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“Nisi Dominus Frustra College of Nursing & Allied Health Sciences Maasin City, Southern LeyteA Case Presentation ONAcute GastroenteritisWith ModerateDehydrationPresented by:Cero, Paola Mariz P. BSN-IIEscoro, Rejina S. BSN-IIMaceda, Danica BSN-IIMonter, Crispin III BSN-IIPresented to:Mrs. Ros...

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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:

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 as

suspected

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.

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.

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

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

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 D5 . 3 NaCl @ 55µgtts/min; infusing well @ ® arm. No vomiting claimed, with good appetite and no other physical discomforts claimed.



Head:

32, A&W

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:

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

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.

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.

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

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

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

School level. He knows how to read, write, and count numbers without help from his mother.

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. 

FOWL...