lOMoARcPSD|16753777
AGE-case-presentation
Bachelor of Science in Nursing (Cebu Normal University)
Studocu is not sponsored or endorsed by any college or university
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
A Case Presentation ON
Acute Gastroenteritis
With Moderate
Dehydration
Presented by:
Cero, Paola Mariz P. BSN-II
Escoro, Rejina S. BSN-II
Maceda, Danica BSN-II
Monter, Crispin III BSN-II
Presented to:
Mrs. Roselle Joy C. Balaquit, RN
Supervising Clinical Instructor
Introduction:
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Gastroenteritis is a catch all term for infection or irritation of the
digestive tract, particularly the stomach and intestine. It is frequently
referred to as the stomach or intestinal flu, although the influenza virus is
not associated with this illness.
Major
symptoms
and abdominal
cramps.
include
These
nausea
andvomiting,
symptoms
are
diarrhea,
sometimes
also
accompanied by fever and overall weakness. Gastroenteritis typically lasts
about three days. Adults usually recover without problem, but children, the
elderly, and anyone with an underlying disease are more vulnerable to
complications such as dehydration.
Gastroenteritis arises from ingestion of viruses, certain bacteria, or
parasites. Food that has spoiled may also cause illness. Certain medications
and excessive alcohol can irritate thedigestive tract to the point of inducing
gastroenteritis. Regardless of the cause, the symptomsof gastroenteritis
include
diarrhea,
nausea
and
vomiting,
and abdominal painand
cramps.Sufferers may also experience bloating, low fever, and overall
tiredness. Typically, thesymptoms last only two to three days, but some
viruses may last up to a week.
A usual bout of gastroenteritis shouldn't require a visit to the doctor.
However, medicaltreatment is essential if symptoms worsen or if there are
complications.
Infants,
young
children,
the
elderly,
and
persons
with underlying disease require special attention in thisregard.The greatest
danger presented by gastroenteritis is dehydration. The loss of fluids
throughdiarrhea and vomiting can upset the body's electrolyte balance,
leading
to
potentially
beat abnormalities
symptoms
are
life-threatening
(arrhythmia).
prolonged.
The
problems
risk of
Dehydration
such
dehydration
should
be
as
heart
increases
suspected
as
if adry
mouth,increased or excessive thirst, or scanty urination is experienced. If
symptoms do not resolve within a week, an infection or disorder more
serious thangastroenteritis may be involved. Symptoms of great concern
include a high fever 38.0 °C or above, blood or mucus in the diarrhea, blood
in the vomit, and severe abdominal pain or swelling. These symptoms
require prompt medical attention.Gastroenteritis is a self-limiting illness
which will resolve by itself.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Epidemiology:
Although often considered a benign disease, acute gastroenteritis
remains a major cause of morbidity and mortality in children around the
world, accounting for 1.34 million deaths annually in children younger than 5
years, or roughly 15% of all child deaths. As the disease severity depends on
the degree of fluid loss, accurately assessing dehydration status remains a
crucial step in preventing mortality. Luckily, most cases of dehydration in
children can be accurately diagnosed by a careful clinical examination and
treated
with
simple,
cost-effective
measures.
Although
dehydration
technically refers to pure water loss and can be associated with euvolemic or
even hypervolemic states in certain pediatric disorders, the term is used
throughout this article in its more general sense to mean overall fluid or
volume loss due to diarrhea.
Worldwide, children younger than 5 years have an estimated 1.7 billion
episodes of diarrhea each year, leading to 124 million clinic visits, 9 million
hospitalizations, and
1.34 million deaths, with more than 98% of these deaths occurring in the
developing world.
Although the prevalence of acute gastroenteritis in children has
changed little over the past 4 decades, mortality has declined sharply, from
4.6 million in the 1970s to 3 million in the 1980s and 2.5 million in the
1990s. One of the most important reasons for this decline has been the
increasing international support for the use of oral rehydration solution (ORS)
as the treatment of choice for acute diarrhea, with the proportion of diarrheal
episodes treated with ORS rising from 15% in 1984 to 40% in 1993.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
General Objectives:
This study aims to convey familiarity and to provide an effective nursing care to a
patient diagnosed with Acute Gastroenteritis through understanding the patient history,
disease process and management.
Specific Objectives:
After 2 hours of case presentation the Group 1 of BSN -2 will be able to:
 To present a thorough assessment through Nursing Health History,
Gordon’s Functional Pattern, Physical Assessment, and the interpretation
of the laboratory examination done on the patient.
 To discuss the anatomy and physiology, pathophysiology of the
patient’s condition, usual clinical manifestations and possible
complicationsof this condition.
 To have knowledge to the client medication and be familiar to that
medication.
 To formulate a workable nursing care plan on the subjective and
objective cues gathered through nurse-patient interaction to be able
tohelp the patient recover.
Nursing Health History
I.
DEMOGRAPHIC PROFILE:
Name: S. D. T.
Address: Combado, Maasin City, Southern Leyte
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Age: 5 years old
Gender: Male
Marital Status: N/A
Occupation: N/A
Religious Orientation: Roman Catholic
Health Care Financing: Philhealth (Voluntary contribution)
Informant: D.D (Patient’s Mother)
Date of Admission: March 3, 2019 ; 5:30pm
Attending Physician:Shiela Marie D. Patano, MD
B. Chief Complaint:
Vomiting with stomach pain
C. History of Present Illness:
The morning prior to admission, Pt. S. D. T. complained of mild stomach
ache and was vomiting thrice since dawn. Pt’s mother stated that they just
observed it for a while but on the afternoon same day, Pt. vomits again twice
this time and so they decided to bring him to the hospital.
D. Past History
According to the informant, Pt. had been hospitalized here at SOYMPH
for the same symptoms of vomiting and stomach ache 3 years ago. He was
admitted for 4 days and recovered from the said illness. He had completed
all his vaccines when he was still a baby. Common illnesses that afflicted the
pt. were fever, cough & colds. He does not have any known allergy in foods
and drugs.
E. Family History of Illness
Pt’s father has asthma and both of his grandparents (father side) have
diabetes mellitus and hypertension. Aside from those mentioned, there was
no other heredo-familial disease present in the family.
GENOGRAM
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Legend:
(Grandparents)
(Mother)
(Father)
(Aunt)
DMalive and well
(Uncle)
diabetes mellitus
(Patient)
HPN-hypertension
A&W-
Paternal
Maternal
75 DM HPN
67, A&W
78, DM, HPN
38, A&W
36, A&W
34, A&W
39, A&W
68,A&W
35, A&W
Pt. S.D.T
F. Physical Assessment (Cephalocaudal Assessment)

Vital Signs:
T- 36.3⁰C, HR-117 bpm, RR- 19cpm

General Survey:
Received sitting on bedside chair, eating with ongoing IVF #3 D 5 .
3 NaCl @ 55µgtts/min; infusing well @ ® arm. No vomiting claimed,
with good appetite and no other physical discomforts claimed.

Head:
Downloaded by Kceey Cruz (ckceey@gmail.com)
32, A&W
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Skull is round in shape, symmetrical (normocephalic). Facial
movement is symmetrical. Hair is evenly distributed in the scalp, black
in color. Scalp is clear from dandruff and lice.No scars and wounds
noted.

Skin:
Pt. has dark-brown complexion and uniform in color, moist, intact
and has no lesions, edema or abrasions noted. Has good skin turgor.
The tissue surrounding the nails are intact and when blanched test
performed, color of the nail returns to pink in less than 2 seconds.

Eyes:
Eyebrows hair is evenly distributed, the pt’s eyebrows are
symmetrically aligned and showed equal movement when asked to
raise lower eyebrows. Eyelashes appeared to be equally distributed.
The bulbar conjunctiva appeared transparent with few capillaries
evident. The sclera is white. Cornea is transparent and smooth. The
pupils are black and equal in size, pupils equally round and responds to
light accommodation. No unusual discharges from the lacrimal ducts
noted upon palpation.

Ears:
The auricles are symmetrical and has the same color with his
facial skin. The auricles are aligned with the outer canthus of eyes.
When palpating for texture, auricles are movable and not tender. The
pinna recoils when folded.

Nose:
Nose has uniform color and symmetrical in shape. Nasal hairs are
very evident when light is flushed through the nasal passageway; its
color is black. No nasal flaring is observed upon respiration. Nasal
septum is straight and in midline. Nasal mucosa is pinkish in color, has
no lesions and discharges and lesions noted. Pt. was able to sniff easily
on both nostrils.

Mouth:
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Pt’s lips are uniformly pink; slightly dry, symmetrical and have a
smooth texture. Pt’s gums are pinkish in color. The buccal mucosa
appeared uniformly pink, moist, soft, glistening and with elastic
texture. The tongue is at midline, moist and pinkish in color. The
smooth palate is light pink and smooth while hard palate has a more
irregular texture. Uvula is positioned at midline of the soft palate.

Neck:
Neck muscles are symmetrical upon inspection. Skin on the neck
is intact with good integrity. Neck lymph nodes are not swollen upon
palpation. Trachea is at the center and immovable upon palpation. No
masses and lesions noted.

Pharynx:
Uvula is found well placed at midline of soft palate. Mucosa is
pinkish in color. Tonsils are not inflamed. There is positive gag reflex.

Chest and Lungs:
Pt’s chest wall is intact with no tenderness and masses noted.
Breathing pattern is regular with respiratory rate of 19 cycles per
minute. No retractions and using of accessory muscles is noted during
respiration.

Breasts and Axillae:
No pain noted as verbalized by the patient. No abnormal masses
detected. No abnormal enlargement of breasts noted. Breasts are
symmetrically positioned.
No tenderness, lesions and discolorations noted in the axillae.

Heart:
Heart sounds are regular with heart rate of 117 beats per
minute. No arrhythmia noted upon auscultation. No heart murmur
heard.

Abdomen:
Pt’s color of the abdomen is same with the rest of his body.
Umbilicus midline inverted. Abdomen has globular in shape and
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
dullness was noted upon percussion. No tenderness noted during the
assessment period.

Back and Extremities:
Pt’s back has no deformities, the backbones aligns centrally. Legs
and toes color is brown with no sign of edema. No redness and swelling
noted in the lower extremities. No lesions noted on both upper and
lower extremities. Both finger and toe nails are complete but are not
well-trimmed and dirty. No feet sores observed.

Genito-Urinary:
Pt. was able to urinate comfortably without discomfort. Pt.
usually urinate 4 times or more daily as verbalized. The urine color is
yellow.
GORDON’S FUNCTIONAL HEALTH PATTERNS
A. Health Perception
Before Hospitalization:
According to his mother, Pt. S.D.T has a mannerism of sticking
anything on his mouth. He still does that mannerism of him even
upto now. He doesn’t practice hand washing every now and then
but her mother always reminding him of washing his hands before
and after meal.
During Hospitalization:
There were still times that Pt. stick his fingers unto his mouth. He
still doesn’t fully understand the concept of health perception
because of his young age.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
B. Nutritional Metabolic Pattern
Before Hospitalization:
The client eats four times a day including breakfast, lunch,
merienda and dinner. According to his mother, he is a picky eater.
He prefers processed foods like hotdogs and ham instead of fruits
and vegetables. He also like to drink powdered milk and can
consume 4 glasses it in a day.
During Hospitalization:
Pt. seldom eats at the hospital. He does not have the appetite for
eating. He also seldom drinks water or other fluids.
C. Elimination Pattern
Before Hospitalization:
Pt. defecates once or twice every day and his stool is soft but
formed and its color is brown and usually has a foul odor. He
urinates four times or more in a day and is yellowish in color. He has
no discomfort in defecating and urinating.
During Hospitalization:
The Pt’s urine output is decreased since he doesn’t like to drink
water or other fluids. He urinates twice or thrice only in the hospital.
He also seldom defecate during his stay at the hospital. He also
perspires but it’s due to the hot environment not from any activity
since he just stays on bed. No reports of vomiting claimed during his
recent hospitalization.
D. Activity- Exercise Pattern
Before Hospitalization:
Especially during the weekend, Pt. used to play outside with his
cousins. They usually play toy cars and the usual games of his age.
He stops playing when he feels tired.
During Hospitalization:
Pt. used his time playing the cell phone of his mother. Most of his
time was spent for resting and sleeping.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
E. Sleep-Rest Pattern
Before Hospitalization:
Pt. usually sleeps at 8-9 p.m. in the evening and usually gets up
7 – 8 a.m. in the morning. After playing or eating he takes a nap but
only seldom because he’s addcited in playing his mother’s
cellphone. He has straight undisturbed sleep at night.
During Hospitalization:
Pt. sleeps early but has sleep disturbances when the nurses take
his vital signs, administer medicines and also due to the
environment.
F. Cognitive-Perceptual Pattern
Before Hospitalization:
Pt. is normal in terms of his cognitive abilities. He has no problems
with his senses. His mother even shared to us that he is already
capable of writing his name and is capable of reading the alphabet
and numbers.
During Hospitalization:
At first, Pt is shy and does not maintain eye contact but as we
get along he relates to us actively. He responded to our questions
enthusiastically. He also related to us some of his school activities.
G. Role-Relationship Pattern
Before Hospitalization:
The patient has a close relationship with his family, but he is
closer to his mother. He is the only son but he treats his cousins as
his brothers and sisters. His mother stated that even though he is
stubborn at times but that is due to his young age. He is also sweet
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
to his parents like giving them kisses and saying “I love you” before
sleeping.
During Hospitalization:
There were no changes on Pt’s closeness towards his family
during his confinement. In fact, his mother stated that he is more
obedient to what she says to him because he wanted to get well
immediately.
H. Coping-Stress Pattern
Before Hospitalization:
According to his mother, when Pt. has problems he always
approach his parents. She even added that when he gets scolded,
he just stays in his room. When he is bullied or when his cousins get
his toys, he does not quarrel with them but instead he reports it to
his parents.
During Hospitalization:
Pt. feels unsafe with people when his mother is not with him. He
cries without the sight of his mother. He is very dependable on his
mother.
I. Sexually-Reproductive Pattern
Prior to admission, Pt. is not yet oriented with any sexual matters
because of his young age.
J. Values-Beliefs Pattern
Before Hospitalization:
Pt. is a Roman Catholic. They attend the mass regularly. His
mother stated that he is afraid to do something bad because he
believes that God will punish him. According to his mother, they
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
consulted a “quack doctor” first if they are sick but when it comes
to their son, they go immediately to a professional doctor.
During Hospitalization:
Pt. together with his mother prayed to the Lord asking for his fast
recovery during his hospitalization.
II. DEVELOPMENTAL TASK

ERICK ERICKSON’S PSYCHOSOCIAL DEVELOPMENT
STAGE
BASIC
ACTUAL
Patient is still in Pre
Industry vs.
Inferiority
Children are at the
stage where they will
(5-12 years old)
be learning to read and
write, to do sums, to do
things on their own.
Teachers begin to take
an important role in the
child’s life as they teach
the child specific skills.
It is at this stage that
the child’s peer group
will gain greater
significance and will
become a major source
of the child’s selfesteem. The child now
feels the need to win
approval by
demonstrating specific
competencies that are
valued by society and
Downloaded by Kceey Cruz (ckceey@gmail.com)
School level. He knows
how to read, write, and
count numbers without
help from his mother.
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
begin to develop a
sense of pride in their
accomplishments.

PIAGET’S STAGE OF COGNITIVE DEVELOPMENT
STAGE
ACTUAL
PREOPERATIONAL
BASIC
During this stage,
STAGE (2-7 years)
young children can
answers
think about things
correctly like how old is
symbolically. This is the
he, what is the color of
ability to make one
his short.
Patient
was
able
to
questions
thing - a word or an
object - stand for
something other than
itself.

FOWLER’s STAGE OF FAITH DEVELOPMENT
STAGE
Stage 1: (3 to 7 years)
BASIC
ACTUAL
Intuitive–Projective
Patient
stage in which children
Catholic
are
believes
beginning
to
be
able to use symbols and
they
their
church
imaginations.
a
Roman
and
in
he
God
seldom
and
but
go
to
attend
However children in this
mass. He always pray
stage
Angel
are
very
self-
of
God
before
focused and inclined to
going to bed because
take very literally (and
according to him his
self-referentially)
Angel will guard him.
ideas
about evil, the devil or
other negative aspects
of religion. The ability to
sort
out
fantasy
reality
is
not
from
well
developed.

is
FREUD’s PSYCHOSEXUAL DEVELOPMENT
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
STAGE
BASIC
PHALLIC STAGE (3-5 or The child becomes
aware of anatomical
6 years old)
sex differences, which
ACTUAL
Prior
to
patient
admission
is
not
yet
oriented about sexual
sets in motion the
matters.
conflict between erotic
attraction, resentment,
rivalry, jealousy and
fear which Freud called
the Oedipus
complex (in boys) and
the Electra
complex (in girls).
This is resolved through
the process of
identification, which
involves the child
adopting the
characteristics of the
same sex parent.

KOHLBERG’S MORAL DEVELOPMENT THEORY
STAGE
BASIC
At the pre-conventional
ACTUAL
LEVEL 1:
level (most nine-year-
Patient
PRECONVENTIONAL
olds and younger, some
understand
and
MORALITY (most nine-
over
respect
who
year-olds and younger,
have a personal code of
some over nine)
morality.
nine),
we
don’t
Instead,
our
moral code is shaped
by
the
standards
adults
and
consequences
following
or
of
the
of
breaking
their rules.
Downloaded by Kceey Cruz (ckceey@gmail.com)
is
able
people
to
are older than him.
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Authority is outside the
individual
and
reasoning is based on
the
physical
consequences
of
actions.
III.
DEFINITION
1. GASTROENTERITISIs an inflammation of the mucosa of the stomach and small intestines.
Clinical manifestations include nausea, vomiting, diarrhea, abdominal
cramping, and distention. Fever, leukocytes, and blood or mucus in the
stool may be present. Most case are self-limiting and do not require
hospitalization. However, older adults and chronically ill patients may be
unable to consume sufficient fluids orally to compensate for fluid loss.
Until vomiting has ceased, the patient should be on NPO status. if
dehydration has occurred, IV replacement of fluids may be necessary. As
soon as tolerated, fluids containing glucose and electrolytes (e.g.,
Pedialyte) should be given. If the causative agent is identified, appropriate
antibiotic, antimicrobial, anti-infective medication is given.
Source:- FIFTH EDITION,MEDICAL SURGICAL NURSING (Assessment and
Management of Clinical Problems) Lewis, Hettkemper, Dirksen Copyright @
2000 by Mosby, Inc.
2. GASTROENTERITISA
self-limiting
disorder,
gastroenteritis
(intestinal
flu,
traveler’s
diarrhea, viral enteritis,and food poisoning) is an inflammation of the
stomach and small intestines. The bowel reacts to any of the varied causes
of
gastroenteritis
with
hypermotility,
producing
secondary depletion of intracellular fluid.
Downloaded by Kceey Cruz (ckceey@gmail.com)
severe
diarrhea
and
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
A major cause of morbidity and mortality in under developed nations,
gastroenteritis occurs in persons of all ages. In the United States, this
disorder ranks second to the common cold as a cause of lost work time and
fifth as the cause of death among young children. It also can be life
threatening in elderly and debilitated persons.
Source: DISEASES Causes and complications.Assessment findings.Nursing
diagnosis and interventions.Current therapy
3. GASTROENTERITISIs an inflammatory process of the stomach or small intestines caused
by viruses, bacteria, parasites, or allergic reactions. It may also be caused by
the ingestion of contaminated food, especially food contaminated by
staphylococci, which produce a toxin that reacts with the small intestines
mucosa. Dysentery caused by bacteria affects the colon. The pathologic
process has varying manifestations that result in abdominal cramping,
diarrhea, and vomiting.
Source: FOCUS ON PATHOPHYSIOLOGY,Barbara L. Bullock, RN, MSN, Reet L.
Henze, DSN, RN
ETIOLOGY
PRECIPITATING
FACTORS
Contaminated food
and water
RATIONALE
ACTUAL
It can cause
gastroenteritis due
to the present of a
certain pathogen
Downloaded by Kceey Cruz (ckceey@gmail.com)
JUSTIFICATION
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
No proper hygiene
Poor sanitation
Poor dietary intake
PREDISPOSING
FACTORS
Age
Malnutrition
Lifestyle
that could damage
the GI tract.
Due to poor
hygiene, pathogens
can easily enters
the body and easily
cause a disease
Pathogen can be
acquired due to
poor sanitation of
environment.
Poor diet intake can
weakens the
immune system and
compromise health
RATIONALE
Infants and young
children are at risk
due to their
immature immune
system; the elderly
are at increased risk
due to weakened
immune system
Due to poor
nutrition children
are prone to
different diseases
Poor lifestyle may
lead to malnutrition
then lead to a
disease

During the
assessment
patient’s nail were
not trimmed and he
doesn’t practice
handwashing

Patient usually often
eats processed
foods and canned
goods
ACTUAL
JUSTIFICATION

The patient is young
who are risk and
prone to different
diseases.

Pt. has poor diet
intake and he
always play on his
cellphone and
doesn’t take a nap
ANATOMY AND PHYSIOLOGY
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Digestion is the process by which food is broken down into smaller pieces
so that the bodycan use them to build and nourish cells and to provide
energy. Digestion involves themixing of food, its movement through
the digestive tract (also known as thealimentarycanal), and the chemical
breakdown of larger molecules into smaller molecules. Every piece of food
we eat has to be broken down into smaller nutrients that the body
canabsorb,which is why it takes hours to fully digest food.
The digestive system is made up of the digestive tract. This consists of a
long tube of organs that runs from themouthto theanusand includes the
esophagus, stomach, smallintestine, and large intestine, together with
theliver , gall bladder , and pancreas, which produce important secretions for
digestion thatdraininto the small intestine. The digestivetract in an adult is
about 30 feet long.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Mouth and Salivary GlandsDigestion - begins in the mouth, where
chemical andmechanical digestion occurs. Saliva or spit, produced by the
salivary glands (located under thetongueand near the lower jaw), is released
into the mouth. Saliva begins to break downthe food, moistening it and
making it easier to swallow. A digestiveenzyme(calledamylase) in the saliva
begins to break down thecarbohydrates(starches and sugars). Oneof the
most important functions of the mouth is chewing. Chewing allows food to
bemashed into a soft mass that is easier to swallow and digest later.
Esophagus
-
Once
food
is
swallowed,
it
enters
the
esophagus,
amusculartube that is about10 inches long. The esophagus is located
between the throat and the stomach. Muscular wavelike contractions known
asperistalsispush the food down through the esophagus tothe stomach. A
muscular
ring
(called
thecardiacsphincter)
at
the
end
of
the
esophagusallows food to enter the stomach, and, then, it squeezes shut to
prevent food and fluid fromgoing back up the esophagus.
Stomach - a J-shapedorganthat lies between the esophagus and the small
intestine in the upper abdomen. The stomach has 3 main functions: to store
the swallowed food and liquid;to mix up the food, liquid, and digestive juices
produced by the stomach; and to slowlyempty its contents into the small
intestine.
Small Intestine - Most digestion and absorption of food occurs in the small
intestine. Thesmall intestine is a narrow, twisting tube that occupies most
of the lower abdomen betweenthe stomach and the beginning of the
large intestine. It extends about 20 feet in length. Thesmall intestine consists
of 3 parts: the duodenum (the C-shaped part), the jejunum (the coiled
midsection), and the ileum(the last section). The small intestine has 2
importantfunctions. First, the digestive process is completed here by
enzymes and other substancesmade by intestinal cells, the pancreas,
and the liver. Glands in the intestine walls secreteenzymes that breakdown
starches and sugars. The pancreas secretes enzymes into the smallintestine
that
help breakdown
carbohydrates,
fats,
and
proteins.
The
liver
produces bile,which is stored in the gallbladder. Bile helps to make fat
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
molecules (which otherwise arenot soluble in water) soluble, so they can be
absorbed by the body. Second, the smallintestine absorbs the nutrients from
the digestiveprocess. The inner wall of the smallintestine is covered by
millions of tiny fingerlike projections calledvilli.The villi arecovered with even
tinier projections called microvilli. The combination of villi andmicrovilli
increase the surface area of the small intestine greatly, allowing absorption
of nutrients to occur. Undigested material travels next to the large intestine.
Large intestine - forms an upside down U over the coiled small intestine. It
begins at thelower right-hand side of the body and ends on the lower lefthand side. The large intestineis about 5-6 feet long. It has 3 parts: thececum,
thecolon,and therectum. The cecum is a pouch at the beginning of the large
intestine. This area allows food to pass from the smallintestine to the large
intestine. The colon is where fluids and salts are absorbed and extendsfrom
the cecum to the rectum. The last part of the large intestine is the rectum,
which iswherefeces(waste material) is stored before leaving the body
through the anus. The main job of the large intestine is to remove water and
salts (electrolytes) from the undigestedmaterial and to form solid waste that
can
be
excreted.Bacteriain
the
large
intestine
help
to break
down
the undigested materials. The remaining contents of the large intestine
aremoved toward the rectum, where feces are stored until they leave the
body through the anus as a bowel movement.
SYMPTOMATOLOGY
SYMPTOMS
Nausea and
Vomiting
Abdominal pain
Fever
Loose and watery
Rationale
The stomach can’t
digest normally,
reflux may occur
Due to the
inflammation/irritatio
n in the GI tract
abdominal pain
occurs
One of the signs that
there is an infection
present
Due to the damage
Actual


Downloaded by Kceey Cruz (ckceey@gmail.com)
Justification
Patient complained
for vomiting
During the
assessment patient
complained mild
pain in his
abdomen
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
stool
of epithelial cell it
may results loose
and watery stool and
dehydration.
PATHOPHYSIOLOGY
PREDISPOSING FACTORS:
PRECIPITATING FACTORS:
-CONTAMINATED WATER AND FOOD
-AGE
-NOPROPER HYGIENE
-LIFESTYLE
-POOR SANITATION
-MALNUTRITION
- POOR DIETARY INTAKE
INGESTION OF CONTAMINATED
WATER AND FOOD
INVASION OF PATHOGEN IN THE
BOWEL WALL
S/S:
-NAUSEA
-VOMITING
-ABDOMINAL PAIN
DAMAGE IN EPITHELIAL CELLS
-PRECIPITATING
FACTORS
DIGESTIVE AND ABSORPTIVE
MALFUNCTION
- PREDISPOSING
FACTORS
- DISEASE PROCESS
BOWEL MUCOSAL ERODES
- SIGNS AND SYMPTOMS
Downloaded by Kceey Cruz (ckceey@gmail.com)
S/S
-BLOATED & ABDOMINAL
DISTENTION
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
COMPREHENSIVE DISCUSSION:
Gastroenteritis
is
an
inflammation
of
stomach
and
intestines.
Individuals with weak immune systems are more prone to these infections.
Some risk factors for developing the condition include drinking contaminated
water and eating contaminated food and being in an unclean or unhygienic
environment. As the child ingested contaminated food and water, pathogen
or microbes invades the bowel wall and try to destroy the epithelial cells of
the stomach which are responsible for the digestion and absorption. When
the epithelial cells are destroyed the digestion and absorption of foods or
nutrients
compromise
and
bowel
mucosa
continues
to
erode.
The
hydrochloric acid also helps to destroy the linings of the stomach which
causes irritation on GIT. As the pathogen stimulates the bowel the intestinal
tract secretes water and electrolytes which causes to increase of peristalsis
and number of defecation, thus, diarrhoea occurs. When diarrhoea goes
severe it promotes dehydration. When dehydration gets worst it may lead to
hypovolemic shock and unluckily leads to death
IV.
MANAGEMENT
Medical Management
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
 Oral rehydration therapy should be the initial because it is as effective
as intravenous therapy in rehydrating and replacing electrolytes in
children with mild to moderate dehydration.
 Let stomach settle. Stop eating solid foods for a few hours.
 Try sucking on ice chips or taking small sips of water.
 Avoid certain foods & substances until feels better. This includes dairy
products such as caffeine, alcohol, nicotine & fatty or highly seasoned
foods.
 Plenty of rest is recommended.
 Get back to a normal diet slowly. Gradually introduce bland, easy to
digest foods such as toast, rice, bananas & potatoes.
 Avoid sugary foods such as ice cream, sodas & candy. These can make
diarrhea worse.
 Handle food properly.
 Be up-to-date on immunizations, including flu & rotavirus vaccinations.
 Drink bottled water, and avoid raw and peeled fruit & vegetables.
 Avoid close contact and sharing personal items with others.
 Disinfect surfaces at home with ½ cup of bleach to 1 gallon of water.
Apply the solution to surfaces and let it dry for 5 minutes. Rinse
thoroughly and allow it to dry.
 Frequently wash bedding, pillows, & blankets.
NO DEHYDRATION
Children who have diarrhea without vomiting and who have been
determined not to be dehydrated based on the physical examination may
be safely continued on an age-appropriate diet. As long as signs or
symptoms of malabsorption do not develop during the treatment period, it
is not necessary to withhold specific foods, including full-strength milk and
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
other dairy products.Some evidence exists showing that complex
carbohydrates, lean meats, yogurt, fruits and vegetables are better
tolerated than fatty foods or foods with high simple sugar content such as
juices and soft drinks. Adding an oral rehydration solution to the regular
feeding routine provides no extra benefit, although the solution may be
accepted by a child who refuses other foods and fluids.
MILD TO MODERATE DEHYDRATION
Children with diarrhea and mild to moderate dehydration on clinical
evaluation should be treated with one of the commercially available oral
rehydration preparations. However drinks such as colas, ginger ale, apple
juice
and
even
commercial
sports
drinks
(e.g.,
Gatorade)
are
inappropriately high in carbohydrates and osmolality. They can cause
osmotic worsening of diarrhea, and their low sodium content may
contribute to the development of hyponatremia. Tea should not be used
because of its low sodium content, and chicken broth is contraindicated
because of its high sodium content.
Made at home: ORS Solution (A special drink for diarrhea)
Give the child a drink made with 6 level teaspoons of sugar and 1/2
level teaspoon of salt dissolved in 1 litre of clean water. Be very careful to
mix the correct amounts. Too much sugar can make the diarrhea worse.
Too much salt can be extremely harmful to the child. Making the mixture a
little too diluted (with more than 1 litre of clean water) is not harmful.
Dosage:
A child under the age of 2 years needs at least 1/4 to 1/2 of a large
(250-millilitre) cup of the ORS drink after each watery stool.
A child aged 2 years or older needs at least 1/2 to 1 whole large (250millilitre) cup of the ORS drink after each watery stool.
SEVERE DEHYDRATION
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Intravenous therapy is usually reserved for use in children with severe
dehydration, which is marked by the presence of shock or near-shock.
LABORATORY/DIAGNOSTIC STUDY
Laboratory
Diagnostic
Procedure
Hematology
Indication
Used to
diagnose
anemia,
infections,
hemophilia
, blood
clotting
disorders,
and
leukemia
Nursing
Considerations





Explain test
procedure.
Explain the
slight
discomforts
may be felt
when skin is
punctured.
Encourage to
avoid stress.
Apply manual
pressure &
dressings over
puncture site.
Monitor the
puncture site
for hematoma
Normal
Findings
Actual Findings
WBC

WBC

5.0010.00
RBC
13.20
RBC

HGB

HCT


4.805.40
11.5016.50
35.0055.00
PLT
HGB

HCT

4.03
356.00

 Results are
high WBC
count
which
indicates
the
presence
of bacterial
infection.
11.90
33.00
PLT

Significance of
Actual Findings
150.00
400.00
 His RBC
countdecre
ases and
the
possible
cause of
this is Iron
Deficiency
Anemia.
 There is
also a
decrease
inhematoc
rit that
may
possibly
cause diet
deficiencya
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
nemia.
Laboratory
Diagnostic
Procedure
Urinalysis
Indication
A urinalysis
is a test for
urine, used
to detect
and manage
a wide
range of
disorders,
such as
urinary tract
infections,
kidney
disease and
diabetes. It
involves
checking
the
appearance,
concentrati
on and
content of
urine.
Abnormal
urinalysis
results may
point to a
disease or
illness.
Nursing
Considerations




Collect
specimens
form infants
and young
children into
a disposable
collection
apparatus
consisting of
a plastic bag
with an
adhesive
backing
around the
opening that
can
befastened
to the
perineal
area or
around the
penis to
permit
voiding
directly to
the bag.
Cover all
specimens
tightly, label
properly and
send
immediately
to the
laboratory.
Observe
standard
precautions
when
handling
urine
specimens.
If the
specimen
cannot be
delivered to
the
Normal Findings
Color
 Pale yellow
to amber
Appearance/Charact
er
 Clear to
slightly hazy
Actual
Findings
Yellow
Significance of
Actual Findings

Clear
6.0
pH
 4.5 to 8
Specific Gravity
 1.005 to
1.025 with a
normal fluid
intake
1.020

Negative
Protein
 Negative
Negative
Sugar
 Negative
1-3

WBC
 Negative
0-2
RBC
 Negative
Few
Epithelial Cells
 Few
Downloaded by Kceey Cruz (ckceey@gmail.com)
Sincethe
color of the
urine is
yellow it
may
indicate,
food
pigments or
high-solute
concentratio
n.
Urinary pH
ismeasured
to
determine
the relative
acidity or
alkalinity of
urine
andassess
the client’s
acid- base
status.
If
thespecific
gravity
increase
urine
becomes
moreconcen
trated.
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
laboratory
or tested
within an
hour, it
should be
refrigerated
or have an
appropriate
preservative
added.
DRUG STUDY (ACTUAL)
Drugs
Mechanism
of Action
Nursing
Indications
Contraindications
Adverse
Reactions
Nursing
Considerations
Metoclopra
mide
Dopamine
antagonist
that acts by
increasing
sensitivity
toAcetylcolin
e results in
increased
motility of
the upper GI
tract and
relaxation of
the pyloric
sphincter
and
duodenal
bulb. Gastric
emptying
time are
shortened.
Parenteral;
facilitates
small
bowel
intubation,
Stim gastric
emptying,
and
increase
intestinal
transit of
barium to
aid in
radiologic
examinatio
n of
stomach.
Gastrointestinal
hemorrhage,
obstruction or
perforation;
epilepsy.
CNS: Agitation,
anxiety,
depression,
dizziness,
drowsiness,
fatigue,headache,
insomnia,
restlessness
CV: Heart failure,
fluid retention,
hypertension,
hypotension,
supraventricular
tachycardia
EENT: Dry mouth
ENDO:
Gynecomastia,
galactorrhea
GI: Constipation,
diarrhea, nausea
SKIN: Rash
Other: Restlessleg
syndrome
Use
metoclopramide
in patients with
hypertension
because it may
increase
catecholamine
levels.
Classifications:
Gastrointesti
nal
stimulant
Dosage:
3mg
IV
Q8
Assess patients
for signs of
intestinal
obstruction such
as abnormal
bowel sounds,
diarrhea,
nausea, &
vomiting before
administering
metoclopramide
.
For I.V. use, it
needs to be
diluted in doses
of 10mg or less.
Give drug over
1-2mins.
Avoid rapid I.V.
delivery because
it may cause
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
anxiety,
restlessness and
drowsiness.
Monitor for
patient
especially with
heart failure or
cirrhosis for
possible fluid
retention or
volume overload
due to transient
increase in
plasma
aldosterone
level.
Store drug in a
light-resistant
container;
discard if
discolored or
contains
particulate.
Drugs
Mechanism
of Action
Nursing
Indications
Contraindications
Adverse
Reactions
Nursing
Considerations
Ranitidine
Competitively
inhibits
gastric acid
secretion
blocking the
effect of
histamine on
histamine H2
receptors.
Food
increases the
bioavalability.
Short-term
and
maintenance
treatment of
duodenal
ulcer. Short
term of
treatment of
active
benign
gastric ulcer
Cirrhosis of the
liver, impaired
renal or hepatic
function.
CNS:Dizziness,
drowsiness,
fever, headache,
insomnia
CV: Vasculitis
GI: Abdominal
distress,
constipation,
diarrhea,
nausea,
vomiting
GU: Acute
interstitial
nephritis
RESPI:
Bronchospasm
SKIN: Alopecia
Other:
Anaphylaxis
Be aware that
ranitidine must
be diluted for
I.V. use if not
using premixed
solution.
Classifications:
Histamine H2
receptor
blocking drug
Dosage:
1 ampule IVTT
Q8
Downloaded by Kceey Cruz (ckceey@gmail.com)
For I.V.
injection dilute
to total of 20ml
with normal
saline solution,
D5W, D10W,
Lactated
Ringer’s
Solution, or
5%sodium
bicarbonate.
For I.V infusion
dilute to total
volume of
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
100ml of same
solution.
Don’t add
additives to
premixed
solution
Stop I.V.
solution
infusion during
piggyback
administration
Drugs
Cefaclor
Classification:
Second
generation
Cepalosporin, 7aminocephalospo
ranic acid
Dosage:
250/5, 6ml
BID
PO
Mechanism of
Action
Interferes with
bacterial cel wall
synthesis by
inhibiting crosslinking of
peptidoglycan
strands, which
stiffen cell
membranes. As
a result,
bacterial cells
ruptures.
Nursing
Indications
To treat otitis
media caused
by
Haemophilus
influenza,
staphylococci,
streptococcus
pneumonia
and
streptococcus
pyogenes;
lower
respiratory
tract
infections,
pharyngitis
and tonsillitis
caused by
S.pyogenes ;
UTI;including
cystitis and
pyelonephiritis
caused by
E.coli
Contraindicatio
ns
Hypersensitivity
to
cephalosporins
or their
components
Adverse
Reactions
CNS: Chills
CV: Edema
EENT: Hearing
loss
GI: Abdominal
cramps,
diarrhea,
elevated liver
function, test
results,
hepatic
failure,
hepatomegaly,
nausea, oral
candidiasis,
vomiting
GU: Elevated
BUN level,
nephrotoxicity
, renal failure,
MS: Arthralgia
RESP: Dyspnea
SKIN:
Ecchymosis,
erythema,
pruritus, rash
Other:superinf
ection
Nursing
Considerations
Use cefaclor
cautiously in
patients with
renal function or
history of GI
tract particularly
colitis, and in
patients who
are
hypersensitive
to penicillin;
10%of them
have cross
sensitivity.
Be aware that
allergic
reactions may
occur a few days
after therapy
starts.
Assess bowel
pattern daily,
severe diarrhea
may indicate
pseudomembra
nous colitis
Assess for super
infection
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
SURGICAL MANAGEMENT

GASTROINTESTINAL SURGERY- is a treatment for diseases of the parts
of the body involved in digestion. This includes the esophagus (ee-sofuh-gus), stomach, small intestine, large intestine, and rectum. It also
includes the liver, gallbladder, and pancreas.
Surgery may be used to remove a cancerous or noncancerous growth
or damaged part of the body, such as the intestine. It may also be used
to repair a problem like a hernia (a hole or weak spot in the wall of the
abdomen). Minor surgical procedures are used to screen and diagnose
problems of the digestive system.
a.)Pre-operative nursing considerations
MEDICAL HISTORY AND CLINICAL ASSESSMENT
-
A detailed medical history and a thorough clinical assessment of the
patient and psychological condition are of utmost importance, as it
may help to identify patient risk factors for imminent morbidity or
mortality. Ideally, the medical history is taken, and the assessment
performed before the patient’s admission to the hospital so that
certain medical conditions can be optimized.
LABORATORY TESTS
-
Preoperative laboratory testing should be performed for all patients
prior to gastrointestinal surgery.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
V.
JOURNAL READING
1.)
Clinical Presentation of Acute
Gastroenteritis in ChildrenWith Functional Abdominal
Pain Disorders
Saps, Miguel*; Mintjens, Stijn†; Pusatcioglu, Cenk K.‡; Cohen, Daniel M.§; Sternberg, Petra*
Journal of Pediatric Gastroenterology and Nutrition: August 2017 - Volume 65 - Issue 2 - p
165–167 doi: 10.1097/MPG.0000000000001466 Short Communication: Gastroenterology
ABSTRACT
Visceral hypersensitivity and abnormal coping are common in children
with functional abdominal pain disorders (FAPDs). Thus, it would be expected
that children with visceral hypersensitivity would report more pain if their gut
is acutely inflamed. The aim of the study was to compare clinical symptoms
and somatization of children with and without FAPDs at time of an episode of
acute gastroenteritis. Seventy children with acute gastroenteritis and their
parents completed the Rome III Diagnostic Questionnaire for Pediatric
Functional GI Disorders and the Children's Somatization Inventory. Twentyone percent of children were diagnosed with an FAPD. Children with FAPDs
showed significantly more nongastrointestinal somatic symptoms than
children without FAPDs. There were no significant differences in abdominal
pain, nausea, vomiting, or school absenteeism between both groups at time
of consultation.
What Is Known
Visceral hypersensitivity is common in children with functional
abdominal pain disorders.
Parental response to the child's illness influences the reporting of child's
pain.
Maladaptive coping, anxiety, somatization, and disability are common
in children with functional abdominal pain disorders.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
What Is New
Children with functional abdominal pain disorders showed greater
somatization as seen in a higher frequency of reported somatic symptoms.
Children with and without functional abdominal pain disorders who
undergo an episode of acute gastroenteritis have similar intensity of
abdominal pain, gastrointestinal symptoms, and school absenteeism.
Some findings of the present study are unexpected and contradict the
currently accepted theoretical models of irritable bowel syndrome.
The pathogenesis and pathophysiology of functional abdominal pain
disorders (FAPDs) is multifactorial and incompletely understood. A large
proportion
of
children
with
FAPDs
are
thought
to
have
visceral
hypersensitivity and hypervigilance that result in a state of heightened
perception to gastrointestinal stimuli.
Children with FAPDs were also found to have abnormal coping skills (1),
higher scores of anxiety and depression and worse quality of life than their
peers (2),Somatization may also play a role in the child's symptoms. Children
with abdominal pain (AP) frequently report nongastrointestinal somatic
complaints (2). Children with chronic AP have higher somatization scores
than healthy patients and organically diseased patients (3). Somatization
seems to mediate the relation between anxiety and depression and coping
styles with pain (4).Multiple studies in adults and children have found a
higher incidence of FAPDs following episodes of acute gastroenteritis (AGE)
(4). Based on the aforementioned literature that demonstrated a higher
sensitivity to gastrointestinal insults and a psychosocial underlay that could
lead to higher report of symptoms, it would be expected that the acute
inflammation of the gastrointestinal (GI) tract in children with FAPDs would
result in higher intensity of GI symptoms.No study has investigated how
children or adults with a known diagnosis of FAPDs manifest at time of an
episode of AGE.We conducted a prospective study to characterize the clinical
presentation of children who consult to the emergency department (ED) for
AGE. The primary aim of the study was to investigate whether clinical
symptoms and somatization differed between children with a history of
FAPDs and those without FAPDs. We hypothesized that children with FAPDs
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
would report greater severity of symptoms and would have higher
somatization scores.
2.)
Surveillance Study of Acute Gastroenteritis Etiologies in
Hospitalized Children in South Lebanon (SAGE study) Pediatr
Gastroenterol Hepatol Nutr. 2018 Jul; 21(3): 176–183.
Published online 2018 Jun 28. doi: 10.5223/pghn.2018.21.3.176
Ghassan Ghssein, Ali Salami, Lamis Salloum, Pia Chedid,* Wissam H
Joumaa, andHadi Fakih †
Abstract
Acute gastroenteritis (AGE) is a major cause of morbidity and remains
a major cause of hospitalization. Following the Syrian refugee crisis and
insufficient clean water in the region, this study reviews the etiological and
epidemiological data in Lebanon.
Methods
We prospectively analyzed demographic, clinical and routine laboratory data
of 198 children from the age of 1 month to 10 years old who were admitted
with the diagnosis of AGE to a private tertiary care hospital located in the
district of Nabatieh in south Lebanon.
Results
Males had a higher incidence of AGE (57.1%). Pathogens were detected in
57.6% (n=114) of admitted patients, among them single pathogens were
found in 51.0% (n=101) of cases that consisted of: Entamoeba histolytica
26.3% (n=52), rotavirus 18.7% (n=37), adenovirus 6.1% (n=12) and mixed
co-pathogens found in 6.6% (n=13). Breast-fed children were significantly
less prone to rotavirus (p=0.041). Moreover, children who had received the
rotavirus vaccine were significantly less prone to rotavirus (p=0.032)
Conclusion
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Our findings highlight the high prevalence of E. histolytica infection as the
major cause of pediatric gastroenteritis in hospitalized children, during the
summer period likely reflecting the insanitary water supplies and lack of
hygiene. Moreover the 42.4% of unidentified causative pathogens should
prompt us to widen our diagnostic laboratory arsenal by adopting new
diagnostic technologies.
VI.
Reference:
1 Woolf (S., Clinical guidelines potential benefits, limitations, and harms
of clinical guidelines. British Medical Journal, 1999.318:p. 527 530.
RCPCH, The next 10 years RCPCH. 2001.
Macfaul, K, Appropriateness of paediatric admissions. Archives of Disease
in Childhood, 1994. 71: p. 51¬-58
Hill, A., Trends in paediatric admissions. British Medical Journal 1989. 298:
p 1479 1483.
BPSU, Joint statement on
emergency departments. 1988.
children
attendances
at
accident
and
OPCS Morbidity statistics from General Practice, Fourth national study,
1991 1992. 1993, London: HMSO.
Armon, KS., T Macfaul, R Werneke, U Gabriel, V Determining the common
presenting problems to paediatric accident and emergency departments
Pediatrics Today, 1999 7. p. 20.
To, T, et al., Hospitalization rates of children with gastroenteritis in
Ontario. Canadian Journal of Public Health. Revue Canadienne de Sante
Publique, 1996. 87(1): p. 62 65.
Barrett, T, A. Lander, and V. Diwakar, Paediatric Vade Mecum.
O'Callaghan C and T Stephenson, Pocket Paediatrics.
SIGN, A guideline developers handbook 2000.
RCPCH Standards for guideline development. 2001.
Downloaded by Kceey Cruz (ckceey@gmail.com)
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Conway, S.P., RR Phillips, and S. Panday Admission to hospital with
gastroenteritis. Archives of Disease in Childhood 1990. 65(6): p. 579 584.
Fleischer, G.R., Paediatric Emergency Medicine. 1997.
Macdonald, LA. and TF Beattie, Intussusception presenting to a paediatric
accident and emergency department. Journal of Accident & Emergency
Medicine, 1995. 12(3): p. 182 6.
Milford, D. V, et al., Haemolytic uraemic syndromes in the British Isles
1985 8: association with Verocytotoxin producing Escherichia Coli. Part 1:
clinical and epidemiological aspects. Archives of Disease in Childhood 1990.
65: p. 716 721.
VII.

Evaluation & Implication
To Nursing Practice
Acquisition of knowledge, skills and ability to provide appropriate
nursing management is one of the targeted goals of nursing students in
studying the illness and/or disease process of acute gastroenteritis as known
to be common illnesses among children.Thus, student-nurses believe that
having the knowledge of the nature and illness and/or disease process of a
certain health condition is an essential aspect that a nurse and a future
nurse must carry out in the identification, classification, formulation and
providing nursing care and interventions to each individual client.

To Nursing Education
The case study presented by the group will provide additional
knowledge about the illness and/or disease process which will then serve as
hints or cues in the identification and in the evaluation of patients risk for
possible complications. The study also warrant improvement on the medical
& nursing interventions and management and provide precautions that may
lead
to
identifying
measures
to
prevent
complications
gastroenteritis.

To Nursing Research
Downloaded by Kceey Cruz (ckceey@gmail.com)
for
acute
lOMoARcPSD|16753777
THE COLLEGE OF MAASIN
“Nisi Dominus Frustra
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Pertinent information and comprehensive patient’s data will aid and
contribute if not support the existing and ongoing research studies. Since
nursing research is made to improve and develop new and factual schemes
on preventing & managing a certain health condition, this case study output
will help researchers and other student-nurses to formulate & enhance
medical & nursing interventions which will aid in effective medical & nursing
collaborative management for acute gastroenteritis
PREDISPOSING
FACTORS:
AGE
ETHNICITY
Family history
Arteriovenous
malformation (AVM)
PRECIPITATING FACTORS:
HYPERTENSION
DIABETES MELLITUS
HEART DISEASE
Downloaded by Kceey Cruz (ckceey@gmail.com)