GASTROeniritis Case Study

8/11/2019 GASTROeniritis Case Study

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Table of Contents

I.

A. Introduction

B. Objectives of the study

C. Scope and Limitation.

II. Patients profile

III. Health history

IV. Developmental data

o PSYCHOSOCIAL THEORY OF ERIK ERICKSON

o COGNITIVE THEORY OF JEAN PIAGET

o FREUDS THEORY OF PSYCHOSEXUAL DEVELOPMENT

V. Medical Management

A. Doctors Order with Rationale:

B. Laboratory Result/significance

VI. Pathophysiology with Anatomy and Physiology

A. Anatomy and Physiology

B. Pathophysiology

VII. Nursing Assessment(system review chart)

VIII. Nursing Management

IX. Health teachings

X. Prognosis

XI. Referrals and follow up

XII. Evaluation

XIII. Implication


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XIV. Bibliograph


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Introduction:

Nursing involves an interrelationship of many people concerned with a

clients responses to potential or actual problems. Health is changing, evolvingconcept that is basic to nursing. For centuries, the concept of disease was the

yardstick by which was measured. Now there is an increasing emphasis on

health and wellness. Most people want to be healthy and feel a sense of loss

when they are not.

In the case of our patient who is suffering from acute gastroenteritis (AGE)

the etiology is to determine, it is said that unlike otherabdominal disorder,AGE is

the most occurring abdominal dysfunction especially among the children. It is

most often results from any non-inflammatory or inflammatory infection of the

colon or either in the upper part of the small bowel. It can range from mild

dysfunction to severe complication, and the most common is dehydration due to

diarrheal reaction of the body.

.Usually this is caused by an infection,[2]

but this is not always the case. It

usually is of acute onset, normally lasting less than 10 days and self-limiting.

Sometimes it is referred to simply as 'gastro'. It is often called thestomach flu

orgastric flueven though it is not related toinfluenza.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of

safe drinking water, or contaminated food-conditions common in developing

nations. Natural or man-made disasters can make underlying problems in

sanitation and food safety worse. In developed nations, the modern food

production system potentially exposes millions of people to disease-causing

bacteria through its intensive production and distribution methods. Common

types of bacterial gastroenteritis can be linked

to SalmonellaandCampylobacterbacteria; however,Escherichia coli0157

and Listeria monocytogenesare creating increased concern in developed

nations.Choleraand Shigella remain two diseases of great concern in
http://www.healthcentral.com/ency/408/000501.htmlhttp://en.wikipedia.org/wiki/Acute_gastroenteritis#_note-Mandell#_note-Mandellhttp://en.wikipedia.org/wiki/Acute_gastroenteritis#_note-Mandell#_note-Mandellhttp://en.wikipedia.org/wiki/Acute_gastroenteritis#_note-Mandell#_note-Mandellhttp://en.wikipedia.org/wiki/Influenzahttp://medical-dictionary.thefreedictionary.com/Escherichia+Colihttp://medical-dictionary.thefreedictionary.com/Escherichia+Colihttp://medical-dictionary.thefreedictionary.com/Escherichia+Colihttp://medical-dictionary.thefreedictionary.com/Cholerahttp://medical-dictionary.thefreedictionary.com/Cholerahttp://medical-dictionary.thefreedictionary.com/Cholerahttp://medical-dictionary.thefreedictionary.com/Cholerahttp://medical-dictionary.thefreedictionary.com/Escherichia+Colihttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Acute_gastroenteritis#_note-Mandell#_note-Mandellhttp://www.healthcentral.com/ency/408/000501.html


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developing countries, and research to develop long-term vaccines against them

is underway.

Non-bacterial gastroenteritis is a syndrome that affects a broad

segment of the population throughout the world. Several studies have

proved that causative agents could be established only in about 30%

of cases[3]and it leads to the suggestion that the virus may be the

aetiological agent. Rota virus has been reported as the commonest

cause of acute non-bacterial diarrhoeal illness.[1]Therefore this study

was undertaken to find out the incidence of Rota virus in acute

diarrhoea cases.

As an NCM501202 students, this care study helps us not just to pass this

said requirement but also to evaluate our efficacy upon rendering our services in

the optimum capacity or the ability to care to a patient suffering this kind of

illness. This study also provide information on actual handling, caring and an

overview of the patients nutritional status and dietary management with acute

gastroenteritis

Objectives of the study

:A case study is designed to determine health problems or possible

health threats arising in a specific client. As student nurses, this would serve as a

tool for our training ground from what we had learned in classroom discussions

and be able to apply these in community setting such as this case.

This case study focuses to accomplish the following objectives on

hypertension:

1. To ascertain the content on the nursing assessment, diagnosis, planning,implementation, and evaluation for these specific disease conditions;

2. To comprehend on the underlying causes and health history on our

clients medical diagnosis upon admission;

3. To compare & contrast the ideal and actual nursing care management for

these specific disease conditions.
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4. Identify the development theory of my patient.

5. Identify history of present illness.

6. Discuss pathophysiology of the disease.

7. Enumerate and discuss the nursing management.

8. Discuss the discharge plan which includes health teachings.

Scope and Limitations

The scope of this study covers from the patients health history,

developmental data, and as well as with his medical and nursing management.

Based upon the assessment done, appropriate interventions were implemented

to have a proper care for the clients health.

The study is limited from the information being collected from the patient.

The data gathering through objective and subjective assessment was limited

based upon our interview (From the mother) and nursing assessment. The

patient was being assessed for 2 days from the time we had our ward duty

exposure.

I. Patients Profile:

Name: Eurey Lambaco

Age: 1month old

Sex:Male

Nationality:Filipino

Highest educational attainment:n/a

Occupation: n/a

Monthly income:n/a

Civil Status:Child


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Religion:Roman Catholic

Birth Day:December 15,2009

Address:Lapasan, Cagayan de Oro City

Vital Signs:

Temp:37.7 c Pulse rate: 130 BPM

Resp. rate: 35CPM .

II. Patients Health History:The Patient X. A 1 month old baby has been experiencing Loose Bowel

Movement (LBM) accompanied with dehydration last January 23, 2010.

Two days prior to admission Patient X encountered onset of loose watery

stools, brownish in color and characterized by non-mucoid and non-blood

streaked for about 4-6 times a day. The client then brought to Sabal hospitals

emergency room. Patients mother claimed that she is not exclusively

breastfeeding her child rather she sometimes bottle feed her child. And she

doesnt always sterilized the childs belongings specifically the utensils which the

child is using when eating.

The client has the chief complaint of loose bowel movement upon his

admission. Patients mother claimed that it was the first admission of the patient.

III. DEVELOPMENTAL DATA

PSYCHOSOCIAL THEORY OF ERIK ERICKSON

Erik Erickson envisioned life as a sequence of levels of achievement. Each stage

signals a task that must be achieved. He believed that the greater that task achievement,


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the healthier the personality of the person. Failure to achieve a task influences the

persons ability to achieve the next task.

FREUDS THEORY OF PSYCHOSEXUAL DEVELOPMENT

According to Freuds theory of psychosexual development, the personality develops

in five overlapping stages from birth to adulthood. The libido changes its location of

emphasis within the body from one stage to another. Therefore, a particular body area has

special significance to a client to a particular stage. The first three stages (oral, anal,

phallic) are called pregenital stages. The culminating stage is genital stage.

If the individual does not achieve a satisfactory resolution at each stage, the personality

becomes fixated at that stage. Fixation is immobilization or the inability of the

personality to proceed to the next stage because of anxiety. The patient belongs to early

childhood where the center of pleasure is in the anus.

COGNITIVE THEORY OF JEAN PIAGET

Cognitive development refers to how a person perceives, thinks, and gainunderstanding of his or her world through the interaction and influence of genetic and

learning factors. Birth- 2years differentiates self from objects. Recognizes self as agent of

action and begins to act intentionally. Achieves object permanence.

IV. MEDICAL MANAGEMENT:

A. Doctors Order with Rationale:

DATE AND TIME ORDER RATIONALE

January 23, 2010

9:00 am

Pls. Admit to room of

choice.

>To provide care and

proper medical

management.


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TPR every 4 hours >To further monitor the

condition of client.

CFACS-V >To check the

characteristics, frequency,

amount, color, stool and

vomitus of the patient.

Diet as tolerated with

aspiration precaution.

>Prescribed food for the

client and prevent aspiration

of foods.

Labs.

Stool Exam

Urinalysis

CBC

>To help physician in

diagnosing his present

health condition and give

specific treatment with

regards to his condition.

>A laboratory test to

determine if a stool sample

contains parasites or eggs

(ova) that are associated

with intestinal infection.

>Used to detect excessive

protein escaping into the

urine to help evaluate and

monitor kidney function,

and to detect kidneydamage affected by his

disease.

>to determine if clients


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blood components are

elevated which could

further help he doctor in

prescribing appropriate

medicatios.

PLR 1L 40gtts/hr. >maintain fluid and

electrolytes balance.

Time tape IVF >To monitor the IV fluids

of the patient.

Monitor hydration status

every 4 hours

>To monitor patients

reaction.

Medications:

E-zinc Drops 1ml OD P.O >Required for normal

development and

maintenance of immune

system.

B. Laboratory Result/significance:

Date/diagnostic

exam done

Lab result Normal

values

Significance

1/24/2010

CBC(HEMATOLOGY)

Hgb:11.3gm%

Hct: 34 vol%

WBC:

7,700/mm3Lymphocytes:

40

Segmenters:

13-18gm%

42-51 vol%

5,000-

10,000/mm325-35 %

55-85%

2-4%

>Decreased in renal

and liver disease,

hypoxia

>Decreased in renal

and liver disease

>no significance

>signifies presence of

parasite and adrenal


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44

Monocytes: 4

Eosinophils: 12

Platelet:

498,000

2-3%

150-350/mm3

hypofunction

>Decreased in renal

and liver disease

> no significance

>signifies presence of

parasite and adrenal

hypofunction

>signifies renal

disease,anemia

1/24/2010

Blood chemistry

BUN:28.5

Createnin:

0.88

Potassium:3.5

Sodium:139.20

15.0-

51.0mgs%

0.8-1.4 mgs%

3.4-5.3mEq/L

135-

155mEq/L

>no significance,

normal

>at the borderline, no

significance

>no significance.

Normal

> no significance.

Normal

Date/diagnostic

exam done

Lab result Normal values Significance


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1/24/2010

URINALYSIS

(RANDOM

SAMPLING)

Color: yellow

Appearance:

clear

Glucose: neg.

Protein: neg.

Reaction: G.S

Spe. Gravity:0.1-

0.10

Wbc:2-4

Rbc; 0-2

Epi. Cell: 0-2

Mucous cells:

none

Urate none

Bacteria:none

.

1/24/2010

Hgb

Hct

Hgb: 9.8

Hct: 30.0

13-18gm%

42-51 vol%

>Decreased in

renal and liver

disease

>Decreased in

renal and liver

disease


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V. PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

A. ANATOMY AND PHYSIOLOGY

The stomach is an expanded section of the digestive tube between the esophagus and

small intestine. Its characteristic shape is shown,

along with terms used to describe the major regions

of the stomach. The right side of the stomach is

called the greater curvature and the left the lesser

curvature. The mostdistal and narrow section of thestomach is termed the pylorus - as food is liquefied

in the stomach it passes through the pyloric canal

into the small intestine.

The wall of the stomach is structurally similar to other parts of the digestive tube, with

the exception that the stomach has an extra oblique layer of smooth muscle inside the

circular layer, which aids in performance of complex grinding motions.

In the empty state, the stomach is contracted and its mucosa and submucosa are thrown

up into distinct folds called rugae; when distended with food, the rugae are "ironed out"

and flat. The image below shows rugae on the surface of a dog's stomach.

Within the stomach there is an abrupt transition from stratified squamous epithelium

extending from the esophagus to a columnar epithelium dedicated to secretion. In most

species, this transition is very close to the esophageal orifice, but in some, particular

horses and rodents, stratified squamous cells line much of the fundus and part of the

body.
http://biology.about.com/library/bldistal.htmhttp://biology.about.com/library/bldistal.htm


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The image below is of the mucosal surface of an equine stomach showing esophageal

epithelium (top) and glandular epithelium (bottom). The creatures attached to the surface

are bots, larval forms of Gasterophilus.

If the lining of the stomach is examined with a hand lens, one can see that it is covered

with numerous small holes. These are the openings of gastric pits which extend into the

mucosa as straight and branched tubules, forming gastric glands.

B. PATHOPHYSIOLOGY

ACUTE GASTROENTERITIS

Definition:

Gastroenteritis is the irritation and inflammation of the digestive tract. This

condition may cause abdominal pain, vomiting and diarrhea. Severe cases of

gastroenteritis can result in dehydration. In such cases, fluid replacement is the

primary factor in treatment. All ages and both sexes may be affected yet the most

severe symptoms are experienced by infants and those individuals over sixtyyears old. The use of certain drugs such as aspirin, antibiotics or cortisone drugs

may increase risk for this condition.

Food poisoning, stress, excessive alcohol or tobacco use, viral infections, food

allergies, improper diet, certain drugs, food consumed in foreign countries and

intestinal parasites are all possible causes for this condition

Gastroenteritis caused by viral infection or bacteria is easily passed from oneperson to another. Care should always be taken to wash the hands often,

especially when preparing food and after bowel movements. Hand washing after

bowel movements is important since the organism that causes this condition lives

in the digestive tract.


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Contaminated food and water; unhygienic lifestyle

Food eaten; irritates stomach

Increase peristalsis movement of the intestines (Inflammatory response to mucous

membrane lining is destroyed due to excessive production of intestinal fluids)

S/SX:

Nausea andvomiting

Diarrhea

Loss of appetite

Fever

Abnormalflatulence

Abdominal cramps

Bloody stools

Fainting and Weakness

Predisposing Factor

Age (1month old)

Precipitating Factors:

>Environmental Sanitation>Personal Hygiene

>Improper handling offoods>unsterilized utensils.
http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Flatulencehttp://en.wikipedia.org/wiki/Flatulencehttp://en.wikipedia.org/wiki/Flatulencehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nausea


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Effect to produce hyperemia (vascular dilatation with local increase in blood flow of

theintestinal mucosa)

Hyperistalsis in the intestine

Fluid loss dehydration

Acute Gastroenteritis

.


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16

VI. NURSING ASSESSMENT REVIEW CHART

VI. Nursing system review chartName: Lambaco, Eurey Date: March 23, 2010

Vital signs:Pulse:130bpm Temperature:37.7 C Resp:35 cpm

Instructions: Place an [x]in the area of abnormality. Comment at the space provided.

Indicate the location of the problem in the figure.

EENT[]impaired vision [] blind [] pain reddened [] drainage sunken fontanels

Forehead and neck are Temp: 37.7c

[] gums [] hard of hearing [] deaf [] burning anterior and

p p osterior fontanelsare still open

[] edema [] lesion on teeth RR: 35cpm[] assess the eyes, ears, nose and throat for abnormality Poor skin turgorUnable to talk clearly Abdominal pain

[x] no problem Abdominal cramps

Respiration IV site[] asymmetric [] tachypnea [] barrel chest

[] apnea [] rales [] cough [] bradypnea [] shallow

Tolerates soft diet[] rhonchi [] sputum [] diminished [] dyspnea

[] orthopnea [] labored [] wheezing

Unable to hear well

[] pain [] cyanotic[] assess respiratory rate, rhythm, pulse blood

Expectoration of

[] breath sounds and comfort [x] no problem

sputum

Cardiovascular

[] arrhythmia [] tachycardia [] numbness

Mildly elevated[] diminished pulses [] edema [] fatigue

blood pressure

[] irregular [] bradycardia[] murmur

[] tingling [] absent pulses [] pain[x] assess heart sounds, rate, rhythm, pulse,

Condom catheter in

blood pressure, circulation, fluid retention and comfortplace

[x] no problem


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17

Gastrointestinal tract

Posterior tibial and[] obese [] distention [] mass [] dysphagia [] rigidity [x] pain

[] assess the abdomen, bowel habits and swallowing

pulses are not[] bowel sounds and comfort [] no problem weight loss

Genito-urinary and Gyne[] pain [] urine [] color [] vaginal bleeding

[] hematuria [] discharge [] nocturia body weakness[] assess urine frequency, control, color, odor and comfort

[] gyne bleeding discharge [x] no problem Diarrhea, watery

stool

Neuro[] paralysis [] stuporous [] unsteady [] seizures

Skin is hot to touch

[] lethargic [] comatose [] vertigo [] tremors[] confused [] vision [] grip

[] assess motor function, sensation, LOC and strength,

Non-pitting edema

grip, gait, coordination and speech [x] no problem

Musculo-skeletal and skin

extremities

[] appliance [] stiffness [] itching [] petechiae [] hot [] drainage[] prosthesis [] swelling [] lesion [] poor turgor [] cool [] flushed

Unsteady - patient

[] atrophy [] pain [] ecchymosis [] diaphoretic []moist

needs assistance[] asses mobility, motion, gait, alignment, joint function

on ambulation

[x] skin color, texture turgor integrity [] no problem

Nursing Assessment II

SUBJECTIVE OBJECTIVE

COMMUNICATION

[] hearing loss Comments wala man pud

problema iyang pandugog, kay pag amu siyangtawgon mlingi man pud siya.

[ ] visual changes

[ ] glasses [ ] language[ ] contact lens [ ] hearing aid

[ ] speech difficulties

Pupil size 2mm

Reaction Pupils are equally rounded and reactive to


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[ x ] denied light and accommodation

OXYGENATION

[ ] dyspnea Comments: wala man pud

Hinuon siya gi ubo.

.[] smoking history

[ ] cough[] sputum

[x] denied

Respiration [x] regular [ ] irregular

Description Regular breathing pattern.

Right: Right lung is symmetrical to left lung.Left: Left lung is symmetrical to right lung.

CIRCULATION

[ ] chest pain Comments: No subjective cue

gathered since the patient is an infant

[ ] leg pain

[ ] numbness of extremities[ x] denied

Heart rhythm [x] regular [ ] irregular

Ankle edema None

Pulse Carotid Radial Dorsalis pedisFemoral + + +Right + + +

LeftComments: Heart beat and heart rhythm are normal.

NUTRITION

Diet Diet for Age with aspiration precaution.[ ] nausea Comments: ginagmay lang jud

iyang ga kan-on

[ ] vomiting

character[ x ] recent change in

weight / appetit[] swallowing

difficulty

[ ] denied

[ ] dentures [x] none

Full Partial

upper [ ] [x] [ ]

lower [ ] [x] [ ]

ELIMINATION

Usual bowel pattern [ ] urinary frequency2x a day 3x a day

[ ] constipation remedy [ ] urgency

[ ] dysuria

Date of last BM [ ] hematuria

March 23, 2010 [ ] incontinence[ x ] diarrhea character [ ] polyuria

Watery stool, yellowish in color

[ ] denied

Comments: loose passive Watery stool, yellowish in

color and in moderate amount.

Bowel sounds: hyperactive (2x/3-5sec.)

Abdominal distention

[ ] yes [x] no

Urine (color, odor,Consistency) : light colored in moderate amount.


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19

MANAGEMENT OF HEALTH AND

ILLNESS

[ ] alcohol (amount and frequency) [x] denied[ ] SBE Last pap smear not applicable

[ ] Last menstrual period not applicable

Briefly describe the patients ability to follow

treatments (diet. Medications, etc.) for chronic

health problems.Patients mother is supportive to treatment regimen

and patient is cooperative..

SUBJECTIVE OBJECTIVE

SKIN INTEGRITY[x] dry

[ ] itching

[x ] other : Poor skin turgor

[ ] denied

[x] dry [ ] cold [ ] pale[ ] flushed [x] warm

[ ] moist [ ] cyanotic

Rashes, ulcers, decubitus (describe size,

location and drainage) None

ACTIVITY / SAFETY

[ ] convulsion Comments: luya judkaayo siya karon, sugod pa atong nagkalibanga siya.

[ ] dizziness

[ ] limited motion

of jointsLimitation in the

ability to:

[x] ambulate[ ] bathe self

[ ] other

[ ] denied

Level of consciousness and orientationPatient is 11 months old.Gait [ ] walker [ ] cane [x] others

[ ] steady [x] unsteady

[ ] sensory losses in face or extremitiesNone

[ ] Range of motion limitation: Patient isstill unable.

COMFORT / SLEEP / AWAKE[x] pain Comments: sige siya ug

hilak, ga sakit jud siguro iyang tiyan ani.

frequency, remedies)

[ ] nocturia[ x] sleep difficulties

[] denied

[x] facial grimace[ ] guarding

[ ] other signs of pain: patient is Frequently

crying.

[ ] siderail release form signed (60+ years)

Not applicable.

COPING

Occupation Not applicable since thepatient is infant

Most supportive person: the mother andfather

Observed non-verbal behavior: noneThe person and his phone number that canbe reached anytime

09063064576- patients father.


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20

VII. Nursing Management

Nursing Diagnosis Intervention Rationale

Hyperthermia related to dehydration as

evidence by flushed skin and warm to

touch

Independent

promote surface cooling by

means of tepid sponge bath

maintain bed rest

increase fluid intake (PO)

Collaborative

administer antipyretic

(paracetamol) as ordered

To lower down body temperature.

To prevent energy consumption.

To maintain fluid and electrolytesbalance in the body.

To lower down body temperature.


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21


Fluid volume deficient related to

excessive losses through normal

routes

Monitor intake and output, note

number, character and amout of

stools. Assess vital signs changes.

Observe for excessively dry skin

and mucous membrane, dry skin

turgor.

Weigh daily.

Administer parenteral as

indicated.

Provide information about over

all fluid balance, renal function

and bowel diseases control aswell as guidelines for fluid

replacement.

Hypotension, tachycardia and

fever can indicate response of

fluid loss.

Indicates dehydration.

Indicator of overall fluid and

nutritional status.

Maintenance of bowel rest that

will require alternate fluid

replacement to correct losses.


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22

Nursing Diagnosis Interventions Rationale

Nutrition, altered: Less than body

requirements related to altered

absorption of nutrients and hyper

metabolic state.

Weigh daily.

Encourage bed rest or limited

activity during acute phase of

illness.

Record intake changes in

symptomalogy.

Provide oral hygiene.

Keep NPO and administer

medication as indicated.

Provide information about

dietary needs.

Decreasing metabolic rate

needs aid in preventing caloric

depletion and conserves

energy.

Useful in identifying specific

deficiency and determining GI

response to foods.

Clean mouth can enhance the

taste of foods.

Promote tissue

healing/regeneration. Prevent

treat anemia, oral route for iron

supplement is ineffectivebecause of intestinal alteration

that for absorption of nutrients.


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23


Acute pain related to hyper peristalsis

prolonged diarrhea, skin/tissue

irritation, peri rectal fissures, fistulas

.

Note non verbal cues.

Permit patient to assume

position of comfort. Cleans rectal area with mild

soap and water wipes after

defecating.

Record abdominal distention

increase temperature and

decrease blood pressure.

Implement prescribe dietary

modifications, administer

medication as indicated.

Non verbal cues may be used in

conjunction with verbal cues to

identify extent of the problem. Reduce abdominal tension and

sense of control.

Protect skin from undigested

bowel contents preventing

excoriation.

May indicate developing

intestinal obstruction from

inflammation.

Complete bowel rest can reduce

pain and cramping.


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24

S N/A

O -sudden loss of weight

-weak-sunken fontanels

-consumes half of share

A Imbalanced Nutrition less than body requirements as evidenced by sudden change in

weight.

P Long term: At the end of an 16 hours of rendering nursing care the patient will be able

to maintain weight.Short term: At the end of 8 hours the patient regain appetite.

I 1. Monitored bowel sounds.

2. Promoted pleasant, relaxing environment.

3. Checked stools.

4. Consulted dietitian.

5. Monitored laboratory studies.

E After giving an intervention the patient have a good appetite and regain his weight.


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25

S N/A

O -Frequently cries

-Restless- facial grimaced

A -Acute pain related to physiologic response of the stomach due to over stimulation

of the gastric acid.

P Long term: At the end of 16 hours rendering nursing care patient will be able to be

relieved from pain as evidence by;

Appears calm and comfortable.

Short term: At the end of 8 hours rendering nursing care the patient will be able to

demonstrate relief from pain.

I 1. Provided with cool and well-ventilated room

2. Monitored vital signs of the patient to check for stability upon pain occur.

3. Given some materials to divert his feeling of pain.

4. Administered with anti-ulcer drugs or anti-pyretic drug as ordered.

E After 8 hours of intervention that has been given, the patient able to be relived from

pain.


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26

S N/A

O -sudden change of weight

-poor skin turgor

-dry mucous membranes

A Risk for fluid volume deficient as evidenced by sudden losses of weight and

loose bowel movement

P Long term: At the end of 8 hours rendering nursing care the patient will

demonstrate a normal pattern of bowel function.Short term: At the end of 5 hours rendering nursing care the patient will be able

to attain normal bowel pattern.

I 1. Monitor intake and output.

2. Increased fluid intake.

3. Assessed vital signs, skin turgor and mucous membrane.

4. Checked and compare laboratory values.

5. Provide IV Fluids with the doctors prescription.

E After giving nursing intervention patient attain normal pattern of bowel

function.


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27

VIII. Health Teaching:

Medication:

Before the patient is discharge, patients mother was instructed to comply all

of his medication regimen as prescribe by the attending physician,(Dr.Bejarasco).

This medication is E-zinc Drops 1ml OD P.O.

Exercise:

Patients mother was instructed to ambulate client ,and deep breathing

excercise and do ADLs as tolerated by patient. Tolerable excercises will promote

blood circulation and, sense of well being, and promote fast healing. Relaxation

exercise may do.

Treatment:

Patients mother instructed to increased fluid intake of client. This is to

promote regain of electrolytes and fluid balance. Treatment regimen such as

some diet restriction, exercise, compliance on medication and to submit self 1

week after being discharge from the hospital. Encouraged to maintain good

hygiene of client.

Out-patient check-up:

Patients mother was instructed to come back 1 week after or if symptoms

persist with Dr. Bejarascos clinic at sabal hospital.This is to check the progress

of the patients treatment and to monitor any signs of further medical assistance.


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Diet:

Patients mother encouraged to let client eat foods with high protein content such

as the egg whites, and lean meats, and also vegetable and encourage increased

fluid intake.

IX. Prognosis:

PROGNOSTIC INDICATORS POOR GOOD

A. Onset of illness X

B. Duration of Illness X

C. Attitude and willingness

to take medication

X

D. Precipitating Factors X

F. Family Support X

X. REFERRALS AND FOLLOW UP

Before the patient is discharged from the hospital, mother was suggestedto return the patient to his physician Dr. Bejarasco one week after discharge for

follow up check-up, for further evaluation, instructions and care.

The recovery of patients wounds depends on medications and treatment

regimen if it was followed religiously as ordered by his physician.

XI. Evaluation:

At the end of two days of nursing care rendered to patient, the patient showed

some sort of progress as evidence by:

Clients stool is semi-formed.

Has good appetite eating.


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Active and regained his strength.

XII. Implication

This study will serve as a reference material in rendering and competent

care to our patient especially those with similar conditions. Through this, we will

be able to develop our knowledge as well as our skills and attitudes in applying

the prescribed procedures to improve the health status of the patient.

This study will act as a baseline data as well as guide for coming up with a

good, reliable, accurate and comprehensive research paper dealing with issues

commonly experienced by patients in the hospital setting. This may aid the

researchers to widen the scope of the study in relation to more or less similar

cases.

XIII. Bibliography:

WEBSITE:

1. http://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_developm

ent&action=edit

2. http://www.patient.co.uk/showdoc/40000681

3. http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_developme

nt#Middle_Adulthood_.2835-60_Years.29

4. "http://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_develo

pment"

5. Category:Developmental psychology

6. ^abMurray PR, Pfaller MA, Rosenthal KS.Medical Microbiology.Mosby,

2005.ISBN 0323033032.

7. ^Seven Surfing Sicknesses.

8. ^abcdeThe Oxford Textbook of Medicine.Edited by David A. Warrell,

Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition

(2003),Oxford University Press,ISBN 0-19-262922-0
http://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_development&action=edithttp://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_development&action=edithttp://www.patient.co.uk/showdoc/40000681http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development#Middle_Adulthood_.2835-60_Years.29http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development#Middle_Adulthood_.2835-60_Years.29http://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/w/index.php?title=Special:Categories&article=Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Category:Developmental_psychologyhttp://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-0http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-0http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-1http://en.wikipedia.org/wiki/Medical_Microbiologyhttp://en.wikipedia.org/wiki/Medical_Microbiologyhttp://en.wikipedia.org/wiki/Medical_Microbiologyhttp://en.wikipedia.org/wiki/Special:BookSources/0323033032http://en.wikipedia.org/wiki/Special:BookSources/0323033032http://en.wikipedia.org/wiki/Special:BookSources/0323033032http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Surfing_Sicknesses_4-0http://surf.transworld.net/2009/01/27/seven-surf-sicknesses/http://surf.transworld.net/2009/01/27/seven-surf-sicknesses/http://surf.transworld.net/2009/01/27/seven-surf-sicknesses/http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-0http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-0http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-2http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-2http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-3http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-3http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-4http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-4http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?view=usa&ci=9780198529989http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?view=usa&ci=9780198529989http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?view=usa&ci=9780198529989http://en.wikipedia.org/wiki/Oxford_University_Presshttp://en.wikipedia.org/wiki/Oxford_University_Presshttp://en.wikipedia.org/wiki/Oxford_University_Presshttp://en.wikipedia.org/wiki/Special:BookSources/0192629220http://en.wikipedia.org/wiki/Special:BookSources/0192629220http://en.wikipedia.org/wiki/Special:BookSources/0192629220http://en.wikipedia.org/wiki/Special:BookSources/0192629220http://en.wikipedia.org/wiki/Oxford_University_Presshttp://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?view=usa&ci=9780198529989http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-4http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-3http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-2http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Oxford_5-0http://surf.transworld.net/2009/01/27/seven-surf-sicknesses/http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Surfing_Sicknesses_4-0http://en.wikipedia.org/wiki/Special:BookSources/0323033032http://en.wikipedia.org/wiki/Medical_Microbiologyhttp://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-1http://en.wikipedia.org/wiki/Gastroenteritis#cite_ref-Murray_3-0http://en.wikipedia.org/wiki/Category:Developmental_psychologyhttp://en.wikipedia.org/w/index.php?title=Special:Categories&article=Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_developmenthttp://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development#Middle_Adulthood_.2835-60_Years.29http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development#Middle_Adulthood_.2835-60_Years.29http://www.patient.co.uk/showdoc/40000681http://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_development&action=edithttp://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_development&action=edit


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9. ^Haffejee IE (1991). "The pathophysiology, clinical features and

management of rotavirus diarrhoea". Q. J. Med.79(288): 289

99.PMID1649479.

10.^Patel MM, Tate JE, Selvarangan R, et al.(2007). "Routine laboratory

testing data for surveillance of rotavirus hospitalizations to evaluate the

impact of vaccination" (Subscription required). Pediatr. Infect. Dis.

J.26(10): 9149.doi:10.1097/INF.0b013e31812e52fd.PMID17901797.

11.^Pediatric ROTavirus European CommitTee (PROTECT) (2006). "The

paediatric burden of rotavirus disease in Europe". Epidemiol.

Infect.134(5): 908

16.doi:10.1017/S0950268806006091.PMID16650331.

12.^Beards GM (1988). "Laboratory diagnosis of viral gastroenteritis". Eur. J.

Clin. Microbiol. Infect. Dis.7(1): 113.doi:10.1007/BF01962164.PMID3132369.

BOOKS:

1. Erikson, Erik H. Childhood and Society. New York: Norton,

1950.

2. Erikson, Erik H. Identity and the Life Cycle. New York:

International Universities Press, 1959.

3. Medical Surgical Nursing by Smeltzer

4. Nursing Pocket Guide by Sheesy Gail

5. NCP by Doenges, 2nd ed. pp.423-430

6. Modern Medical Guide by Harold shryock, M.D. pp 285-287

7. Maternal and Child Health Nursing by Adele Pillitteri pp

1264-1265

8. Texbook of Medical- Surgical Nursing by Brunner andsuddarths pp 1020-1033
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