8358289 Acute Gastroenteritis

8/2/2019 8358289 Acute Gastroenteritis

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I. INTRODUCTION

Gastroenteritis is a catchall term for infection or irritation of the digestive tract,particularly the stomach and intestine. It is frequently referred to as the stomach orintestinal flu, although the influenza virus is not associated with this illness. Majorsymptoms include nausea and vomiting, diarrhea, and abdominal cramps. Thesesymptoms are sometimes also accompanied by fever and overall weakness.Gastroenteritis typically lasts about three days. Adults usually recover withoutproblem, but children, the elderly, and anyone with an underlying disease are morevulnerable to complications such as dehydration. (www.wikipedia.com)

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 foodsafety worse. In developed nations, the modern food production system potentiallyexposes millions of people to disease-causing bacteria through its intensiveproduction and distribution methods. Common types of bacterial gastroenteritis canbe linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157and 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.( www.emedicines.com)

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarelylife-threatening in the United States and other developed nations. However, anestimated 220,000 children younger than age five are hospitalized withgastroenteritis symptoms in the United States annually. Of these children, 300 die asa result of severe diarrhea and dehydration. In developing nations, diarrheal illnessesare a major source of mortality. In 1990, approximately three million deaths occurredworldwide as a result of diarrheal illness.(www.emedicines.com)

Locally, In July 22, 2004, the Department of Health (DOH), Philippines declared an

epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns inCentral Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused

by ingestion of spoiled or bacterial contaminated water or food.

According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the saidintestinal infection were recorded in just 45 days (from May 31 to July16, 2004). From the studies

on the medical diagnoses of 81 cases, Dayrit concluded that infectious (transmittable) cholera

disease was the main cause of the epidemic.(www.doh.gov.ph)

http://www.answers.com/topic/catchall

http://www.answers.com/topic/influenza

http://www.answers.com/topic/nausea

http://www.answers.com/topic/diarrhea

http://www.answers.com/topic/cramp

http://www.answers.com/topic/fever

http://www.answers.com/topic/dehydration

http://www.answers.com/topic/cholera

http://www.answers.com/topic/inconvenient



http://www.doh.gov.ph/

http://www.answers.com/topic/catchall

http://www.answers.com/topic/influenza

http://www.answers.com/topic/nausea


http://www.answers.com/topic/cramp

http://www.answers.com/topic/fever


http://www.answers.com/topic/cholera

http://www.answers.com/topic/inconvenient



http://www.doh.gov.ph/



Locally, here in Tagum City, at Davao Regional Hospital pediatric department acute

gastroenteritis was considered number 3 among the most common pediatric cases. It is common in

this area because some of the people are not aware regarding the proper handling and preparationof food.

Gastroenteritis is a general term referring to inflammation or infection of thegastrointestinal tract, primarily the stomach and intestines.[1] It can be caused by infection with

bacteria, viruses, or other parasites, or less commonly reactions to new foods or medications. Itoften involves stomach pain (sometimes to the point of crippling), diarrhea and/or vomiting, with

noninflammatory infection of the upper small bowel, or inflammatory infections of the colon. It

usually is of acute onset, normally lasting fewer than 10 days and self-limiting. Sometimes it isreferred to simply as 'gastro'. It is often called the stomach flu or gastric flu even though it is not

related to influenza. If inflammation is limited to the stomach, the term gastritis is used, and if the

small bowel alone is affected it is enteritis. As such, this has a relationship on the concept fluidsand electrolyte. Because dehydration the most common complication of gastroenteritis if not

treated or no immediate intervention done it could lead to shock and eventually can lead to death.

http://en.wikipedia.org/wiki/Inflammation

http://en.wikipedia.org/wiki/Infection

http://en.wikipedia.org/wiki/Gastrointestinal_tract

http://en.wikipedia.org/wiki/Stomach

http://en.wikipedia.org/wiki/Intestine

http://en.wikipedia.org/wiki/#_note-0

http://en.wikipedia.org/wiki/Bacteria

http://en.wikipedia.org/wiki/Virus

http://en.wikipedia.org/wiki/Adverse_drug_reaction

http://en.wikipedia.org/wiki/Diarrhea

http://en.wikipedia.org/wiki/Vomiting

http://en.wikipedia.org/wiki/Small_bowel

http://en.wikipedia.org/wiki/Colon

http://en.wikipedia.org/wiki/Acute_(medical)

http://en.wikipedia.org/wiki/Self-limiting

http://en.wikipedia.org/wiki/Influenza


http://en.wikipedia.org/wiki/Gastritis

http://en.wikipedia.org/wiki/Enteritis

http://en.wikipedia.org/wiki/Inflammation

http://en.wikipedia.org/wiki/Infection

http://en.wikipedia.org/wiki/Gastrointestinal_tract


http://en.wikipedia.org/wiki/Intestine

http://en.wikipedia.org/wiki/#_note-0

http://en.wikipedia.org/wiki/Bacteria

http://en.wikipedia.org/wiki/Virus

http://en.wikipedia.org/wiki/Adverse_drug_reaction

http://en.wikipedia.org/wiki/Diarrhea

http://en.wikipedia.org/wiki/Vomiting

http://en.wikipedia.org/wiki/Small_bowel

http://en.wikipedia.org/wiki/Colon

http://en.wikipedia.org/wiki/Acute_(medical)

http://en.wikipedia.org/wiki/Self-limiting

http://en.wikipedia.org/wiki/Influenza


http://en.wikipedia.org/wiki/Gastritis

http://en.wikipedia.org/wiki/Enteritis



OBJECTIVES

General:

1. To fully understand the underlying disease process of aplastic anemia.

Specific:

1. To identify the epidemiological data of aplastic anemia globally,

nationally and locally.

2. To learn about the major etiologies of aplastic anemia.

3. To determine the previous and present clinical history of the patient.

4. To perform physical assessment with special attention on the systems

focus.

5. To show the laboratory examination results with the corresponding

normal values, actual result from the patient, and it interpretation.

6. To understand the anatomy and physiology of the blood and blood

formation and its pathology during aplastic anemia.

7. To trace and understand the pathophysiology of aplastic anemia.

8. To learn the basic principle of medical management of aplastic

anemia.

9. To use the nursing process to identify nursing problems from the client

and provide the appropriate nursing care plan.



10. To understand the pharmacological management set on the client and

provide nursing interventions.

11. To identify the discharge plan for the patient’s rehabilitation to conduct

an evaluation of the client’s condition from admission to present.

II. ASSESSMENT

A. BIOGRAPHIC DATA

Name : Bb. Zoo Sy

Case Number : 185098

Age : 3 months old

Sex : Male

Weight (upon admission) : 43 kgs.

Civil Status : Single

Birthdate : January 8, 2007

Address : Prk. 1 #96 Linoan Montevista, ComVal

Nationality : Filipino

Attending Physician : Dr. Dagooc

B. CHIEF COMPLAINT



Based on the patient’s chart, it appears that seizure, dyspnea,weakness, poor suckling, LBM with watery stool were the chief complaints experience by Bb. Zoo Sy which eventually made her familysought for admission.

C. HISTORY OF PRESENT ILLNESS

One week prior to admission, patient experienced on and off fever,no consultation and medicines given to the patient at home. Until 3 daysprior to admission patient was positive of several episodes of LBM,yellowish to greenish in color, mucoid, non blood streaked and positivefever again no consultation done. Upon admission, the patientexperienced 2 episodes of upward rolling of eyeballs with cycling motionof extremities at the ER. With admitting vital signs of BP- 70/50 mmHg,CR- 140bpm, RR- 58cpm, Temp- 36.4˚C, with pulse oxymeter reading of 96% O2 saturation.

D. PAST MEDICAL HISTORY

E. PERSONAL, FAMILY AND SOCIO-ECONOMIC

Bb. Zoo Sy was born January 8, 2007. He was the youngest of the4 children in the family. Two weeks prior to admission Bb. Zoo Sytogether with his siblings were left by their mother. While his father wasa hardworking businessman who was then at GenSan. The income of hisfather is just enough to support their basic needs.

III. REVIEW OF SYSTEMS (PHYSICAL ASSESSMENT)

A. GENERAL SURVEY



Bb. Zoo Sy was lying flat on bed, lethargic with sunken fontanels,sunken eyeballs, dry pale lips, dyspnea, and distended abdomen.

B. VITAL SIGNS

Date Shift Time Temp BP RR PR Intak

e

Outpu

t

05/03/0

7

11pm-

7am

1:15 am 36.4 70/50 58 140

3:50am 36.2 70/50 56 156

5:00am 36 70/50 42 132

7:00am 36.5 70/50 38 123

7am-

3pm

8:50am 36.4 70/50 42 120

9:55 am 36.8 90/60 48 127

11:16 am 37 80/50 48 130

12:20pm 37 80/50 46 134

1:26 pm 36.9 90/60 49 128

2:55pm 37.6 90/50 52 136 u-350cc

3-11pm 5:00pm 37.3 100/60 43 118

6:15pm 37.4 90/60 43 120

7:15pm 37.5 100/60 33 115

8:20pm 37.6 90/50 37 103

9:50pm 37.2 90/50 40 130 u-200cc

10:45

pm

37.2 90/50 38 100



05/04/0

7

11pm-

7am

12:30am 36.9 90/50 34 133

1:54 am 36.8 90/60 43 124

3:06 am 36.8 90/50 40 109

4:15am 36.8 80/50 37 118

5:50am 36.5 90/60 37 129 u-290cc

6:40am 36.5 80/50 40 110

05/04/0

7

7am-

3pm

8:39am 37 90/60 38 112

10:08am 37..3 80/50 38 116

11:35am 37 90/50 40 120

12:45pm 37.7 80/50 34 124 u-170cc

1:40pm 38.8 90/50 36 126

2:51pm 38.1 90/50 37 128

05/04/0

7

3-11pm 4:50pm 38 80/50 37 110 OF-30cc

6:30pm 37.3 80/50 40 108 u-110cc

7:45pm 36.8 80/50 45 81 OF-30cc

9:10pm 37 80/50 43 99

10:30pm 36.3 80/50 41 107

05/05/0

7

11pm-

7am

12:25am 36.4 80/50 45 95

2:10am 36.7 90/50 43 102

4:20am 37.1 90/50 42 128 OF-30cc

6:00am 37.1 90/50 46 132 u-130cc

7:00am 37 42 123

05/05/0

7

7am-

3pm

8:42am 36.5 80/50 48 120 OGT-30cc



9:56am 36.8 90/50 44 118

10:54am 37 90/50 47 122 u-80cc

12:22pm 37.8 90/50 42 128 OGT-50cc

1:18pm 38.3 46 132

2:40pm 37 90/50 40 128 OGT-50cc

05/05/0

7

3-11pm 4:48pm 38.5 90/50 49 118 OGT-130cc

6:13pm 38 90/50 42 135

7:27pm 37.3 90/60 45 110 u-100cc

8:34pm 37.7 90/60 40 137

10:31pm 37.5 90/50 45 120

05/06/0

7

11pm-

7am

12:55am 37 90/60 48 125 Milk-50cc

2:15am 37 90/60 44 130 u-90cc

3:40am 37 90/60 49 127 Milk-50cc

5:10am 36.9 90/60 40 135

6:30am 36.9 90/60 43 132

05/06/0

7

7am-

3pm

8:36am 36.8 90/60 40 128

10:25am 37.2 90/60 44 132

12:00pm 37 90/60 46 135 u-100cc

05/06/0

7

3-11pm 6:10pm 36.2 90/50 43 140 Milk-90cc

H2O-10cc

u-100cc

05/07/07

11pm-

7am

1:30pm 37.2 90/60 41 127 u-100cc

05/07/0

7

7am-

3pm

9:00pm 37.3 39 136 u-50cc



05/07/0

7

3-11pm 6:30pm 36.2 43 132 milk-90cc u-90cc

05/08/0

7

11pm-

7am

12:00am 37 90/50 40 120 Milk-70cc

4:00am 37.2 90/60 36 115 u-100cc

05/08/0

7

7am-

3pm

8:00pm 36.4 90/50 38 108 u-30cc

12:00pm 36 90/60 36 120 u-90cc

3-11pm 6:00 37 90/50 40 138

11pm-

7am

12:00 36.6 90/50 28 113 H2O-180cc u-340cc

4:00 36.8 90/60 37 118

05/09/0

7

7am-

3pm

8:00 36.4 90/60 28 120 H2O-90cc u-60cc

12:00 36.8 90/60 34 125

3-11pm 3:00 37.1 90/60 39 140 H2O-90cc u-60cc

05/10/0

7

11pm-

7am

1:30 37.1 90/50 40 142 H2O-60cc u-100cc

7am-

3pm

9:30 36.5 40 143 H2O-407cc u-100cc

05/11/0

7

11pm-

7am

1:50 38.9 90/60 42 148 u-120cc

7am-

3pm

9:00 36.7 90/60 40 142 Milk-40cc u-140cc

3-11pm 5:25 36.5 80/50 43 137 Milk-30cc u-110cc

05/12/0

7

11pm-

7am

2:00 36.7 80/50 30 138 Milk-2.5 oz u-120cc

7am-

3pm

11:00 37.5 90/50 46 156 Milk-4 oz u-350cc

6:15 36.8 90/60 29 135 u-150cc

05/13/0 11pm-

7am

12:50 37 90/50 45 133 Milk-2 oz u-100cc



7

7am-

3pm

10:00 37.1 90/60 48 160 Milk-8 oz u-50cc

3-11pm 6:30 37.3 80/50 32 130 Milk-4 oz u-130cc

05/14/0

7

11pm-

7am

1:45 36.9 90/60 34 136 Milk-6 oz u-100cc

7am-

3pm

10:30 36.8 90/60 36 140 Milk-6 oz u-120cc

3-11pm 5:45 36.7 80/50 34 120 Milk-3.5 oz u-90cc

05/15/0

7

7am-

3pm

8:10am 36.7 100/70 37 123 Milk-70cc u-200cc

12:30pm 36.5 90/70 36 124 Milk-50cc

3-11pm 5:30pm 37.4 90/50 40 144 Milk-3.5 0z u-140cc

05/16/0

7

11pm-

7am

1:30am 36.5 90/60 36 140 Milk-4 oz u-90cc

05/16/0

7

7am-

3pm

8:00am 36.8 90/50 42 128 Milk-60cc u-100cc

12:00pm 36.5 90/50 38 126 Milk-135cc

C. NUTRITIONAL STATUS

Upon admission, patient was placed on NPO with OGT F8and keep distal and open. Admitting weight was 5.2kg. During ourshift patient was on dropper feeding.



D. NEUROLOGIC STATUS

Patient was lethargic as observed by NOD.

E. INTEGUMENTARY SYSTEM

Fine and evenly distributed, thin and dry hair was noted. Hisnails were in convex shape, smooth in texture , capillary refill of five seconds an untrimmed finger nails with poor skin turgor. Hisskin was pale, dry, with fine and fare complexion

F. HEENT

The size of head was in proportion with the body. The eyeswere symmetrical with the ears; with sunken fontanels and eyes.When the eyes were tested papillary reaction to light, the pupilconstricted to 2mm. Ear had no discharges noted. Nasal septum

were intact and in the midline. Patient had cleft lip. The throat wasfunctioning well and in normal condition.

G. PULMONARY SYSTEM

Respiratory rate was 58 cpm and dyspnic. Upon

auscultation, crackles were heard and with symmetrical chestexpansion. With history of Pneumonia.

H. CARDIOVASCULAR SYSTEM



Patient’s CR was 140 bpm which is normal. No murmurheard upon auscultation. There was no history of cardiopulmonarydisease.

I. GASTROINTESTINAL SYSTEM

The abdomen was distended, soft and there was no palpablemass felt upon palpation. Hypoactive bowel sound heard uponauscultation. The patient vomited 3-5 times a day and defecatedmore than 6 times a day with watery stool.

J. MUSCULOSKELETAL SYSTEM

The patient manifested good posture and moved voluntarily;he had symmetrical musculature on both sides of the body.Weakness was noted.

K. GENITO- URINARY SYSTEM

Patient voided 60 – 350 cc per shift as weighed and yellowin color.

IV. LABORATORY AND DIAGNOSTIC EXAMINATION

LABORATORY EXAM

NORMALVALUE

RESULT INTERPRETATION

Hemoglobinmass

concentration

Male- 13.5-18g/dl

83.3 This shows that thehemoglobin level is very

low than normal thatindicates decrease tissue

pefusion.



Leukocytenumber

concentration

5-10x10 9/l 17.9 This indicates low level of sodium in the blood or

hyponatremiaNeutrophils 0.55-0.65 0.35 Neutrophils is lower than

normal which indicatates

risk for infection.Eusinophils 0.22-0.04 0.79 The eusinophils is higherthan normal range which

involved in allergicreactions(neutralizes

histamine; digest foreignproteins).

Lymphocytes volume0.22 0.79 Lymphocytes is higherthan normal range which

may help in fightingagainst infection.

Sodium 1.35-148mmol/L

130.4 mmol/L This indicates that thelevel of sodium is slightly

lower than normal.Potassium 3.5-5 mmol/L 3.15 mmol/L The potassium level is

slightly below than normalrange.

Calcium 1.13-1.32mmol/L

0.84 mmol/L This indicates that thelevel of calcium is lower

than normal range.RBS 3.9-6 mmol/L 0.84 mmol/L The RBS is just within the

normal range.

Erythrocytesvolume fraction

0.25 0,25 This shows that theerythrocyte volume

fraction level is just withinthe normal range.

Erythrocytenumber

concentration

7.5 mmol/L

Stool exam No ova found Thrombocytes(Platelet)

150,000-450,000 /mm3

SYMPTOMATOLOGY



Clinical

manifestations

Present

in the

patient

Rationale

Abdominal pain orcramping

Decreased circulatingoxygen in the body canlead to excessive blood

loss & bone marrowdestruction

Nausea

Vomiting /

Fever / To compensate with thediminishing blood supply

to all body systems.

Poor feeding /

Unintentional weightloss

/

Excessive sweating

Clammy skin / Due to the decreasedplatelets in the blood

Muscle pain or jointstiffness

Incontinence (loss of bowel control)

Extreme thirst Due to decreasedplatelets in the blood

Urine that is darker incolor

Dry skin / Due to decreasedclotting factor in the

blood

Dry mouth /

Sunken cheeks or eyes /



In infants, dry diapers(for more than 4-6 hrs)

V. ANATOMY AND PHYSIOLOGY

Anatomy of the Digestive System

If a human adult’s digestive tract were stretched out, it would be 6 to 9 m (20

to 30 ft) long. In humans, digestion begins in the mouth, where both mechanical and

chemical digestion occur. The mouth quickly converts food into a soft, moist mass.



The muscular tongue pushes the food against the teeth, which cut, chop, and grind

the food. Glands in the cheek linings secrete mucus, which lubricates the food,

making it easier to chew and swallow. Three pairs of glands empty saliva into the

mouth through ducts to moisten the food. Saliva contains the enzyme ptyalin, which

begins to hydrolyze (break down) starch—a carbohydrate manufactured by green

plants.

Once food has been reduced to a soft mass, it is ready to be swallowed. The

tongue pushes this mass—called a bolus—to the back of the mouth and into the

pharynx. This cavity between the mouth and windpipe serves as a passageway both

for food on its way down the alimentary canal and for air passing into the windpipe.

The epiglottis, a flap of cartilage, covers the trachea (windpipe) when a person

swallows. This action of the epiglottis prevents choking by directing food from thewindpipe and toward the stomach.

Mouth

The mouth plays a role in digestion, speech, and breathing. Digestion begins

when food enters the mouth. Teeth break down food and the muscular tongue pushes

food back toward the pharynx, or throat. Three salivary glands—the sublingual gland,

the submandibular gland, and the parotid gland—secrete enzymes that partially

digest food into a soft, moist, round lump. Muscles in the pharynx swallow the food,

pushing it into the esophagus, a muscular tube that passes food into the stomach.

The epiglottis prevents food from entering the trachea, or windpipe, during

swallowing.

Esophagus

The presence of food in the pharynx stimulates swallowing, which squeezes the

food into the esophagus. The esophagus, a muscular tube about 25 cm (10 in) long,

passes behind the trachea and heart and penetrates the diaphragm (muscular wall



between the chest and abdomen) before reaching the stomach. Food advances

through the alimentary canal by means of rhythmic muscle contractions (tightenings)

known as peristalsis. The process begins when circular muscles in the esophagus wall

contract and relax (widen) one after the other, squeezing food downward toward the

stomach. Food travels the length of the esophagus in two to three seconds.

A circular muscle called the esophageal sphincter separates the esophagus

and the stomach. As food is swallowed, this muscle relaxes, forming an opening

through which the food can pass into the stomach. Then the muscle contracts, closing

the opening to prevent food from moving back into the esophagus. The esophageal

sphincter is the first of several such muscles along the alimentary canal. These

muscles act as valves to regulate the passage of food and keep it from moving

backward.

Stomach

The stomach, located in the upper abdomen just below the diaphragm, is a

saclike structure with strong, muscular walls. The stomach can expand significantly to

store all the food from a meal for both mechanical and chemical processing. The

stomach contracts about three times per minute, churning the food and mixing it with

gastric juice. This fluid, secreted by thousands of gastric glands in the lining of the

stomach, consists of water, hydrochloric acid, an enzyme called pepsin, and mucin

(the main component of mucus). Hydrochloric acid creates the acidic environment

that pepsin needs to begin breaking down proteins. It also kills microorganisms that

may have been ingested in the food. Mucin coats the stomach, protecting it from the

effects of the acid and pepsin. About four hours or less after a meal, food processed

by the stomach, called chyme, begins passing a little at a time through the pyloric

sphincter into the duodenum, the first portion of the small intestine.

Liver



The liver is the largest internal organ in the human body, located at the top of

the abdomen on the right side of the body. A dark red organ with a spongy texture,

the liver is divided into right and left lobes by the falciform ligament. The liver

performs more than 500 functions, including the production of a digestive liquid

called bile that plays a role in the breakdown of fats in food. Bile from the liver passes

through the hepatic duct into the gallbladder, where it is stored. During digestion bile

passes from the gallbladder through bile ducts to the small intestine, where it breaks

down fatty food so that it can be absorbed into the body. Nutrient-rich blood passes

from the small intestine to the liver, where nutrients are further processed and

stored. Deoxygenated blood leaves the liver via the hepatic vein to return to the

heart.

Small Intestine

Most digestion, as well as absorption of digested food, occurs in the small

intestine. This narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most of the

lower abdomen, extending about 6 m (20 ft) in length. Over a period of three to six

hours, peristalsis moves chyme through the duodenum into the next portion of the

small intestine, the jejunum, and finally into the ileum, the last section of the smallintestine. During this time, the liver secretes bile into the small intestine through the

bile duct. Bile breaks large fat globules into small droplets, which enzymes in the

small intestine can act upon. Pancreatic juice, secreted by the pancreas, enters the

small intestine through the pancreatic duct. Pancreatic juice contains enzymes that

break down sugars and starches into simple sugars, fats into fatty acids and glycerol,

and proteins into amino acids. Glands in the intestinal walls secrete additional

enzymes that break down starches and complex sugars into nutrients that the

intestine absorbs. Structures called Brunner’s glands secrete mucus to protect theintestinal walls from the acid effects of digestive juices.

The small intestine’s capacity for absorption is increased by millions of

fingerlike projections called villi, which line the inner walls of the small intestine. Each

villus is about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a single layer of



cells. Even tinier fingerlike projections called microvilli cover the cell surfaces. This

combination of villi and microvilli increases the surface area of the small intestine’s

lining by about 150 times, multiplying its capacity for absorption. Beneath the villi’s

single layer of cells are capillaries (tiny vessels) of the bloodstream and the lymphatic

system. These capillaries allow nutrients produced by digestion to travel to the cells

of the body. Simple sugars and amino acids pass through the capillaries to enter the

bloodstream. Fatty acids and glycerol pass through to the lymphatic system.

Large Intestine

A watery residue of indigestible food and digestive juices remains unabsorbed.

This residue leaves the ileum of the small intestine and moves by peristalsis into thelarge intestine, where it spends 12 to 24 hours. The large intestine forms an inverted

U over the coils of the small intestine. It starts on the lower right-hand side of the

body and ends on the lower left-hand side. The large intestine is 1.5 to 1.8 m (5 to 6

ft) long and about 6 cm (2.5 in) in diameter.

The large intestine serves several important functions. It absorbs water—about

6 liters (1.6 gallons) daily—as well as dissolved salts from the residue passed on by

the small intestine. In addition, bacteria in the large intestine promote the breakdown

of undigested materials and make several vitamins, notably vitamin K, which the

body needs for blood clotting. The large intestine moves its remaining contents

toward the rectum, which makes up the final 15 to 20 cm (6 to 8 in) of the alimentary

canal. The rectum stores the feces—waste material that consists largely of

undigested food, digestive juices, bacteria, and mucus—until elimination. Then,

muscle contractions in the walls of the rectum push the feces toward the anus. When

sphincters between the rectum and anus relax, the feces pass out of the bod



VII. PLANNING

A. COURSE IN THE WARD

DOCTORS ORDER

May 3, 2007

2:30 am - to CIU

- suction secretions now

- insert OGT F8 and keep distal end open

- O2 @ 4 Lpm via face mask

- Diazepam 1.5 mg IVTT now then PRN for frank seizures

- Give PLR 156 cc IV bolus now x 1 hr

- Admit to pedia ICU

- Secure signed consent to care

- NPO

Labs:

-CBC, BT, U/A, CXR-APL, blood CS, S/E

-RBS stat, ABG stat, serum electrolytes stat



Meds:

1. Ceftriaxone 500 mg IVTT now then OD

2. Ampicillin 260 mg IVTT every 6 hrs

3. Phenobarbital 104 mg IVTT now as LD then 13 mg IVTT q 12 hrs

4. Paracetamol 60mg IVTT q hrs, PRN for Temp=37.8 C

- Monitor vs q hourly and record

- I and O q shift and record

- Hook to pulse oximeter and maintain O2 sat >90% or =90%

- Maintain on MHBR

- Replace GI losses, v/v replacement, with PLR

- Refer accordingly

- Place under droplight. Keep thermoregulated.

- Secure 1 unit of FFP of patient’s blood type and transfuse 78 cc x 4 hrs x 3 cycles afterproper retyping

- IVF to follow: PLR 156 cc to run for 1 hr then refer

-

May 3, 2007

3:35am -IVF to follow PLR to run @ 10 cc/hr x 2 hr then refer



May 3, 2007

6:00am -IVF to follow: D5LR 1L to run @ 86cc/hr x 6 hr then refer

May 3, 2007

7:00am -(Change present IVF to D5 IMB 500 cc + 10 mEq KCl @ 22 cc/hr x 24 hrs)-HOLD

- start Dopamine @ 2 cc/hr, hook to infusion pump

- follow up to FFP transfusion and all labs

- disregard all IVF to patient

- give PLR 100cc IV bolus x 1 hr then refer

- start another line with D5 0.3 NaCl @ KVO rate, sidedrip with Dopamine @ 2cc/hr

-RBS monitoring q 6 hrs

May 3, 2007

9:00am - give another PLR 100cc IV bolus x 1 hr then refer

10:00am - give D10 water 10cc IV bolus now

- IVF to follow: D5LR 1L @32cc/hr x 8hrs then refer

RBS 49mg/dL,for repeat RBS after 30 runs



4:15pm - refer surgery for venous cutdown

8:20pm - referred for IVF insertIion

- May not do cutdown

May 4, 2007

3:15pm - IVF to follow D5 IMB @ 28-29 cc/hr x 6 hrs then refer

- cutdown drip

- D/C all IVF to follow

- IVF to follow: D5 IMB 500cc @ 20cc/hr, SD with Dopamine @ 2cc/hr, hook to infusionpump

- D/C D5 LR attach to heplock

- Refer to social worker for assistance and availability of meds (ceftriaxone)

- Still for U/A, ABG

- May have milk feeding @ 30cc q 3hrs per OGT

May 5, 2007



11:30 am - IVF to ff : D5 IMB 500 cc @ 3 cc/hr x 24 hours (50 kcal)

- increase milk feeding @ 50 cc @ 3 hours

- continue meds

- decrease 02 to 2 LPM via nasal cannula

9:40 pm - may have dropper feeding @ 50 cc every 3 hrs with SAP

May 6, 2007

7:45 am - Transferred patient to GW-Gastro

- VS monitoring q 4 hours and meds

- D/C 02 inhalation

- IVF to ff D5IMB 500 cc to run @ 5 cc/hr x 24

- Still for U/A and fecalysis

- D/C dopamine drip

May 7, 2007

8:30 am - C/D IVF and attach to heplock

- continue meds



May 8, 2007

9:30 am - continue meds

- increase dropper feeding + 70 cc/hr with SAP (71 kcal)

- Pls. ff up cranial CT scan, U/A, blood CS, fecalysis., serum electrolyte

- For repeat CBC plt. Today

May 9, 2007

10:40 am - for LP today

- Pls. secure consent for LP

- Ff up cranial CT scan

- Continue meds

- Shift Phenobarbital IV to PO Phenobarbital 6 g/tab. Dissolve 1 Tab into 5 cc give it toBID

May 10, 2007

9:30 am - Silver sulfadiazine cream apply to affected area TID

- Still for LP



- Continue meds

May 11, 2007

9:55 am - for LP today

- NPO x 4 hrs starting 12 pm

- Pls. give Diazepam 1.5 g IVTT prior to LP

- Continue meds

May 12, 2007

6:45 am - Post LP order

- NPO x 4 hrs

- Feed on bed x 4 hrs

- For RBS stat

- Refer for cyanosis, apnea, dyspnea and other S/S

- Refer accordingly

May 13, 2007

9:30 am - Transfer to neuroservice under Dr. Gazmen/Golingay



- Continue meds

May 14, 2007

12:00 nn - for compliance of Ceftriazone

- measure head circumference

- increase Ampicillin + 400 mg IVTT q 6hr

- for urine culture

- for repear CBC, plt

- FeSo4 (1 tab) 4 ml accordingly

- Multivita 0.3 ml accordingly

- Still for cranial CT scan

- Vit K 1 mg IM

May 15, 2007

9:30 am - Ff up CSF culture result

- Continue meds

- Still for Vit. K 1 ml IM as previously ordered (5/14/07)

- Still for cranial CT scan



- Measure head circumference pls and chart

- Still for repeat CBC, plt, pls facilitate

May 16, 2007

7:00 am - Continue meds

- for cranial ultrasound pls give request

- facilitate repeat CBC plt

- Transfer to MR

NURSES’ NOTES

May 3,2007

11pm-7am 1:15am>Admitted this 3 months old, male child, lethargic, afebrile, dyspneic in due todifficulty in breathing. Vital signs checked. Seen and examined by Dr. Dagooc with ordersmade. Lab exams requested. IVF of PLR IL @ 156 cc as IV bolus. OGT inserted. O2

inhalation @ 4 Lpm per face mask. Suctioning of secretions done. For CXR-ADL. Ushered toward per wheelchair. Endorsed to NOD.

2:50am>In from ER per wheelchair, stupurous. On NPO with Ogt distal end to bedsidebottle. With an IVF of PLR, with ongoing infusion of 156ccx1hr. with O2 inhalation on @4Lpm via face mask. Ushered to room. Placed on bed comfortably. O2 inhalationcontinued. vs checked and recorded. Lab exams and medicines prescribed followed up.Watched for.



May 3,2007

7am-3pm 7:00am>On bed, stupurous. On NPO with OGT open to bedside bottle. With PLR @104cc in2 hrs. with O2 inhalation @ 4Lpm via face mask. With pulse oximeter with O2 saturation @99%. To secure 1 unit Fresh Frozen Plasma for transfusion. Lab exams followed up. vstaken and recorded. Medicated. Seen and examined by Dr.Dagooc with orders made and

carried out. Cared for.

May 3,2007

3-11pm 3:00pm> on bed stupurous and afebrile. On NPO with Ogt open to bedside bottle. With IVF@ right arm D5 o.3 NaCl @ KVO rate, with side drip of dopamine @ 2 cc/hr via infusionpump. With D5 LR @ 32 cc/hr x 8 hrs, on KSS. Still for insertion. On O2 inhalation. Still tosecure FFP for transfusion. Vs checked and recorded. Lab exams followed-up. due medsgiven. Watched for any unusualities.

4:15pm>Seen by Dr.Tiongco, ordered for IV cutdown, refer to surgery by Dr. Gazmen.

May 3,2007

11-7 am 11:00pm> Received asleep on bed, afebrile. On NPO

7-3 pm 7:00am> On bed awake, weak, pallor, coherent and responsive, on MHBR, with 02inhalation @ 5 Lpm via face mask. With ongoing BT #2 FWB 500 cc with serial # 112-07-23172 blood type A+. On left arm is PNSS 1L @ 200 cc/hr. Due meds given. With FBC tourobag. Endorsed to NOD.



3-11pm 3:00pm> Received lying on bed, awake, responsive, and coherent to verbalcommunication. On MHBR position. With droopy eyes noted. With pale lips, dry and warmskin noted, capillary refill less than 2 seconds. Established rapport. On NPO exceptmedications. With 02 inhalaltion @ 5 lpm via nasal cannula. With double line IVF- #7 PNSS1L @ 200 cc/hr infusing well @ L brachial vein, #8 PNSS 1L @ 100 cc/hr infusing well @ Rbasilica vein. With FBC attached to urobag draining amber colored urine. On CBR withoutBRP-reinstructed.

4:00pm> VS, I & O checked and recorded every hour.

4:25pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilicvein.

5:20pm> Temp. 37.8 C, NOD aware. TSB done

6:00pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilicvein.

10:00pm> Still to secure 6 units of platelet and 3 units of fresh whole blood. Advise forbone marrow biopsy, still undecided.

11:00pm> Watched and monitored for any unusualities. Endorsed to NOD.

May 4, 2007



11.7 11 pm> Received asleep on bed, afebrile, on milk feeding 30cc every 3 hours per OGT, With IVFof D5IMB @ 20 cc/hr with side of 2 cc/hr, with heplock @ left and right foot, with O2 @4 Lpm, tosecure another unit of fresh frozen plasma followed-up, V/S checked, due meds given, cared andwatched for.

May 5, 2007

7.3 7 am> On bed, on milk feeding/OGT 30cc every 1hr, # 4 D5IMB @ 20cc/hr, with side drip to run@ 2cc/hr, O2 @ 4cc/mask. To secure 1 unit Fresh Frozen Blood for transfusion. Watched andcared for.

3.11 3 pm> Received patient on bed awake, febrile. On milk feeding 30cc every 3hr per OGT,checked patency, with Ivf ofD5IMB 500cc @3cc/hr infusing well, withside drip dopamine @ 2cc/hrper infusion pump, with O2 inhalation @ 5Lpm via face mask, still to secre fresh frozen plasmafollowed-up. V/S checked once recorded. Watched and cared for.

11.7 11pm> On bed asleep, on dropperfeeding 50cc every 3hr, with IVF of D5IMB @ 3cc/hr x 24hr,infusing well @ the level of 400cc/hr, with side drip of dopamine @ 2cc/hr infusing via infusion

pump. O2 @5 Lpm via face mask. Still to secure fresh frozen plasma for transfusion. V/S checkedand recorded. Lab exams followed-up,due meds given. Watched for any unusualities.

May 6, 2007

7.3 7am> On bed asleep, on dropper feeding 50cc every 3hr, with IVF D5IMB @ 3cc/hr x 24hr, withattached O2 @ 5Lpm via face mask, to secure kit fresh frozen plasma for transfusion. Lab examsfollowed-up. V/S taken and checked. Endorsed to NOD.



7:45> seen and examined by Dr. Garingalao with orders made and carried out. Transferred toCardio Ward as ordered.

3-11 3pm> On bed, asleep, dropper feeding, with IVF of D5IMB @ 5cc/hr.

Still for blood CS. still to secure urine and stool exam. Followed up availability of fresh frozenplasma. V/S checked. Meds given. Endorsed to NOD.

11.7 11pm. Received on bed asleep, on dropper feeding 50cc every 3hr, with IVF of D5IMB @ 5cc/hron KSS. V/S checked and recorded. Meds followed up. Cared for.

May 7, 2007

7.3 7am> on bed awake, dropper feeding, with IVF regulated infusing well. V/S checked andrecorded. Meds cut off. Watched and cared for.

3-11 3pm> Received on bed awake, on dropper feeding, helock KSS, labs followed up. still to secureblood followed up. V/S checked and recorded, medicated, watched and cared for,

11-7 11pm> received lying on bed, awake, patient not in respiratory distress, minimal wheezes heardupon auscultation, with cleft lip, with good capillary refill, with good skin turgor, warm to touch,with heplock on right metatarsal vein. On dropper feeding, for blood CS, U/A, S/E, ABG.

12am> VS checked and recorded, afebrile. Bedside care done; linens stretched and tucked well.Health teachings rendered to mother such as increasing OFI, encouraged to promote goodhygiene. Instructed to keep child away from allergens such as dust, smoke, ect...instructed torefer any unusualities and to comply medical regimens. Infant was able to defecate 180cc- softin characteristics and yellowish in color.



4am> V/S checked and recorded; afebrile; watched and cared for.

5am> morning care done. Intake and output summed up and recorded.

7am> Left on bed with watcher. Endorsed to NOD.

May 8, 2007

7.3 7:30am> received on bed awake with mother on side, with cleft lip palate, with heplock on rightmetatarsal vein; on on respiratory distress. On syringe feeding, able to consume milk feeding50cc, able to defecate with semisolid character of stool and yellowish in color about 30cc. VSchecked and recorded, afebrile T: 36.4, PR:109, RR:39, BP:90/50. Bedside care done. Instructedmother to increase OFI and to report for vomiting and type of stool and its consistency. V/Srechecked and documented. Give ample time for sleeping.

3pm> Health teaching given regarding proper hygiene, milk preparation, proper feedingtechniques and burping of the baby after each feeding. Observed closely for sign of intolerancelike vomiting and nausea.

3.11 3pm> Received on bed, awake on dropper feeding 70cc every 3hr, with heplock attached; stillpatent. V/S checked and recorded, afebrile; lab exams followed up. due meds given, watchedand cared for.

11-7 11pm> Received on bed asleep ,with watcher on side, not in distress, with cleft lip, with goodskin turgor and warm to touch, with heplock in right metatarsal; V/S checked and recordedafebrile; bedside care done. Linens stretched and properly tucked; left on bed comfortably.Health teachings rendered to watcher such as increasing OFI of patient, promote goodventilation and relaxation, encouraged mother to breastfed.



May 9, 2007

7.3 7am> Received patient on bed, sleeping with mother on side, with heplock @ right metatarsal

vein, on bottle feeding, able to consumed 90cc. V/S checked and recorded, afebrile, T:36.4,PR:120, RR:28,BP:90/60. instructed mother to feed baby every 3-4 hours and should preparemilk formula using sterile or distilled water and to report any sign of dehydration such as crackedlips and sunken fontanels.

3pm> Endorsed to NOD.

3-11 3pm> received patient on bed awake, on dropper feeding, with heplock attached on; V/S takenand recorded, afebrile. Followed up availability of meds. Watched and cared for.

11-7 11pm> Received asleep on bed, afebrile; on dropper feeding with aspiration precaution, withheplock attached, still for lumbar puncture, with consent, lab exams followed up, meds followedup, V/S checked an recorded. Watched and cared for.

May 10, 2007

7-3 7am> On bed awake, on breast feeding with heplock, patent and intact. V/S checked andrecorded, labs followed up, medicated, watched and cared for.



3-11 3pm> Received on bed, awake, on dropper feeding 70cc every 3hrs; with heplock attached. Stillpatent. V/S checked and recorded, afebrile. Lab exams followed up. Due meds given. Cared for.

11-7 11pm> Received on bed, asleep, on dropper feeding; with heplock attached; V/S checked andrecorded; meds given, cared for.

May 11, 2007

7-3 7am> On bed, awake, on dropper feeding, with attached on. V/S checked and recorded, medsgiven. Cared for.

3-11 3pm> Lying on bed asleep, on NPO temporarily; for lumbar puncture any time today withconsent. Still for cranial CT scan. V/S checked and recorded. Medicines provided, followed up

intervention.

11-7 11pm> Received asleep on bed, afebrile, on dropper feeding, with heplock attached, still for LPwith consent. Lab exams and medicines followed up. V/S checked, cared for.



May 12, 2007

7-3 7am> On bed awake, NPO for 4 hours reminded, flat on bed x 4 hours, instructed, with heplock,patent and intact, watched and cared for.

3-11 3pm> On bed asleep, on dropper feeding 79cc every 3 hours, with heplock attached on. V/Schecked and recorded. Lab exams followed up. Due meds given; watched for.

11-7 11pm> received asleep on bed, afebrile; on dropper feeding, with strict aspiration precaution,with heplock attached, cranial ultrasound and lab exams followed up, V/S checked, medsfollowed up, cared for.

May 13, 2007

7-3 7am> On bed, awake, with heplock patent and intact, V/S checked and recorded, labs followedup, meds prescribed, watched and cared for.



3-11 3pm> Received on bed, awake; on dropper feeding every 3 hours. With heplock attached, stillpatent. V/S cheched and recorded; afebrile. Lab exams followed up. Due meds given. Cared for.

11-7 11pm> Received asleep on bed; afebrile, on dropper feeding, with heplock attached. Urinalysisand cranial ultrasound followed up, V/S checked, due meds given, cared for.

May 14, 2007

7-3 7am> Received patient cuddled by mother, awake. On breastfeeding, with heplock attached on.V/S taken and recorded. Afebrile. Medicated. Watched and cared for.

3.11 3pm> On bed, afebrile, dropper feeding, with heplock attached; followed up cranial ultrasound;urine CS followed up, fresh frozen plasma was available.

11-7 11pm> Received on bed, asleep, on dropper feeding, with heplock; V/S taken and recorded,meds given; cared for.



May 15, 2007

7.3 7am> Received lying flat on bed, asleep with watcher at bedside. With heplock attached to rightmetatarsal vein; still patent and intact. With cleft lip and dry skin warm to touched. With normalcapillary refill less than 2 seconds, with good skin turgor. Instructed on dropper feeding every 3-4 hours.

8am> V/S checked and recorded; within normal ranges. Intake and output monitored closely asordered. Instructed watcher to report any signs of dehydration such as dry lips and skin, sunkeneyes and fontanels, vomiting, LBM, and weakness.

9am> Bed linen stretched and tucked well. Arranged things properly. Provided with restfulenvironment conducive for sleep. Changed soiled diaper into clean one, with semi-solid stool,yellow in color weighing 70gs.

10am> Vitamin K given 1mg IM as ordered. Watched out for any signs of adverse reactions, notnoted. Able to consumed 70cc of milk via bottle feeding.

10:40am> Changed soiled diaper into clean one, with semi- solid formed stool, yellow in colorweighing 80gs. Measured head circumference as ordered: 40cm. health teaching imparted on

proper hygiene, importance of proper feeding and burping after each feeding, and to observe forvomiting and LBM. IVTT meds given by NOD; watched out for any signs of adverse reaction, notnoted.

12nn> V/S rechecked and recorded. Intake and output monitored closely as ordered. Watchedout for any unusualities, not noted. Provided with restful environment conducive for sleep. Needsattended to and cared for.




3-11 3pm> On bed asleep. On dropper feeding 70cc every 3 hours, with heplock attached. V/Schecked and recorded. Watched and cared for.

11-7 11pm> Received on bed, asleep. On dropper feeding 70cc every 3 hours. With heplockattached. V/S checked and recorded. Meds given, cared for.

May 16, 2007

7-3 7am> Received carried by watcher per arm, awake andconscious. With no heplockattached. With cleft lip and dry skin warm to touch. With normal capillary refill less than 2seconds, with good skin turgor. Instructed on dropper feeding every 3-4 hours. Still forcranial ultrasound; repeat CBC, platelet; for transfer to miscellaneous room.

8am> V/S checked and recorded; within normal ranges. Intake and output monitoredclosely as ordered. Bed linens stretched and tucked well. Provided with restfulenvironment conducive for sleep. Able to consume 60cc of milk via bottle feeding with

good appetite. Instructed watcher to report any signs of dehydration such as dry lips andskin, sunken fontanels, vomiting and diarrhea.

9am> Asleep; provided with restful and safe environment.

10am> Transferred to miscellaneous room as ordered. Bed linens stretched and tuckedwell. Arranged things in proper place.



11am> IVTT meds given by medicating NOD as ordered. Watched out for any signs of adverse reations, not noted. Instructed watcher to bottle feed within 3-4 hours.

12:30pm> V/S rechecked and recorded. Intake and output monitored closely as ordered.Watched out for any unusualities, not noted. Needs attended and cared for.


NURSING CARE PLAN

Dat

e

Assessment Need Nursing

Diagnosis

Objective

of Care

Nursing Intervention Evaluation

M

A

Y

S/O:

• Watery,loosestool(6x/day)in mod. amt

• Vomited5x/shift withsticky vomitusin scantyamount

P

h

y

s

i

o

Fluid volumedeficit r/t severedehydration to

considerelectrolyte

imbalance 2˚Acute

Gastroenteritis

Rationale:

Within 2days of

providingnursing care,will maintain

fluid andelectrolytesvolume at afunctionallevel as

evidenced

•Maintained accurate Intakeand Output

-patient may reduce fluidintake during periods of crisis because of malaise,anorexia,and so on.

• Monitored v/s,comparingwith patient’s normal/

After 8 hrs of nursing care,

GOAL PARTIALLYMET

Patient regainedand maintainedfluid volume at afunctional level



,

2

0

0

7

7am –

3pm

• Sunkenfontanel noted

• Sunkeneyeballs noted

• Dry lips &mucusmembranenoted.

• Distendedabdomen noted

• Poor suckingnoted

• Delayedcapillary refillnoted

• Pale skin

• Wt=5.2kgs.

• FFP @ 78ccx 4hrs x 3 cycles.

With serial #111-06-13473type B+

• SerumNa=130.4mEq

• Serum Ca=0.84mEq

• Serum K=3.15mEq

l

o

g

i

c

Fluids &Electrolyte

s

AcuteGastroenteritis isan inflammation

on the stomach &GI tract which ismanifested by

diarrhea,abdominal painassociated with

nausea, vomiting,fever, andabdominaldistention&excessive

elimination of waste caused

electrolyteimbalance

Reference: MedicalSurgical Nsg. 10th Ed by

Brunners & Suddarth

by:

- willdefecatesemi-formedstool at lest2 times aday

- there willbe decreaseoccurrenceof vomitingat least 12times a day

- willmanifestmoist lipsand mucousmembranesand capillaryrefill in 2-3seconds

- weight of 5.2 kgs willincrease to5.7 kgs

- fever willsubside withthetemperatureof less than37.5

previous readings

- reduction of circulatingblood volume can occurfrom ↑fluid loss resulting inhypotension andtachycardia

• Observed for fever,

changes in LOC,skin turgor,dryness of skin and mucousmembranes, pain.

- symptoms reflective of DHN/ hemoconcentrationwith consequentvasoocclusive state.

• Monitored v/s closely duringblood transfusions andnoted presence of dyspnea,crackles,ronchi,wheezes,diminished breath soundscough and cyanosis.

- patient’s heart may bealready weakened andprone to failure due tochronic demands,placedon it by the anemic state.Heart may be unable totolerate the added fluidvolume from thetransfusions or rapid IVfluid administered toheart crisis/shock

as evidenced by:

BP=110/70mmHg

PR=96bpm

Urine Output=30cc/hr



•Administered fluids asindicated

- replaces losses/deficits.Fluids must be givenimmediately to decreasehemoconcentration andprevent further interaction

Dat

e


Diagnosis

Objective

of Care


A

P

R

I

L

3

0,

2

Subjective:

“Dili man koganahanmulihok ky dali

ra man kokapuyon”, asverbalized.

Objective:

• Pale lips

• Tachycardia(PR=101bpm)

• O2 inhalation @5L/min via

Safety

&

Security

ActivityIntolerance r/t

imbalancebetween O2

supply anddemand 2˚Hypovolemic

shock

Rationale:

Hypovolemicshock resultsfrom loss of fluids & occursmore rapidlythan fluid intake

Within 8 hrsof nurse-patient

interaction,will

demonstratea ↓ in

physiologicsigns of

intoleranceas evidenced

by:

-PR,RR, & BPwill remainwithin

• Assessed the degree of dehydration.

- to provide baselineinformation.

• Established a 24 hour fluidsand electrolytesreplacement needs androutes (IV,PO) to be used.

- prevents peak/valleys influid level.

• Administered IV fluids asindicated and regulatedwell at prescribed rate.

After 2 days of providingnursing care,

GOAL PARTIALLY

MET

As evidencedby:

- defecated semi-solid stools at lest2 times a day

- vomited at



0

0

7

3 –

11pm

nasal cannula

• Weakness,bodymalaise,fatigue

• HemoglobinMassConcentration=20.

• BP=80/60mmHg

• RR=28cpm

Energy

Mgt.

which results tothe imbalance of O2 supply anddemand to thebody. Thisoftenly causesfatigue 7weakness whichcan interferewith the

individual’sability to work.

Reference: MedicalSurgical Nsg. 10th Edby Brunners &Suddarth

normalranges

-decrease infatigue

-increaseability toparticipate in

activities,such aspersonalhygiene &nail care.

- to correct fluid losses.

• Administered one unit freshfrozen plasma.

- to replace electrolytelosses.

• provided nutritious diet viaNGT.

- to meet the body’s nutrientrequirements.

• administered anti- infectiveas ordered by the physician.

- prevents the spread of enteropathogen

Encougaged to properlysterilize water.

-inhibits the growth of microorganism.

Monitored the I & O, andweight everyday.

- to assess the fluid level.

Administered Paracetamolfor fever as ordered.

- to lower down doytemperature to normal range.

Instructed watcher to

least twice a day.

- manifestedmoist lips andmucousmembranes andcapillary refill of at least 2-3seconds..

- weightincreased to 5.5kgs from 5.2 kgs

- fever subsidedwith atemperature of



perform TSB.

- provide comfort an loweredbody temperature.

Dat

e


Diagnosis

Objective

of Care


AP

R

I

L

3

Risk Factors:

• Decreasedhemoglobin(20gm/dL)

• Invasiveproceduressuch as foleycatheterinsertion, bloodtransfusion, andstarting double

Safety

&

Security

Risk for Infectionr/t inadequate

secondarydefenses 2˚

Aplastic Anemia

Rationale:

Aplastic anemiamakes onesusceptible tocomplications onRBCs, WBCs &

Within 8 hrs of nurse-patientinteraction,

will participateon

interventionsto prevent/

reduce risk of infection as

evidenced by:

- Body

•Washed hands before &after each care activity , evenif sterile gloves were used

-Reduces risk of cross -contamination

• Inspected wounds/site of invasive devices daily,paying particular attentionto parenteral nutrition lines.Noted signs of local

After 8 hrs of nursing care,

GOAL MET

Patient was ableto identifyinterventions toprevent orreduce risk of infection as



0,

2

0

0

7

3 –

11pm

IV lines

Objective:

• Febrile @37.8˚C

• Not taken abath for 2 days

•

Untrimmedfingernails

Infection

Protection

platelets whichgives high riskfor infection.WBC, inparticular, fightsagainst foreignsubstances thatenters the body.

Reference:

Medical SurgicalNsg. 10th Ed byBrunners &Suddarth

temperaturewill be withinnormal ranges

-verbalizationof understandingon properhygiene

inflammation/infection.

- May provide portal of entryfor infection, primaryinfecting organisms,as wellas early identification of secondary infections.

• Noted signs and symptomsof sepsis (systemic

infection): fever, alteredLOC.

-To assess causative/contributing factors

• Monitored temperaturetrends.

-fever (38.5ºC - 40˚C) is the

result of endotoxin effect onthe hypothalamus andpyrogen-released endorphins

•Instructed and educated toparticipate in hygienic care

- facilitate in promotingpersonal wellness

evidenced by:

-Bodytemperaturedown to 37˚C

-“kinahanglan jud d I na limpyopirmi atong

lawas”, asverbalized.



B. DISCHARGE PLAN

Clients with Acute Gastroenteritis, watchers are instructedto take the following plan for discharge:

M- Medications should be taken regularly as prescribed , onexact dosage, time, & frequency, making sure that thepurpose of medications is fully disclosed by the health careprovider.

E- Exercise should be promoted in a way by stretching hand andfeet every morning and exercise burping every after bottle

feeding.

T- Treatment after discharge is expected for patients andwatcher with Acute Gastroenteritis to fully participate incontinuous treatment.

H- Hygiene must be maintained for patients with AcuteGastroenteritis. Promotion of personal hygiene should beencouraged such as, daily bathing and changing of diaperswhen soiled.

O- OPD such as regular follow-up check-ups should be greatlyencouraged to clients wather with Acute Gastroenteritis asordered by physician to ensure the continuing managementand treatment.

D- Diet should be promoted, since, during admission, the patientwas on NPO. Proper selection of milk that are suitable forbabies will help enhance immunity.



VIII. PHARMACOLOGICAL MANAGEMENT

• Diazepam

a. Doctor’s Order: 1.5mg IVTT now then PRN for frank seizures

b. Indication : Management of general anxiety disorder, panicdisorders, and provides pre- operative sedation.

c. Mechanism of Action: Depresses all levels of CNS, including the

limbic and reticular formation, probably through the increasedaction of GABA, which is a major inhibitory neurotransmitter in thebrain.

d. Nursing Responsibilities:

Assess effectiveness of therapy according to diagnosis – seizure.

Monitor RR, HR and BP.

Do not overuse or miss regularly scheduled doses. Administer

drug properly as ordered.

If used or seizures, report immediately lack of seizure control.

• Ceftriaxone



a. Doctor’s Order: 500mg IVTT now then OD

b. Indication: Treatment for lower respiratory tract infection

c. Mechanism of Action : Inhibits bacterial cell wall synthesis by

binding to one or more o the penicillin binding protein.d. Nursing Responsibilities:

Assess for previous history of reaction to other cephalosphorin orpenicillin. Monitor for allergic reactions.

Assess for bowel function (if severe diarrhea occurs, discontinuedrug).

Monitor urine output (if decreased, notify the physician)

• Ampicillin

a. Doctor’s Order: 260mg IVTT q 6hrs

b. Indication : For susceptible bacterial infections

c. Mechanism of Action: Interferes with bacterial cell wall synthesisduring active multiplication, causing cell wall death and resultant

bactericidal against susceptible bacteria.d. Nursing Responsibilities :

Monitor effectiveness of therapy and active reaction, includingdevelopment of opportunistic infections.

• Phenobarbital

a. Doctor’s Order : 104mg IVTT now as LB/13mg IVTT q 12hrs

b. Indication: For generalized tonic clonic (grand mal) and partial

seizures.

c. Mechanism of Action: Interferes with transmission of impulsesfrom the thalamus to the cortex of the brain, resulting in animbalance and facilitatory mechanism.




Constant observation and frequent monitoring of BP, RR and HR.

Monitor infusion site for irritating extravasations.

• Paracetamol

a. Doctor’s Order: 60mg IVTT q 4hrs (PRN for temp ≥ 37.8 °C)

b. Indication: For mild to moderate pain and fever.

c. Mechanism of Action: Reduces fever by acting on thehypothalamus to cause vasodilation and sweating.


Monitor for effectiveness o therapy.

Recheck Temp 15minutes after administration.

• Dopamine

a. Doctor’s Order: 2cc/°.

b. Indication: Treatment of shock which persist after adequate fluidvolume replacement.

c. Mechanism of Action: Stimulates both adrenergic anddopaminergic receptors, lower doses are mainly dopaminergicstimulating and produce renal and mesenteric vasodilation, higherdoses also are both dopaminergic and Beta1 adrenergicstimulating and produce cardiac stimulation and renalvasodilation.


Monitor infusion site for extravasation.

Monitor closely for AR and S/S of overdosage.

• Silver Sulfadiazine

a. Doctor’s Order : Apply to affected area TID.

b. Indication : prevention and treatment of infection and burns.



c. Mechanism of Action : Acts upon the bacterial cell wall and cellmembrane.


Monitor development of granulation.

Observe for hypersensitivity reactions (irritation, redness, burning oritching in unburned areas).

IX. EVALUATION

X. BIBLIOGRAPHY

A. BOOKS

Doenges, Marielyn E., ET. Al. (2002) Nursing Care Plans,Guidelines for Individualizing Patient Care. (6th Edition)



Doenges, Marielyn E., ET. Al. (2004). Nurse’s Pocket Guide. (9th

Edition)

Kozier, Barbara ET. Al. (2004). Fundamentals of Nursing, Concepts,Process and Practice. (7th Edition)

Marieb,Elaine N. (2004). Essential of Human Anatomy andPhysiology. (7th Edition).

MIMS. (105th Edition, 2005)

Smeltzer, Suzanne C. ET. Al. (2000). Textbook of Medical-SurgicalNursing. (9th Edition).

Smeltzer, Suzanne C. ET. Al. (2000). Textbook of Medical-SurgicalNursing. Volume 1 (10th Edition)

Turkoski, Beatrice B., ET. Al. Drug Information Handbook forNursing including Assessment, Administration, MonitoringGuidelines and Patient Education (2000-01).

B. INTERNET

http://en.wikipedia.org/wiki/Aplastic_anemia

http://www.aamds.org

C. OTHERS

Microsoft Encarta Encyclopedia 2007.

A Case Study

On

Aplastic Anemia

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Presented to:


http://www.aamds.org/


http://www.aamds.org/



Ms. Zosi Farah W. Fernandez, RN

--------------------------------------------------------

In Partial Fulfillment of the Requirements

In

Related Learning Experience

Presented by:

Cabibil, Ervin Rol C.

Colita, Arven Troy L.

Abundo, Jissa A.

Albero, Karren Rose A.

Aquino, Sunshine S.

Benilan, Melody E.

Cadiente, Joyce C.

Haguyahay, Faith E.

Hinay, Rodelyn B.

Javier, Kathleen Alyce B.

Legal, Chinki C.

Travilla, Allen Rose Y.

BSN3 A1

8358289 Acute Gastroenteritis

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