Case Presentation

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Case Presentation

• Acute Gastro Enteritis
• (A.G.E)
• PREPARED BY MARIAMMA JOHN
• STAFF NURSE, PEDIA WARD

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DEMOGRAPHIC DATA

• Name Case no.2
• MR No. 195077
• Diagnosis Acute Gastroenteritis
• Age 1 year
• Gender Female
• D.O. A 23/01/2013
• D.O.D 25/01/2013

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PHYSICAL ASSESSMENT

• General Assessment
• Chief complaint Febrile, Lethargic and
  decreased Activity
•  
• Skin Dehydrated, Dry, Pale and mottled, Cold
  extremities, capillary refill gt 3 sec
•  
• Head and Neck Neck Veins Flattened, Sunken
  Eyes, Fontanel Sunken
• Thorax Normally symmetrical in size
• Cardiovascular Tachycardia present, no
  tachypnoea
• Genitourinary Redness of the perineal area,
  urine concentrated and dark color
• Gastrointestinal Abdomen is hyperactive and
  distended. Loose stools more than 7 times per day

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PATIENT HISTORY

• Past Medical History
• There is no past medical history of any illness
• Present Medical History
• Now the baby is admitted with the complaints
  of loose stool, vomiting and fever

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MILES STONE CHART 0-1 YEAR

• CHILDS AGE and MASTERED SKILLS
• 1 MONTH
• Lifts head when lying on tummy. Respond to sound.
  Stares at faces.
• 2 MONTHS
• Vocalizes gurgles and coos. Follows objects
  across field of vision. Notices his hands. Holds
  head up for short periods.
• 3 MONTHS
• Recognizes your face and scent. Holds head
  steady. Visually tracks moving objects.
• 4 MONTHS
• Smiles, laughs. Can bear weight on legs. Coos
  when you talk to him.
• 5 MONTHS
• Distinguishes between bold colors. Plays with his
  hands and feet.
• 6 MONTHS
• Turns toward sounds and voicesImitates
  soundsRolls over in both directions
• 7 MONTHS
• Sits without support. Drags objects toward
  herself.
• 8 MONTHS

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TOPIC PRESENTATION

• GASTROENTERITIS
• Definition
• Gastroenteritis is an upset stomach. It causes
  nausea and vomiting. It is sometimes called
  stomach flu, caused by viruses and bacteria.

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ANATOMY AND PHYSIOLOGY

• The gastrointestinal tract is a muscular tube
  made by epithelial cells. The individual
  components of the gastrointestinal system are
  oral cavity, salivary glands, esophagus, stomach,
  small intestine and large intestine.

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PHYSIOLOGY

• ORAL CAVITY Mechanical breakdown of food
  occurring in mouth. Insalivations and absorption
  of small molecules such as glucose and water are
  the functions of oral cavity
• SALIVARY GLANDS 3 pairs of salivary glands
  present ,which produce saliva
• ESOPHAGUS It is a muscular tube which extend
  from pharynx to stomach .It acts as a transport
  medium between compartments.
• STOMACH Stomach is a j shaped bag located
  just left of the midline between the esophagus
  and small intestine. Its functions are
• The short term storage of ingested food
• Mechanical breakdown of food
• Chemical digestion of proteins by acids, enzymes

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ETIOLOGY

• VIRAL E.g. Rotavirus , Adenoviruses, Norovirus
  , Parvovirus and Astroviruses
• BACTERIAL E.g. Salmonella, Shigella, E- coli,
  Clostridium deficit
• PARASITES AND PROTZOANS E.g. Giardia,
  Cryptosporidium

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• PATHOPHYSIOLOGY ACUTE GASTROENTERITIS

• Predisposing Factors
• Age
• Malnutrition

• Precipitating Factors
• Contaminated
• Food and Water

Direct Invasion of the bowel wall
Ingestion of fecally contaminated food and water
Endotoxins are released
Stimulation and Destruction of mucosal lining of
the bowel wall
Attempted Defecation
Excessive gas formation
Digestive and Absorptive Malfunction
Secretion of food and electrolytes in the
intestinal lumen
GI Distention
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• Increase Peristaltic Movement

Mild Diarrhea
Fluid and Electrolytes Imbalance
Increased Protein in the Lumen
LI is overwhelmed and unables to reabsorb the
lost food
Intense diarrhea gt10times watery stool
Serious Fluid Volume Deficit
Hypovolemic Shock
Death
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SIGNS AND SYMPTOMS

• Book Based
• Diarrhea
• Nausea
• Crampy abdominal pain
• Vomiting
•  
• Patient Manifested
• Nausea
• Diarrhea
• Vomiting
• Fever
• Dehydration
• Tachycardia

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INTERVENTION

• Maintain hydration
•  
• Promoting intake of nutrients
•  
• Reduce hyperthermia
•  
• Monitoring and preventing potential complications
• Promoting family knowledge
•  
•  
•  

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TREATMENT

• BOOK BASE
• A.G.E is usually an acute and self limiting
  disease that does not require medication
• The preferred treatment in those with mild
  to moderate dehydration is oral rehydration
  therapy, metaclopromide or ondansteron if needed
• If it is viral
• soft anti diarrheal diet
• Oral rehydration
• IV Fluids
• Bacterial Antibiotics
• PATIENT TREATMENT
• Treated with
• IV Fluids,
• ORS solution,
• Inj. Perfalgan 200mg iv prn,
• Voltaren suppository 12.5mg prn

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COMPLICATIONS

• Pseudomembraneous enterocolitis ( usually only
  seen in those who are taking antibiotics) 
• Gastro intestinal bleeding 
• Dehydration
• Electrolyte Imbalance (Hypokalemia,
  Hypernatremia) 
• Shock 
• Sepsis ( secondary bacterial infection )
•  

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PRIORITIZATION OF NURSING PROBLEMS

• Altered fluid volume deficit due to diarrhea and
  vomiting
• Altered electrolyte imbalance due to diarrhea and
  vomiting
• Imbalanced nutrition less than body requirement
  due to less food intake
• Hyperthermia related to infection
• Lack of skin integrity due to severe loose stool

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NURSING CARE PLAN
ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
SUBJECTIVE Patients Mother Complaints Of Increase No Of Loose Stools And Vomiting OBJECTIVE Loose Stool More Than 7 Times Per Day Dry Skin Cracked Lips Altered fluid volume deficit related to active fluid loss Within 12hrs of nursing intervention patient will Hydrated Normal lips No vomiting Encouraged oral intake of fluids Given nutritionally enrich drinks with more taste enrich with electrolyte (e.g. Pedialyte) Administered IV Fluids 5 dex in ½ NS 5 ml kcl at 60ml / hour Provided rest with calm and quiet environment Monitored intake and output chart Provided soft Anti-Diarrheal diet Helps to promote hydration To avoid dehydration Helps to provide fluids , calories and electrolytes To maintain electrolyte imbalance Will determine if output exceeds input Fiber and solid food may cause gastric irritation After 12 hours of nursing intervention the goals was partially met as evidenced by Frequency of diarrhea decreased Still dehydration No fatigue No vomiting
NURSING care plans
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ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
SUBJECTIVE Patient mother complaints baby feel hot while touching OBJECTIVE Fever ( 39 40 c) Drowsy Tachycardia Weakness Hyperthermia related to infection Within 24 hours patient will completely relieved from fever Removed excessive clothing Provided tepid sponge bath Encouraged fluid intake Administer IV Fluids 5 dex in ½ NS 5 ml kcl at 60ml / hour Administered Antipyretics (e.g. Inj.perfalgan 200mg IV PRN, Rofenac suppository 12.5mg PRN ) Excessive clothing may elevate temperature High temperature causes coagulation of cell protein and cell die. High temperature leads to brain damage To prevent dehydration To prevent electrolyte imbalance To reduce body temperature After 2 days of nursing intervention the goals are fully met. No fever No weakness Fully nourished
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NURSING HEALTH TEACHING

• Encourage the mother to feed the baby with a
  nutritious diet which is not harmful to the
  stomach
• Advise to increase the activities gradually
• Advise the mother to prepare the food in a
  hygienic manner
• Advise the mother to maintain the personal
  hygiene of the baby
• Encourage rest to the baby

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CONCLUSION

• Patient relieved from signs and symptoms.
  Discharge medications Pedialyte and voltarin
  suppository 12.5mg prn. Review after 1 week
•  

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BIBLIOGRAPHY

• Brunner Suddarths. Test book of Medical
  Surgical Nursing. 12thEdition.
• Lippincott Manual of Nursing Practice. 9th
  Edition.

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• KHALAS
• Shukran for listening