The document describes a case study of a 26-year-old male patient admitted with acute gastroenteritis presenting with abdominal pain, nausea, vomiting and watery stools. It provides background on acute gastroenteritis including common causes, signs and symptoms, and diagnostic tests. It also outlines the patient's history, physical exam findings, laboratory results, treatment including loperamide and hyoscine butylbromide, and nursing care plans to address his pain, fluid deficits, and gastrointestinal symptoms.
2. INTRODUCTION
Acute Gastroenteritis
Acute Gastroenteritis is inflammation of the
gastrointestinal tract , involving both the
stomach and the small intestine and resulting
in acute diarrhea . The inflammation is caused
most often by infection with certain viruses ,
less often by bacrteria or their toxins , parasites
or adverse reaction to something in the diet or
medication.
3. Different species of bacteria can cause
gastroenteritis, including
Salmonella , Shigella, Staphylococcus,
Campylobacter jejuni, Clostridium, Escherichia
coli, Yersinia , and others.
Each organism causes slightly different sympto
ms but all result in diarrhea. Colitis,
inflammation of the large intestine, may also be
present. Some types of acute gastroenteritis will
not resolve without antibiotic treatment,
especially when bacteria or exposure to
parasites are the cause. Physicians may want to
diagnose the cause by analyzing a stool
sample, when stomach symptoms remain
4. PATIENT’S PROFILE:
Name : A. P.
Age : 26 years old
Sex : Male
Nationality : Indian
Status : Single
Religion : Hindu
Weight : 71Kg.
Date Admitted : 2012/11/18
Chief Complaint: abdominal pains, nausea
and vomiting, watery stools
Admitting Diagnosis: Acute Gastroenteritis
5. PAST HEALTH HISTORY
The patient use to have typical cough, colds
and fever and never had experienced major
illness that required hospitalization. He does
not have any known allergies to food or drugs.
PRESENT HEALTH HISTORY
Two days prior to admission, the patient
experienced persistent loose watery bowel
movement accompanied by vomiting,
abdominal pains and fever.
6. ANATOMY AND PHYSIOLOGY
The human digestive system is a complex
series of organs and glands that processes
food. In order to use the food we eat, our body
has to break the food down into smaller
molecules that it can process; it also has to
excrete waste. Most of the digestive organs
(like the stomach and intestines) are tube-like
and contain the food as it makes its way
through the body. The digestive system is
essentially a long, twisting tube that runs from
the mouth to the anus, plus a few other organs
(like the liver and pancreas) that produce or
store digestive chemicals.
7. The Digestive Process: The start of
the process - the mouth:
The digestive process begins in
the mouth. Food is partly broken
down by the process of chewing
and by the chemical action of
salivary enzymes (these
enzymes are produced by the
salivary glands and break down
starches into smaller molecules).
8. On the way to the stomach: the esophagus
After being chewed and swallowed, the food
enters the esophagus. The esophagus is a
long tube that runs from the mouth to
the stomach. It uses rhythmic, wave-like
muscle movements (called peristalsis) to force
food from the throat into the stomach. This
muscle movement gives us the ability to eat
or drink even when we're upside-down.
9. In the stomach
The stomach is a large, sack-like organ that churns
the food and bathes it in a very strong acid (gastric
acid). Food in the stomach that is partly digested and
mixed with stomach acids is called chyme.
In the small intestine
After being in the stomach, food enters
the duodenum, the first part of the small intestine. It
then enters the jejunum and then the ileum (the final
part of the small intestine). In the small intestine, bile
(produced in the liver and stored in the gall
bladder),pancreatic enzymes, and other digestive
enzymes produced by the inner wall of the small
intestine help in the breakdown of food.
10. In the large intestine
After passing through the small intestine, food
passes into the large intestine. In the large intestine,
some of the water and electrolytes (chemicals like
sodium) are removed from the food. Many microbes
in the large intestine help in the digestion process.
The first part of the large intestine is called the
cecum (the appendix is connected to the cecum).
Food then travels upward in the ascending colon.
The food travels across the abdomen in the
transverse colon, goes back down the other side of
the body in the descending colon, and then through
the sigmoid colon.
11. The end of the process
Solid waste is then stored in the rectum until it
is excreted via the anus.
12. Pathophysiology:
The mechanisms potentially responsible for
viral diarrhea include lysis of enterocytes,
interference with the brush border function that
leads to malabsorption of electrolytes,
stimulation of cyclic adenosine monophosphate
(CAMP), and carbohydrate malabsorption. For
bacterial gastroenteritis, the pathophysiology
involves the elaboration of toxin by
enterotoxigenic pathogens and the invasion
and inflammation of mucosa by invasive
pathogens. Parasitic organisms invade
epithelial cells and cause villus atrophy and
eventual malabsorption.
13. Signs and Symptoms
Low grade fever to 100°F (37.8°C)
Nausea with or without vomiting
Mild to moderate diarrhea
Crampy and painful abdominal bloating
More serious symptoms include:
Blood in vomit or stool
Vomiting more than 48 hours
Fever higher than 40°C
Swollen abdomen or abdominal pain
Dehydration that is manifested by weakness,
light-headedness, decreased and concentrated
urination, dry skin and poor turgor, and dry lips
and mouth
14. Diagnostic Tests:
Blood test
Physical examination to rule other existing
conditions such as appendicitis
20. Nursing implications:
Monitor therapeutic effectiveness.
Discontinue if there is no improvement after 48
hours of therapy for acute diarrhea.
Monitor fluid and electrolyte balance.
Notify physician promptly if the patient
with ulcerativecolitis develops abdominal
distention or other GI symptoms
21. 2. Generic Name: Hyoscine ButylBromide
Brand Name: Buscopan
Classification: Antispasmodic
Uses:
Spastic states and to prevent nausea and
vomiting
22. Adverse Effects:
Overdose may produce temporary paralysis of
ciliary muscle; papillary dilation; tachycardia;
palpitations; hot, dry, or flushed skin; absence
of bowel sounds; hyperthermia; increased
respiratory rate; EKG abnormalities; nausea;
vomiting; rash over face or upper trunk; CNS
stimulations; and psychosis (marked by
agitation, restlessness, rambling speech, visual
hallucinations, paranoid behavior, and
delusions, followed by depression).
23. Nursing implications:
Use cautiously in patients with autonomic
neuropathy, hyperthyroidism, coronary artery
disease, arrhythmias, heart failure,
hypertension, hiatal hernia with reflux
esophagitis, hepatic or renal disease, known
as suspected GI infection, or ulcerative colitis.
Use cautiously in children.
Use cautiously in patients in hot or humid
environments; drug can cause heat
24. Assessment Nursing Planning Interventions Evaluation
Diagnosis
Subjective: Acute After 4 hours of 1. Place patient on After 4 hours of
“My abdomen is pain related nursing a comfortable nursing
very painful!” as to abdominal interventions, position interventions,
the patient will the patient
patient claimed. distension. 2. Monitor and
report a relief reported relief
-with pain scale of from pain as record VS from abdominal
6/10 manifested by a 3.Assess patient’s pains
calm facial level of pain - no facial
Objective: expression. 4. Provide warm grimace
abdominal compress over the - calm facial
cramping abdominal area expression
irritability 5. Administer -Pain scale of
holds medications as 0/10
abdomen ordered
facial grimace
25. Assessment Nursing Planning Interventions Evaluation
Diagnosis
Objective: Deficient fluid After 8 hours of 1. Establish rapport After 8 hours of
passage of loose volume RT excessive nursing 2. Monitor and nursing
watery stool losses through interventions, record VS interventions,
the patient will the patient
nausea normal routes AMB 3.Assess patient’s
report reported
Vomiting frequent passage of understanding of condition understanding of
abdominal loose watery stool causative factors 4. Monitor Input causative factors
cramping for fluid volume & Output balance for fluid volume
Poor skin turgor deficit 5. Maintain deficit
adequate - good skin turgor
weakness hydration,
- no vomiting noted
increase fluid
intake.
6. Provide
frequent oral
care
7. Administer
Intravenous
fluids as
prescribed
8 Restrict solid
food intake, as
indicated
