Freud’s theory of psychosexual stages,
Erikson’s theory describes the impact of social experience across the whole lifespan. At each
stage of development, Erikson described conflicts that act as turning points in life.
Generativity is an extension of love into the future. It is a concern for the next generation
and all future generations. As such, it is considerably less "selfish" than the intimacy of the
previous stage: Intimacy, the love between lovers or friends, is a love between equals, and it is
necessarily reciprocal. With generativity, that implicit expectation of reciprocity isn't there, at
least not as strongly. Few parents expect a "return on their investment" from their children; If
they do, they aren't very good parents!
We can say that our patient belongs on the generativity state. His concern is more on raising his
children. He is happy looking at his children achieving goals interacting to others as they grow to
the world of maturity. He Assist his children to become responsible and happy
adults.
Robert Havighurst
Developmental Theory
Middle Age (30-60years old)
A development task is a task which arises at or about a certain period in the life of the
individual, successful achievement of which leads to his happiness and to success with later
tasks, while failure leads to unhappiness in the individual, disapproval by society, and difficulty
with later tasks.
Tasks
Assisting teenage children to
become responsible and happy
adults.
Achieving adult social and civic
responsibility.
Reaching
and
maintaining
satisfactory performance in one’s
occupational career.
Developing adult leisure time
activities.
Relating oneself to one’s spouse
as a person.
To accept and adjust to the
physiological changes of middle
age.
Adjusting to aging parents
able
∕
unable
∕
∕
∕
∕
Justification
Our client had raise well his two daughters to
be a totally equip individual.
Our client is aware to his own responsibilities
∕
According to our patient.
∕
Our patient is not active in any sports
We can observe that they have a good
relationship with each other.
As we are going on eith our interview with him
he was able to verbalize that emerging disease
is higher when a person grows older.
According to him he knows that all people
becomes old.
As we assess, he was not able to achieved all task. He is not fun of
any sports or leisure time activities and also has no satisfactory in
performing occupational career. But as we observe he was happy raising
his family well together with his wife.
ANATOMY AND PHYSIOLOGY
Gastrointestinal System
The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity,
where food enters the mouth, continuing through the pharynx, oesophagus, stomach and
intestines to the rectum and anus, where food is expelled. There are various accessory organs that
assist the tract by secreting enzymes to help break down food into its component nutrients. Thus
the salivary glands, liver, pancreas and gall bladder have important functions in the digestive
system. Food is propelled along the length of the GIT by peristaltic movements of the muscular
walls.
The primary purpose of the gastrointestinal tract is to break down food into nutrients, which can
be absorbed into the body to provide energy. First food must be ingested into the mouth to be
mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and
small intestine where proteins, fats and carbohydrates are chemically broken down into their
basic building blocks. Smaller molecules are then absorbed across the epithelium of the small
intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation (passing of faeces). In the case of gastrointestinal disease or
disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may
develop symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction.
Gastrointestinal problems are very common and most people will have experienced some of the
above symptoms several times throughout their lives.
Basic structure
The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium.
The contents of the tube are considered external to the body and are in continuity with the
outside world at the mouth and the anus. Although each section of the tract has specialised
functions, the entire tract has a similar basic structure with regional variations. The wall is
divided into four layers as follows:
Mucosa: The innermost layer of the digestive tract has specialised epithelial cells supported by
an underlying connective tissue layer called the lamina propria. The lamina propria contains
blood vessels, nerves, lymphoid tissue and glands that support the mucosa. Depending on its
function, the epithelium may be simple (a single layer) or stratified (multiple layers).
Areas such as the mouth and oesophagus are covered by a stratified squamous (flat) epithelium
so they can survive the wear and tear of passing food. Simple columnar (tall) or glandular
epithelium lines the stomach and intestines to aid secretion and absorption. The inner lining is
constantly shed and replaced, making it one of the most rapidly dividing areas of the body!
Beneath the lamina propria is the muscularis mucosa. This comprises layers of smooth muscle
which can contract to change the shape of the lumen.
Submucosa: The submucosa surrounds the muscularis mucosa and consists of fat, fibrous
connective tissue and larger vessels and nerves. At its outer margin there is a specialized nerve
plexus called the submucosal plexus or Meissner plexus. This supplies the mucosa and
submucosa.
Muscularis externa: This smooth muscle layer has inner circular and outer longitudinal layers
of muscle fibres separated by the myenteric plexus or Auerbach plexus. Neural innervations
control the contraction of these muscles and hence the mechanical breakdown and peristalsis of
the food within the lumen.
Serosa/ Mesentery: The outer layer of the GIT is formed by fat and another layer of epithelial
cells called mesothelium.
The Individual Components of the Gastrointestinal System
Oral cavity
The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified squamous
oral mucosa with keratin covering those areas subject to significant abrasion, such as the tongue,
hard palate and roof of the mouth. Mastication refers to the mechanical breakdown of food by
chewing and chopping actions of the teeth. The tongue, a strong muscular organ, manipulates the
food bolus to come in contact with the teeth. It is also the sensing organ of the mouth for touch,
temperature and taste using its specialised sensors known as papillae.
Insalivation refers to the mixing of the oral cavity contents with salivary gland secretions. The
mucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a limited role in
the digestion of carbohydrates. The enzyme serum amylase, a component of saliva, starts the
process of digestion of complex carbohydrates. The final function of the oral cavity is absorption
of small molecules such as glucose and water, across the mucosa. From the mouth, food passes
through the pharynx and oesophagus via the action of swallowing.
Salivary Glands
Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland with
numerous acini lined by secretory epithelium. The acini secrete their contents into specialised
ducts. Each gland is divided into smaller segments called lobes. Salivation occurs in response to
the taste, smell or even appearance of food. This occurs due to nerve signals that tell the salivary
glands to secrete saliva to prepare and moisten the mouth. Each pair of salivary glands secretes
saliva with slightly different compositions.
Parotids: The parotid glands are large, irregular shaped glands located under the skin on the side
of the face. They secrete 25% of saliva. They are situated below the zygomatic arch (cheekbone)
and cover part of the mandible (lower jaw bone). An enlarged parotid gland can be easier felt
when one clenches their teeth. The parotids produce a watery secretion which is also rich in
proteins. Immunoglobins are secreted help to fight microorganisms and a-amylase proteins start
to break down complex carbohydrates.
Submandibular: The submandibular glands secrete 70% of the saliva in the mouth. They are
found in the floor of the mouth, in a groove along the inner surface of the mandible. These
glands produce a more viscid (thick) secretion, rich in mucin and with a smaller amount of
protein. Mucin is a glycoprotein that acts as a lubricant.
Sublingual: The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at
the floor of the mouth. They produce approximately 5% of the saliva and their secretions are
very sticky due to the large concentration of mucin. The main functions are to provide buffers
and lubrication.
Oesophagus
The oesophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It
extends from the pharynx to the stomach after passing through an opening in the diaphragm. The
wall of the oesophagus is made up of inner circular and outer longitudinal layers of muscle that
are supplied by the oesophageal nerve plexus. This nerve plexus surrounds the lower portion of
the oesophagus. The oesophagus functions primarily as a transport medium between
compartments.
Stomach
The stomach is a J shaped expanded bag, located just left of the midline between the oesophagus
and small intestine. It is divided into four main regions and has two borders called the greater
and lesser curvatures. The first section is the cardia which surrounds the cardial orifice where the
oesophagus enters the stomach. The fundus is the superior, dilated portion of the stomach that
has contact with the left dome of the diaphragm. The body is the largest section between the
fundus and the curved portion of the J.
This is where most gastric glands are located and where most mixing of the food occurs. Finally
the pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal
duodenum via the pyloric sphincter. The inner surface of the stomach is contracted into
numerous longitudinal folds called rugae. These allow the stomach to stretch and expand when
food enters. The stomach can hold up to 1.5 litres of material. The functions of the stomach
include:
16. The short-term storage of ingested food.
17. Mechanical breakdown of food by churning and mixing motions.
18. Chemical digestion of proteins by acids and enzymes.
19. Stomach acid kills germs.
20. Some absorption of substances such as alcohol.
Most of these functions are achieved by the secretion of stomach juices by gastric glands in the
body and fundus. Some cells are responsible for secreting acid and others secrete enzymes to
break down proteins.
Small Intestine
The small intestine is composed of the duodenum, jejunum, and ileum. It averages approximately
6m in length, extending from the pyloric sphincter of the stomach to the ileo-caecal valve
separating the ileum from the caecum. The small intestine is compressed into numerous folds
and occupies a large proportion of the abdominal cavity. The duodenum is the proximal Cshaped section that curves around the head of the pancreas. The duodenum serves a mixing
function as it combines digestive secretions from the pancreas and liver with the contents
expelled from the stomach. The start of the jejunum is marked by a sharp bend, the
duodenojejunal flexure. It is in the jejunum where the majority of digestion and absorption
occurs.
The final portion, the ileum, is the longest segment and empties into the caecum at the ileocaecal
junction. The small intestine performs the majority of digestion and absorption of nutrients.
Partly digested food from the stomach is further broken down by enzymes from the pancreas and
bile salts from the liver and gallbladder. These secretions enter the duodenum at the Ampulla of
Vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are
broken down to small building blocks and absorbed into the body's blood stream. The lining of
the small intestine is made up of numerous permanent folds called plicae circulares. Each plica
has numerous villi (folds of mucosa) and each villus is covered by epithelium with projecting
microvilli (brush border). This increases the surface area for absorption by a factor of several
hundred. The mucosa of the small intestine contains several specialised cells. Some are
responsible for absorption, whilst others secrete digestive enzymes and mucous to protect the
intestinal lining from digestive actions.
Large Intestine
The large intestine is horse-shoe shaped and extends around the small intestine like a frame. It
consists of the appendix, caecum, ascending, transverse, descending and sigmoid colon, and the
rectum. It has a length of approximately 1.5m and a width of 7.5cm. The caecum is the expanded
pouch that receives material from the ileum and starts to compress food products into faecal
material. Food then travels along the colon. The wall of the colon is made up of several pouches
(haustra) that are held under tension by three thick bands of muscle (taenia coli).
The rectum is the final 15cm of the large intestine. It expands to hold faecal matter before it
passes through the anorectal canal to the anus. Thick bands of muscle, known as sphincters,
control the passage of faeces. The mucosa of the large intestine lacks villi seen in the small
intestine. The mucosal surface is flat with several deep intestinal glands. Numerous goblet cells
line the glands that secrete mucous to lubricate faecal matter as it solidifies. The functions of the
large intestine can be summarised as:
The accumulation of unabsorbed material to form faeces.
Some digestion by bacteria. The bacteria are responsible for the formation of intestinal gas.
Reabsorption of water, salts, sugar and vitamins.
ETIOLOGY
PREDISPOSING
FACTORS
Age
ACTUAL
√
JUSTIFICATION
Our patient is 62 years old thus, this factor
increases his risk acquiring enteritis because
of the weakening of defenses as an individual
gets older.
Our patient is an asian. This disease is highly
Ethnic
Group/Race
prevalent
x
in
Africa
because
of
their
environment Hence, our patient's ethnicity
doesn't subject him much to this kind of
disease.
Genetic
x
Sex
√
This is not common in the family.
Acute enteritis often occurs in men because of
their vices (e.g. Alcohol drinking)
PRECIPITATING
FACTORS
ACTUAL
JUSTIFICATION
Our patient’s lifestyle doesn’t subject him to this
Lifestyles
disease
Diet
√
Alcohol Consumption
√
Smoking
√
Obesity
x
Our patient is inclined to eating and is not very
cautious of his diet.
This affects the functioning of the central nervous
system, thus affecting also the other systems.
This
causes
systemic
vasoconstriction
thus
decreasing nutrient supply through out the body.
Our patient's body size is proportional to his
height.
Symptoms
SYMPTOMATOLOGY
ACTUAL
JUSTIFICATION
Increased
Diarrhea
Fever
Abdominal pain
√
fluid
secretion
and
decreased
reabsorption may lead to diarrhea.
Results from the inflammatory process brought
about by pathogenic invasion.
Thos results from the alterations occurring in the
gastrointestinal tract.
Possible cause may be stretching of stomach and/or
Nausea and Vomiting
gastrointestinal alterations. Toxins may also lead to
this condition.
Orthostasis
Result from inadequate supply of nutrients
throughout the body.
Tachycardia
Compensatory mechanism of the body.
Hypotension
Result from decreased in blood supply.
Precipitating Factor:
Predisposing Factor:
-Diet
-Lifestyle
-Environment
-Cancer
-Age
-Genetic
-Race
Pathogenic
Microorganisms
-Escherichia Coli
-Shigella
-Salmonella
-Staphylococcus Aureus
Adherence to mucosa
of gastrointestinal tract
Invasion of
gastrointestinal tract
Enterotoxin
Production
Interacts with
mucosa
Destruction of
epithelial cells
Systemic
invasion
Inflammation of
mucosal lining
Affects GI
motility
Superficial
Inflammation
of
ulceration
of
layer of tissue
mucosa
beneath epithelium
of mucosa
Increased fluid
secretion and/or
decreased
absorption
s/s:
-hyperemia
-Edema
Increased luminal
fluid content that
cannot be adequately
reabsorbed
hypomotility
Increase in the
osmotic load
presented to
intestinal lumen
Hastening of the
colonization
process
Diarrhea
- Abdominal
cramps
Further
destruction of GI
tract
Accumulation of
fluid inside the
GI system
- Vomiting
Excretion of
intestinal fluid
If treated:
Access to
systemic
circulation
Spread of
infection in
another part of
the body
If not treated:
-Antibiotics
-antimotility
Resolution of
disease
If treated:
-Antibiotics
Septicemia
If not treated
Good prognosis
Profuse
excretion of GI
contents
Invasion of
major organ (e.g.
carditis,
meningitis,
pylonephritis)
Continuing excretion
of fluid and
electrolytes
If treated:
-Fluid replacement
-Electrolyte
solution
Restoration of
level of fluid &
electrolytes
Good prognosis
Dehydration
s/s:
-Orthostasis
-lightheadness
-Diminished
urine formation
-Fatigue
If not treated:
Depletion of fluid
and electrolyte in the
body
Multiple organ
dysfunction
Inadequate distribution
of nutrients throughout
the body
Hypovolemic
shock
Failure of compensatory
mechanisms
Cellular hypoxia resulting
to irreversible changes
Multiple organ
faliure
Cardio pulmonary
arrest
Death
Date
Basic test with Normal Values
Rationale
Results of
Actual Test
Clinical Significance
Nursing
Intervention
Before and After
the Exam
9/12/08
Hemoglobin
Male:
140-170
Female
120-150
Is the main intracellular protein
of the red blood cells, transport
oxygen and remove Carbon
dioxide from them for excretion
of the lungs.
Whole blood contains about 15 g
of hemoglobin per 100 ml
High
To measure the severity
of anemia or
polycythemia and
monitor response to
therapy
154 g/L
indicates an aboveaverage concentration
of oxygen-carrying
proteins in your blood
PRE-TEST
Identify
any
medication that is
currently used by
the patient that
may
alter
the
result.
Tell the patient
that
the
test
requires a blood
sample.
Explain
who will perform
the
venipucture
and when.
Explain
to the
patient that he
may feel slight
discomfort
from
the tourniquet and
needle puncture.
POST TEST
Apply pressure on
the puncture site.
Erythrocytes(RBC)
Male: 4.0-6.0
Female; 4.0-5.0
Carries oxygenated blood the
rest of the body and carry un
oygenated blood to the lung.
To supply figures for
computing the
erythrocytes indices,
which reveal RBC size
and hemoglobin
content.
To support other
hematologic test in
diagnosis of anemia
and polycythemia
Leukocytes (WBC)
5.0-10.0
- White blood cells constitute the
body’s primary defense against
“invader”. Leukocytes protect
the body from any foreign
substance
To detect infection or
inflammation
To determine the need
for further tests, such
as the WBC differential
or bone marrow biopsy
Lymphocytes
0.20-0.35
- the second most
numerous of the
many WBC in the
blood
To determine primary
and secondary
immunodeficiency
disease
0.28
Monocytes
0.02-0.06
To determine the stage
and severity of an
0.09
5.00
10^12/L
7.2
10^9/L
Normal
Normal
Normal
High
- Contains the
chromatic material
with gray
bluepattern
and gray cytoplasm
filled with fine
reddish
auzurophilic granules
infection
Eosinophils
0.01-0.05
- a granuloytic
biloded WBC,
larger than
neutrophils
To detect parasitic
infection
high moncyte count can
be a sympton of mononucleosis
0.01
Normal
URINALYSIS
Sept. 1, 2009
Color: yellow
Transparency: clear
Chemical Examination
Glucose: negative
Reaction: 6.0
Specific Gravity: 1.020
Microscopic Exam
Pus cells: 0-1/ hpf
RBC: 0-2/ hpf
X- RAY
The lungfields are clear. The heart is not enlarged. Aortic knob calcification noted. No other
remarkable findings.
Impression: Atherosclerosis Aorta
HGT
Result:
Normal Values:
150 mg/dL
80 – 120 mg/dL
ECG REPORT
Atrial Rate: 63/min
Rhythm: Sinus
Frontal axis: +68 degree
FR Interval: 0.18/sec
Elec. Position: Intermediate
QRS duration: 0.10/sec
QT Interval: 0.40/sec
Interpretation: Left Atrial Enlargement
Comments:
Inverted Pwaves in V1
Notched P waves in II, III: AVF
TUMOR MARKERS
Result
CEA
Normal Value
1.41
0.3ng/ml
FECALYSIS
Macroscopic Exam:
Color: brown
Consistency: watery
Microscopic Exam:
Parasitic Ova: No Ova found nor intestinal parasitic seen
Blood Chemistry
Test:
Na
K
Normal Range
127.1
3.56
135-148 mmol/L
3.5-5.3 mmol/ L
Ca
COMPLETE
DEFINITION OF DIAGNOSIS
1.03
1.13-1.32 mmol/ L
Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and
stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract,
involving both the stomach and the small intestine resulting in acute diarrhea. The inflammation
is caused most often by an infection from certain viruses or less often by bacteria, their toxins,
parasites, or an adverse reaction to something in the diet or medication. Worldwide, inadequate
treatment of gastroenteritis kills 5 to 8 million people per year, and is a leading cause of death
among infants and children under 5.
http://en.wikipedia.org/wiki/Gastroenteritis
Gastroenteritis is an infection of the bowel (intestines) that causes diarrhea and sometimes
vomiting. It is common in infants and children. It is more serious in infants and young children than it is
in adults. Diarrhea and vomiting can cause the loss of important fluids and minerals the body
needs(dehydration). Infants and children lose fluids and minerals quicker than adults.
Focus on Pathophysiology by Barbara L. Bullock and Reet L. Henze; pg 810-812
Gastroenteritis is an inflammation of the gastrointestinal tract. Most often this is caused by an
infection. Other causes include allergies , autoimmune problems, poisons, or
toxins.
Brunner and Suddarth’s textbook of Medical Surgical Nursing vol.2
10th edition by Suzanne C. smeltzer and Brenda G. Bare; pg 1008
MEDICAL ORDER
09-01-09
Phycisian’s order:
DAT
VSq4
Labs
CBC, urinalysis, Hgt
Stool
Serum electrolytes, Na, K, Ca
ECG
CXR PA
Start PLR @ fast drip 300 cc/ hr @ 160 cc/hr
Hydration q4
I and O q 2
Prescribed med: Loperamide 1 tb TID po
Refer for Dr. Glero for possible Colonoscopy
This patient was admitted under the service of Dr. Bandolon in due to complain of LBM. The Dr.
ordered Vital signs q4. As well as ordered to have diagnostic examination such as: labs, urinalysis,
hgt, Serum electrolytes (Na, K, Ca), ECG, CXR PA. Stool cultures are indicated in cases of dysentery
or where the diagnosis of AGE is unclear. Serum electrolytes should be considered in cases of
moderate to severe dehydration, when the case is not straightforward, or when IV fluids are required.
With IVF of PLR IL @fast drip @ 160 cc/hr as ordered. Maintained hydration procedure. Prescribed
med, Loperamide 1tb TID po. Still for referral to Dr. Glero for colonoscopy.
NURSING MANAGEMENT
The patient had been received on bed, awake conscious and coherent. His vital signs were in
the normal range. Vesicular breath sounds were heard upon auscultation and symmetrical chest
expansion was observed during assessment. He had been infused by PLR running at 160 cc/hr.
He was given a medication of Loperamide 1 tab po a drug effective against diarrhea resulting
from gastroenteritis or inflammatory bowel disease as ordered by the physician. Health
teachings rendered to him such as: encouraged to verbalize feeling and concerns, Stressed out
importance of proper hygiene, encouraged to comply with the treatment regimen. The patient
was watched closely for any signs of unusuality. A quiet and peaceful environment was provided
to the patient. His intake and output was monitored.
SURGICAL MANAGEMENT
ACTUAL
Colectomy
Consists of the surgical resection of any extent of the large intestine (colon).
Colonoscopy
It is the endoscopic examination of the large colon and the distal part of the small bowel
with a CCD camera or a fibre optic camera on a flexible tube passed through the anus. It may
provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or
removal of suspected lesions.
POSSIBLE
Flexible sigmoidoscopy
If symptoms not resolving. It bis a procedure used to see inside the sigmoid colon
and rectum. Flexible sigmoidoscopy can detect inflamed tissue, abnormal growths, and
ulcers. The procedure is used to look for early signs of cancer and can help doctors
diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus,
and weight loss.
DRUG STUDY
Generic Name : Loperamide
Brand Name: Imodium
Classification:
Therapeutic: Antidiarrheal
Pharmacologic: Piperidine Derivative
Ordered Dose: 4mg
Suggested Dose:
Adults: 16 mg P.O.
Mode of Action:
Direct action on intestinal muscles to decrease GI peristalsis;reduces volume, increases bulk,
electrolytes not lost.
Indications:
-Diarrhea (cause undetermined)
-Traveler's diarrhea
-Chronic diarrhea
-To decrease amount of ileostomy discharge/
PRECAUTIONS:
-Pregnancy (B)
-Lactation
-Children<2yr
-Hepatic disease
-Dehydration
-Bacterial Disease
Side Effects:
CNS: Dizziness, drowsiness, headache, fatigue, fever
GI: Constipation, nausea and vomiting, abdominal pain, anorexia, dry mouth, Toxic Megacolon
Skin: Rash, pruritus
Drug Interaction:
-Increase: CNS depression-alcohol, antihistamines, analgesics, opoiods, sedative/hypnotics
-DRUG/HERB:
-Increase : CNS depression: chamomile, hops, kava, Skullcap, valerian
-Increase: Antidiarrheal effect- Nutmeg
NURSING CONSIDERATION:
ASSESS
-Stools: Volume, Color Characteristics
-Electrolytes (K, Na, Cl) if on long-term therapy
-Skin turgor q8h if dehydration is suspected
Bowel pattern ; for rebound constipation,
-Dehydration, CNS problems in children
-Abdominal distention, toxic megacolon, may occur in ulcerative colitis
ADMINISTER
-Do not break, crush, or chew caps
-For 48 hr only
-Do not mix oral solutions with other solutions.
PATIENT/ FAMILY TEACHING:
-Tell patient to swallow tablets whole and not to open or crush
-Those following a sodium restricted diet should be cautious
-Instruct patient to take drug 30 min. before meals.
-To avoid OTC products unless directed by prescriber
-That ileostomy patient may take the drug for extended time.
-Not to operate machineries or drive if drowsiness occurs.
-Caution patient to avoid hazardous activities
-Increase oral fluid intake
-Encourage adequate restl
-Stressed the importance of proper hygiene.
-May use gum, hard candy , and ice chips to relieves nausea&vomiting and dry mouth if not
contraindicated.
-Not to scratch rashes.
-To eat foods which are nutritious.
NURSING
CARE
PLANS
NURSING CARE PLAN
Name of Patient: Mr. C.
Attending Physician: Dr. Bandolon
Impression/Diagnosis: Acut Enteritis
DATE
&
TIME
CUES
NEED
Age: 62 years old
Sex: Male
NURSING
DIAGNOSIS
NURSING PLAN
NURSING INTERVENTION
EVALUATION
S
E
P
T
E
M
B
E
R
0
3,
2
0
0
9
@
3
11
SHIFT

Subjective:
“Dili jud ko
ganahan maggawas2x dahil
ani akoang
colostomy bag”
Objectives:
>Colostomy
attached @ right
lower quadrant
abomen.
>draining with
brownish watery
stool
P
H
Y
S
I
O
L
O
G
I
C
Disturbed body
image related to
presence of
colostomy bag as
evidenced by refusal
to participate in
care.
Definition:
21. Confusion in
mental picture
of one’s
physical self.
> IVF of PLR
1L regulated
@ 160 cc/hr @
right median
brachial vein
N
E
E
D
Source:
Nurse’s Pocket
Guide Diagnoses,
Prioritized
Interventions, and
Rationales 10th
Edition by Doenges,
Moorhouse, and Murr
After 8 hours span of
care the patient will be
able to:
> Verbalize acceptance
of self in situation,
incorporating change
into self-concept
without negating selfesteem.
> Demonstrate
beginning acceptance
by viewing/touching
stoma and participating
in self-care.
Established rapport
with the client
® to gain trust and
cooperation with the patient
 Monitored VS
® to have a baseline data in
assessing the patient
 Encouraged the
patient to verbalize
feelings about stoma.
Offer to be present
when the stoma is
first viewed and
touched.
® A free expression of
feelings allows the patient
the opportunity to verbalize
and identify concerns.
 Ascertained whether
support and
counselling were
initiated when the
possibility/or
necessity of
colostomy was first
discussed.
® provides information
about client’s level of
knowledge and anxiety about
individual situation.
 Encouraged client to
verbalize feelings
regarding the
September 03,
2009
@ 11 pm
“ GOAL
PARTIALLY
MET”
After 8 hours span
of care the patient
was able to:
> Verbalized
feelings about
stoma/illness;
begin to deal
constructively
with situation as
evidenced by
patient's
verbalization of
“okay na sa akoa
ning colostomy
bag kay kabalo
ko para man pud
ni sa akoang
kalusugan.
Masanay lang ko
ani.”
colostomy.
® helps client realize that
feelings are not unusual and
that feeling guilty about them
is not helpful.
 Review reason for
surgery and future
expectations.
® client may find it easier to
deal with an colostomy done
to correct chronic or long
term disease than for
traumatic injury even if
colostomy is only temporary.
 Note behaviours of
withdrawal, increased
dependency,
manipulation, or noninvolvement in care.
® Suggestive of problems in
adjustment that may require
further evaluation and more
extensive therapy.
 Provide opportunity
for client to deal with
ostomy through
participation in self
care.
®Independence in self care
helps improve self
confidence and acceptance of
situation.
 Plan care activities
with client.
® to promote sense of
control and gives message
that client can handle
situation, enhancing self
concept.
 Maintain positive
approach during care
activities, avoiding
expressions of
revulsion.
® to assist client to accept
body changes and feel all
right about self.
 Ascertain client’s
desire to visit with a
person with an
ostomy. Make
arrangements for visit
if desired.
® to help reinforce teaching
and facilitates acceptance of
changes.
DATE
&
TIME
CUES
NEED
Subjective:
“Sakit dri dapita
oh!(patient
pointing to the IV
insertion site)”
P
H
Y
S
I
O
L
O
G
I
C
NURSING
DIAGNOSIS
I
S
E
P
T
E
M
B
E
R
Objectives:
VS of:
0
3,
2
0
0
9
@
3
11
Temp=36.8
BP=110/80
RR=22
PR=68
CR=69
Restlessness
noted
Pain scale
of 7
from 010
range.
Acute pain related
to infiltration of the
IV site as evidenced
by
guarding
behavior.
® The patient
claimed that his
IVsite began to
swell and redness
occur surrounding
the site.
Source:
Nurse’s Pocket
Guide Diagnoses,
Prioritized
Interventions, and
Rationales 10th
NURSING PLAN
NURSING INTERVENTION
Assess area for signs of
After 8 hours span of
inflammation (e.g.
care the patient will be
Redness, swelling,
able to:
etc.)
> Verbalize reduce pain
Assess the pain scale of
sensation
the patient
> Demonstrate a
®Aids in anticipating/
relaxation behaviour
planning for meeting
individual needs.
Maintain a supportive
firm attitude.
®Client need empathy to
know caregivers will be
consistent in their assistance.
Stress the importance of
proper hygiene.
®to reduce harbouring of
microorganisms.
Assist and encourage
good grooming.
®Enables the client to look
good.
Encourage significant
others to do as much
as possible for self.
®re-establishes the sense of
EVALUATION
September 03,
2009
@ 11:00 pm
Goal Met!
After 8 hours span
of care the patient
was able to:
The patient
verbalized
reduce pain
sensation with a
pain scale of 2
from 0-10 range.
He also
demonstrated a
relaxation
behaviour as
such deep
breathing
exercise and
divertional
activities.
SHIFT
Edition by Doenges,
Moorhouse, and Murr
Pg. 246-247
Grimaced
face
noted
independence and foster self
worth and enhances
rehabilitation process.
Perform warm compress
on IV site.
® Provide comfort.
● Terminate the IV line
If it is not patent
anymore then reinsert
if it still needed.
®To provide relief and
prepare for any medications
to be given via IVTT.
● Inform the
physician so that
medications or
other medical
interventions may
be provided.
®to make the physician
aware as well as for
prescription of medications
for further relief.
Redness and
swelling
noted on
the IV
site.
DATE &
TIME
CUES
NEE
D
NURSING DIAGNOSIS
NURSING PLAN
NURSING INTERVENTION
S
E
P
T
E
M
B
E
R
0
3
@
3
11
SHIFT
Objectives:
XVI. With good Skin
turgor
XVII. Capillary refill
time of less than 2
seconds.
XVIII. Intake= 750cc
XIX. Output=1020cc
XX. Laboratory
results:
HCT: 0.48 (M:
0.40-0.60; F: 0.380.4)
XXI. With colostomy
draining brownish
watery stool.
XXII. Weight of
XXIII. IVF of PLR 1L
regulated @ 160
cc/hr infusing
well @ right
median brachial
vein
VS of:
Temp=36.8
BP=110/80
RR=22
PR=68
CR=69
P
H
Y
S
I
O
L
O
G
I
C
Risk for deficient fluid
volume related to
altered absorption of
fluid secondary to
disease process.
Definition:
At risk for experiencing
vascular, cellular, or
intracellular
dehydration.
N
E
E
D
Source:
Nurse’s Pocket Guide
Diagnoses, Prioritized
Interventions, and
Rationales 10th Edition
by Doenges,
Moorhouse, and Murr
Independent:
 Established rapport with the client
After 8 hours
® to gain trust and cooperation with the patient
span of care the
 Monitored VS
patient will be
® to have a baseline data in assessing the patient
able to:
 Monitored intake and output carefully, measure
Maintain adequate
liquid stool.
hydration as
® to provide direct indicators of fluid balance.
evidenced by
 Weigh regularly.
moist mucous ® a gain/ loss of 1L of fluid is reflected in a body weight
membrane,
change of 2.2 lb.
good skin
 Evaluates skin turgor, capillary refill, and mucous
turgor and
membranes.
capillary refill, ® to reflect hydration status/ possible need for increased
stable vital
fluid replacement.
signs, and
 Limit intake of ice chips during period of gastric
individually
inubation.
appropriate
® Ice chips can stimulate gastric secretions and wash out
urinary output.
electrolytes..
Demonstrate
 Monitored laboratory results (Hct and electrolytes).
behaviours or
® to detect homeostasis or imbalance, and aids in
lifestyle
determining replacement needs.
changes to
 Administered IV fluid and electrolytes as
prevent
indicated.
development
® may be necessary to maintain adequate tissue
of fluid
volume deficit perfusion/organ function.
Identify
individual risk
factors and
appropriate
interventions.
DATE
&
TIME
CUES
NEE
D
NURSING
DIAGNOSIS
NURSING PLAN
NURSING INTERVENTION
S
E
P
T
E
M
B
E
R
Objectives:
XXIV. Restlessn
ess
XXV. Anorexia
noted
XXVI. Laborator
y results:
HCT: 0.48
(M: 0.400
0.60; F: 0.383
0.4)
Blood chemistry:
2
NA- 127.1 ( 1350
148mmol/L)
0
K- 3.56 ( 3,5-5.3
9
mmol/L)
CA- 1.03 ( 1.13@
1.32 mmol/L )
>Chemical
3
Examination:
Glucose:
11
negative
SHIFT Albumin: trace
Reaction: 6.0
Specific Gravity:
1.020
VS of:
Temp=36.8
BP=110/80
P
H
Y
S
I
O
L
O
G
I
C
N
E
E
D
Risk for
imbalanced
nutrition: less than
body requirements
related to altered
absorption of
nutrients as
evidenced by
diarrhea.
After 8 hours span of
care the patient will be
able to:
>Maintain normal
hydration status.
Obtain a thorough nutritional assessment.
® to identify defencies/ needs to aid in choice
of interventions.
Auscultate bowel sounds.
® return of intestinal function indicates
readiness to resume oral intake.
Resume solid foods slowly.
® reduces incidence of abdominal cramps,
nausea.
Definition:

Intake of
nutrients
insufficient to
meet
metabolic
needs.
Source:
Nurse’s Pocket
Guide Diagnoses,
Prioritized
Interventions, and
Rationales 10th
Edition by Doenges,
Moorhouse, and
Murr
Identify odor-causing foods and temporarily
restrict from diet. Gradually reintroduce
one food at a time.
® sensitivity to certain foods is not uncommon
following intestinal surgery. Client can
experiment with food several times before
determining whether it is creating a problem.
Recommend client increase use of yogurt,
buttermilk, and acidophilus preparations.
® may help prevent gas and decrease odor
formation.
Suggest client with colostomy limit prunes,
dates, stewed apricots, strawberries, grapes,
bananas, cabbage family, beans, and avoid
foods high in cellulose.
® Digestion of cellulose requires colonic
bacteria that are no longer present.
Discuss mechanics of swallowed air as a factor
RR=22
PR=68
CR=69
in the formation of flatus and some ways
client can exercise control.
® drinking through a straw, snoring, anxiety,
smoking, ill-fitting dentures, and gulping down
food increase the production of flatus. Too
much flatus not only necessitates frequent
emptying, but also can cause leakage from too
much pressure within the pouch.
Consult with dietician.
® helpful in assessing client’s nutritional needs
in light of changes in digestion and intestinal
function, including absorption of vitamins and
minerals.
Advance diet from liquids to low residue food
when oral intake is resumed.
® low residue diet may be maintained during
first 6-8 weeks to provide adequate time for
intestinal healing.
Administer enteral/parenteral feedings when
indicated.
® in the presence of severe debilitation/
intolerance of oral intake, parenteral or enteral
feedings may be given to supply needed
components for healing and prevention of
catabolic state.
● Hyrdration rounds rendered by ROD.
®TO assess patient' hydration status and
provide necessary interventions.
DATE
&
TIME
CUES
NEED
NURSING
DIAGNOSIS
NURSING PLAN
NURSING
INTERVENTION
EVALUATION
S
E
P
T
E
M
B
E
R
0
3
2
0
0
9
@
3
11
SHIFT
Subjective: ( - )
Objectives:
With
colostomy
on ® lower
quadrant
abdomen.
S/P Colectomy
on year
Laboratory
results:
>CBC result:
-Hgb=154 g/L
(High)
Monocytes=0.0
9 (High)
>Chemical
Examination:
Glucose:
negative
Albumin: trace
Reaction: 6.0
Specific
Gravity: 1.020
VS of:
Temp=36.8
P
H
Y
S
I
O
L
O
G
I
C
N
E
E
D
Impaired tissue
integrity related to
S/P colectomy as
evidenced by
disruption of skin:
presence of incision
and sutures, drains.

After 8 hours span of
care the patient will be
able to:


Definition:
XXVIII.
Damag
e to mucous
membrane, corneal,
integumentary, or
subcutaneous
tissue.
Source:
Nurse’s Pocket
Guide Diagnoses,
Prioritized
Interventions, and
Rationales 10th
Edition by Doenges,
Moorhouse, and Murr
Maintain
hoemostasis
Verbalize
learnings on how
to prevent
complications.
Established
rapport with the
client
® to gain trust and
cooperation with the
patient


Observe wounds,
note characteristic
of drainage.
® postoperative
hemorrhage is
most likely to
occur during first
48 hours
Encouraged side
lying position with
head elevated.
Avoid prolonged
siiting.
® to promote drainage
from perineal wound/
drains, reducing risk of
pooling. Prolonged
siiting increase perineal
pressure, reducing
circulation to wound,
and may delay healing.

Note poor
hygiene/ health
practices.
® may cause impacting
September 05, 2009
@ 11:00 pm
“ GOAL
PARTIALLY MET”
After 8 hours span
of care, the patient:


Maintained
homeostasi
s.
Verbalized
learnings
on how to
prevent
complicati
ons.
BP=110/80
RR=22
PR=68
CR=69
XXVII.IVF of
PLR 1L
regulated
@ 160
cc/hr
infusing
well @
right
median
brachial
vein
tissue health.

Inspect wound
daily, or as
appropriate, for
changes..
® To promote timely
intervention/ revision of
plan of care.

Encouraged
adequate periods
of rest and sleep
® to limit metabolic
demands, maximize
energy available for
healing, and meet
comfort needs.

Encouraged
position changes,
active/ passive and
assistive
excersises.
® to promote circulation
and prevent excessive
tissue pressure.

Emphasize need
for adequate
nutrition/ fluid
intake.
®to optimize healing
potential.
 Render health
teachings:
-Teach patient
and/or significant
others on how to
perform
colostomy care.
-To practice
hygienic measures
at all times.
-watch out or
observe for any
signs of infection
such as redness,
swelling, pain,
pallor, pus. Etc.
and report it
immediately.
® to prevent gowth of
pathogens.
 Change dressings
as needed.
®large amounts of
serous drainage require
that dressings be
changed frequently to
reduce skin irritation
and potential
forinfection.
 Irrigate wound as
indicated, using
normal saline,
diluted hydrogen
peroxide, or
antibiotic solution.
● ® may be
required
to treat
infection
contamina
tion.
DISCHARGE PLANNING
Medication
Instruct the patient about the importance of taking the medication regularly and in complying
with the treatment regimen
® complying with the treatment regimen as prescribed will help prevent further
complication
Discuss with the significant others and to the client regarding the names of drugs, its dosage,
time of administration, its possible side effects and right way of taking it.
® Awareness of the medication would encourage patient to comply means for faster
recovery
Instruct patient and significant other to verify the medicine label and compare it to the
prescription sheet before taking it.
® To ensure safety in taking the drugs.
Do not administer any drugs that are not prescribed by the physician. Do not intent to self
medicate.
® Drugs taken with other drugs may have an antagonist or synergistic effect which may
aggravate patient’s present condition
It is important that the patient should follow and complete the whole course of the drug therapy.
® To alleviate the status of the patient leading to faster recovery.
Tell the patient and the significant other to report any untoward signs and symptoms for the side
effects of the drugs being taken
® To reduce further complications and prompt interventions may be given.
Exercise
Encourage patient to have a good exercise such as passive ROM according to his capacity
® To improve physical fitness, improve emotional state and weight control as it promote
a good circulation
Encourage to have a deep breathing exercise.
® To promote relaxation and prevent pulmonary congestion.
Massage and exercise areas especially on the ankle, elbow and knees and on joints at least on
once daily.
® This prevents muscle stiffening and rigidity.
Encourage patient to sit up and ambulate according to his capacity.
® To minimize pressure sores and promotes tissue perfusion.
Advice patient to have adequate rest and sleep.
® For him faster recovery and to restore enough energy.
Advice patient to avoid strenuous activity.
® Strenuous activity can cause fatigue.
Treatment
22. Explain to the family about the present condition and the factual informations about the
said disease.
® To give a better information and education about the patient’s underlying condition
23. Encourage significant others to support the patient’s treatment regimen.
® To convey moral support and allay anxiety
24. Maintain a relaxing environment.
® This helps the patient to be relaxed and stress-free
Hygiene

Encourage patient to take a bath everyday.
® Knowing its importance and proper interventions adds encouragement and prevents
infection

Instruct that it is essential to have a good and clean environment.
® To prevent infections and possible disease and promoting comfort.

Advice to maintain a good oral hygiene.
® To prevent gum diseases.

Advice to maintain a good oral hygiene.
® To prevent transmission of pathogen, thus lessen the possibility of infections.

Educate to have frequent skin care and avoid use of irritating soaps.
® Prevents dryness of the skin and removes its wastes products.
Diet

Advice patient to increase oral fluid intake.
® This is important for circulation and elimination.

Encourage patient to eat nutritious foods according to him plan to maintain him normal
body weight and to stay healthy.
® To achieve and maintain nutritional status.

Encourage to increase high caloric intake and regulate protein intake.
® To promote tissue repair and have good nutritional status.

Encourage to include favorite foods in diet.
® Patient may have low interest to eat, thus needs to achieve satiety level.
Outpatient referrals

Encourage patient and significant for follow-up check-ups regularly.
® To monitor the underlying condition of the patient.

Instruct the client to make an appointment with their surgeon for 7 to 10 days after the
discharge.
® To monitor the underlying condition of the patient.

Instruct the patient to follow the prescribed medications at home and take it religiously at
the right time, dosage, and route of administration
® To achieve an effective treatment and avoid further complications of the disease.

Tell the patient to report any abnormalities or unusualties observed after taking the
medications
® To avoid any serious adverse reactions and to give prompt intervention.
5) Instruct the client to call him surgeon if she develops nausea, vomiting or
abdominal pain.
® To give prompt intervention.RECOMMENDATION
RECOMMENDATIONS:
As nurses, our vital role is to provide health care and deliver services in the hospital to
improve the health status of each individual. This nursing case study is important for us because
it enables us to give the proper health teaching to our chosen client.
We recommend this case to the following persons and institution for the further
improvement of the study.
To the Family:
We recommend this study for the family of our patient to follow the treatment prescribed
such as: to take the medications as on time and right dosage and other recommended measures
by the physician, encourage having adequate rest to hasten the recovery of the patient. Through
the adherence and fulfillment of the suitable medical management, this will speed the client’s
improvement.
To the Students:
We recommend this study for the students as a reference to the next generation in order
for them to have knowledge and deeper understanding of the said topic.
To the School
We recommend this study to our school for giving us a precise details and an access of
further study of this case. We advocate also for giving us an abundance time to research in order
to prevent typographical and grammatical errors.
BILBLIOGRAPHY
Books:
Doenges, Moorhouse, Geissler-Murr. Nursing Care Plans: Guidelines for Individualizing
Care. 6th ed. F.A. Davis Company. Philadelphia.2002.
Suzzane C. Smeltzer, Brenda Bare. Brunner and Suddarth’s TEXTBOOK OF medical-Surgical
Nursing. Lippincott Williams and Wilkins. Philippines. 2004
Doenges, Marilyn, Mary Frances Moorhouse, and Alice Murr. Nurse’s Pocket Guide 11th
edition. F.A. Davis Company
Nowak, Thomas. A. Gordon Handford. Pathophysiology, Concepts and Application for Health
Care Professionals. Third Edition. McGraw-Hill Companies, Inc. 1221 Avenue of the
Americas, New York. 2005
Carol Mattson Porth. Pathophysiology, Concepts of Altere Health States. Sixth Edition.
Lippincott Williams & Wilkins
Potter and Perry. Fundamentals of Nursing, 5th ed. Mosby. St. Louis. 2001.
Amy M. Karch. 2007 Lippincott’s Nursing Drug Guide. Lippincott Williams & Wilkins
Barbara B. Hodgson and Robert J. Kizior. Saunders Nursing Drug Handbook 2003
George R. Spratto and Adrienne L. Woods. PDR Nurses Drug Handbook. 2008 Edition.
Thomson Delmar Learning, Inc.
Judith Hopfer Deglin and April Hazard Vallerand. Davis’s Drug Guide for Nurses.10th Edition.
F.A. Davis Company 2007
Davis’s Drug Guide for nurses 9th edition; copyright 2005 F.A Davis company by Deglin and
Vallerand
Internet:
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http://en.wikipedia.org/wiki/Live
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http://www.intestinedoctor.com/Image/detox_pathways.jpg
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www.emedicine.com
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http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/enteritis.htm
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http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=enteritis&co
ntent_id=274
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http://www.medicinenet.com/enteritis/page7.htm
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http://emedicine.medscape.com/article/277496-overview
http://www.medscape.com/viewarticle/406725_2
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http://www.epidna.com/showabstract.php?pmid=18043553&redirect=yes&terms=enteriti
s+pathophysiology
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http://www.mayoclinic.com/health/enteritis/DS00035/DSECTION=risk-factors
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http://www.find-health-articles.com/rec_pub_18043553-from-enteritis-pathophysiologyclinical.htm