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    University of Perpetual Help Dr. Jose G. Tamayo Medical UniversitySto.Nio, Bian, Laguna

    College of Nursing

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    Presented by:Group 21(BSN IV-5)Arreola, Jorge C.

    Azuela, Irene D.

    Claros, Danie T.

    Cometa, Maclyn Rose M.

    De Grano, Marie Kathleen Rose S.

    Dizon, Lorenzo B.

    Libiran, Paul Michael

    Obado, Angelique C.

    Padrid, Shirley A.

    Palacios, Alexander D.Ponay, Irene Fe A.

    Roxas, Rafael Conrado J.

    Mrs.Renello Bautista, RN

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    Gastroenteritis is an inflammation of the mucosa of

    the stomach and the small intestine. Clinical

    manifestations includes nausea, vomiting, diarrhea,

    abdominal cramping and distention, Fever, increased

    WBC, and blood or mucus in the stool may be present.

    Causative agent are varied, Most cases are self limiting

    and do not require hospitalization. However, older adults

    and chronically ill patients maybe unable to consume

    sufficient fluids orally to compensate for fluid loss. Until

    vomiting has ceased, I.V replacement of fluids maybe

    necessary. As soon as tolerated, fluids containing

    glucose and electrolytes should be given. If the causative

    agent is identified, appropriate antibiotic, antimicrobial, or

    antiinffective drugs are given.

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    PERSONAL DATA

    PATIENT PROFILEName: C.D.I

    Age: 1year old

    Address: Mercedes Homes, Binan,Laguna

    Birth Date: July 18, 208Religion : Baptist

    Nationality: FilipinoCivil Status: single

    Fathers Name:Antonio IlaoMothers Name: Laila Ilao

    Admission Date: November 30 2009Admission Time: 5:30 pm

    Initial Diagnosis:Age with somesigns of Dehydration

    Chief Complain: fever and chills

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    One day prior to admission the patient was apparently wellwhen he suddenly experience eight episodes of loss bowel

    movement (LBM) of yellow pasty mucoid, non bloody streaked stool.Associated with undocumented fever. Patient was given

    paracetamol120mg per 5 ml TID which afforded temporary relief.On the day of admission , still with persistence of fever

    associated with 5 to 6 episodes of vomiting of previously ingestedfood, non mucoid, non blood streaked. This was also associated with

    chills . this promoted consult and subsequently admitted.

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    General:Awake active in cardio respiratory distress

    Vital signs:Blood pressure: 90 / 60 mmHg

    Cardiac Rate: 125 bpmRespiratory Rate: 28 cpm

    Temperature: 38.5 C

    Anthropometric MeasurementsHeight : 85 cmWeight : 13.4 kg

    No stunting and no wastingSkin :

    Warm to touch with poor skin turgor with rashesHEENT:

    Pink palpebral conjctivae anicteric sclerae. No nasoaural discharges and no CLAD.C/L:

    Symmetrical chest expansion ,no retractions clear breath soundsCV: > (-) murmur regular rhythm

    Abdomen:Slightly globular soft (+) hyperactive bowel sounds no tender, no organomegaly

    Extremities :

    No gross depormity no edema no cyanosis capillary refill less than 2 secs.

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    HEMATOLOGY

    Dec. 01,2009

    NORMAL FINDINGS RESULT

    Hemoglobin 120-150gm/l 130gm/l

    Hematocrit 0.40-0.54 0.39

    RBC 4-5.6*10(12)/l 4.4*10(12)/l

    WBC 5.0-10.0*10(9)L 12.1*10(9)/l

    Platelets 150-400*10(9)/l 224*10(9)/l

    DIFFERENTIAL COUNTSegmenters 0.50-0.70 0.63

    lymphocytes 0.20-0.40 0.33

    Monocytes 0-0.05 0.04

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    URINALYSIS

    Dec.01,2009

    NORMAL FINDINGS RESULT

    Color Strawto DarkYellow Yellow

    Transparency Clear Hazy

    Reaction(pH) 5.5-7.0 5.0

    Protein None Trace

    Glucose Negative Negative

    Specific Gravity 1.010-1.025 1.025

    Pus cells 0-3/hpf 3-7/hpf

    RBC 0-3/hpf 0-2/hpf

    Epithelial cells Small amounts

    Hyaline,coarse,Fine granular

    RBC,WBC,waxycasts.

    Moderate

    Mucus Threads Moderate

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    FECALYSIS

    Nov.30,2009

    NORMAL FINDINGS RESULT

    Color Brown Yellowish

    Consistency Formed Soft

    OVA/Parasites Negative None Found

    FECALYSISNov.01,2009

    NORMAL FINDINGS RESULT

    Color Brown Gr eenish brown

    Consistency Formed Watery

    OVA/Parasites Negative None Found

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    TEST NORMAL FINDINGS RESULT

    Sodium 135.0-148.0 139.8mmol/l

    Potassium 3.50-5.30 4.10mmol/l

    BLOOD CHEMISTRY REPORT

    Nov.30,2009

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    HEMATOLOGY

    Dec.02,2009

    NORMAL FINDINGS RESULT

    Hemoglobin 120-150gm/L 110gm/L

    Hematocrit 0.40-0.54 0.33RBC 4-5.6*10(12)/L 3.8*10(12)/L

    WBC 5.0-10.0*10(9)L 8.4*10(9)/L

    Platelets 150-400*10(9)/L 208*10(9)/L

    DIFFERENTIAL COUNT

    Segmenters 0.50-0.70 0.60

    lymphocytes 0.20-0.40 0.35

    Monocytes 0-0.05 0.05

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    URINALYSIS

    Dec.02,2009

    NORMAL FINDINGS RESULT

    Color Strawto DarkYellow Light YellowTransparency clear SlightlyHazy

    Reaction(pH) 5.5-7.0 5.0

    Protein Negative Negative

    Glucose Negative Negative

    Specific Gravity 1.010-1.025 1.020

    Pus cells 0-3/hpf 1-3/hpf

    RBC 0-3/hpf 0-2/hpf

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    FECALYSIS

    Dec.02,2009

    NORMAL FINDINGS RESULT

    Color Brown Gr eenish Yellow

    Consistency Formed Mushy

    OVA/Parasites Negative None Found

    Others (yeast cell) Few

    FECALYSISDec.03,2009

    NORMAL FINDINGS RESULT

    Color Brown YellowConsistency Formed Mucoid

    OVA/Parasites Negative None Found

    Others (Yeast cell) Few

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    HEMATOLOGY

    Dec.04,2009

    NORMAL FINDINGS RESULT

    Hemoglobin 120-150gm/L 110gm/L

    Hematocrit 0.40-0.54 0.33RBC 4-5.6*10(12)/L 4.2*10(12)/L

    WBC 5.0-10.0*10(9)L 8.4*10(9)/L

    Platelets 150-400*10(9)/L 232*10(9)/L

    DIFFERENTIAL COUNT

    Segmenters 0.50-0.70 0.60

    lymphocytes 0.20-0.40 0.35

    Monocytes 0-0.05 0.05

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    URINALYSIS

    Dec.04,2009

    NORMAL FINDINGSRESULT

    Color Strawto DarkYellow Yellow

    Transparency Clear Clear

    Reaction(pH) 5.5-7.0 6.0

    Protein Negative +1

    Glucose Negative Negative

    Specific Gravity 1.010-1.025 1.030

    Pus cells 0-3/hpf 0-1/hpf

    RBC 0-3/hpf 1-2/hpf Epithelial cells Small amounts

    Hyaline,coarse,fine granular

    RBC,WBC,waxycasts

    Occasional

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    HEMATOLOGY

    Dec.05,2009

    NORMAL FINDINGS RESULT

    Hemoglobin 120-150gm/l 117gm/L

    Hematocrit 0.40-0.54 0.35

    RBC 4-5.6*10(12)/l 4.0*(12)/L

    WBC 5.0-10.0*10(9)L 4.11*10(9)/L

    Platelets 150-400*10(9)/l 356*10(9)L

    DIFFERENTIAL COUNT

    Segmenters 0.50-0.70 0.48

    lymphocytes 0.20-0.40 0.45

    Monocytes 0-0.05 0.07

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    ANATOMY OF THE GASTROINTESTINAL TRACT

    The GI tract is the pathway food takes from the mouth, through the esophagus,stomach, small and large intestine within where the nutrients are extracted for the needs

    of the body. The residue then passes to the rectum where it is evacuated.The first part of the pathway is the esophagus, which is a conduit that guides food

    from the mouth, where it is prepared by chewing, down to the stomach where it is stored.The stomach is both a storage space, holding as much as a quart and a half of ingestedfood, and a secretory organ that produces the gastric, acid necessary for digestion.However, the stomach does not absorb food. When food enters the stomach from theesophagus it remains for a short period while it is mixed wfth gastric. acid. The stomachthen by involuntary muscle contractions (peristalsis) empties the food gradually into the

    duodenum, the first part of the small intestine.The small intestine consists of three parts: the duodenum, the jejunum and the

    ileum. In these three parts, certain digestive secretions are mixed with food, and thenutrients are absorbed into the blood stream.

    The duodenum treats the food it receives with bile from the liver and enzymes fromthe pancreas. It also adds liquid duodenal fluid that comes from the wall of the duodenumitself. The food, bile, enzymes and liquids brought together in the duodenum are thenpassed into the jejunum.

    The jejunum or second portion of the small intestine, is approximately 10 feet long.It lies immediately behind the duodenum and continues the process of digestion, breakingdown food into essential elements.

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    The ileum, or third portion of the small Intestine, like the jejunum, is about 10 feetlong. It is here that a major part of the absorption of food products and liquidsoccurs. Waste products of the digestive process are passed from the small intestineor terminal ileum, into the large Intestine, also known as the colon. The beginning ofthe colon is in the right lower quadrant of the abdomen, near the appendix The colonmoves waste products through about four feet by the continuing process of undulating motions or peristalsis, which is common to all parts of the gastrointestinaltract. The primary function of the colon is to store waste products of digestion priorto evacuation. The colon absorbs small amounts of water and electrolytes.

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    PHYSIOLOGY OF THE GASTROINTESTINAL TRACTTHE DIGESTION PROCESS

    Digestion is the process by which food broken down so that it can be used by the body. Whenyour digestive system functions properly you are rarely aware of it. Your digestion system begins in

    your mouth. The digestive tract is a long tube running from the mouth to the anus. In a living body it iscontracted to twelve to fourteen feet. This tube is divided into certain specialized compartments, eachwith a more or less different function.

    Digestion begins in the mouth. Your teeth and tongue break down or masticate food and yoursalivary glands break it down further with liquid enzymes. Saliva is a watery tasteless liquid mixture thatmoistens chewed food and begins chemical digestion. The salivary glands produce this saliva. Salivacontains an enzyme that begins the breakdown of starches into sugars. Saliva contains amylase that isan enzyme that begins the chemical digestion of complex carbohydrates, such as the sweet potatoes

    and stuffing in your dinner.Once the food is chewed and

    softened in the mouth, the tongue rolls it into a ball or bolus and then pushes the bolus to the throat tobe swallowed. During swallowing, a small flap of tissue called the epiglottis prevents food from enteringthe windpipe. The food then passes into the esophagus.

    The esophagus is a muscular tube connecting the mouth with the stomach. The esophagusmoves the food to the stomach by a serious of muscular contractions called peristalsis. Peristalsis is thewavelike contraction of muscles that move food through the digestive system.

    As the food is swallowed, the food travels through your esophagus to your stomach. The stomachis a saclike organ of digestion and has walls made of layers of muscle, each arranged on a differentangle. As the food enters the stomach, muscle contractions begin to twist, turn, and churn the food.The twisting, turning, and churning of food in the stomach is part of mechanical digestion. The stomachproduces gastric juice and mixes it with the food. This gastric juice contains enzymes that begin thedigestion of proteins. Proteins are the only substances digested in the stomach. Proteins are onlypartially digested in the stomach. The food is churned and mixed with stomach fluids until a thick paste

    called chyme is produced. The chyme passes through the stomach into the small intestine.

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    The small intestine is a long, coiled organ about one inch in diameter. The small intestine may be 7.5to 9 meters in length. Digestion is completed in the small intestine. The liver releases bile into thesmall intestine. Bile prepares the fats for digestion. Pancreatic juice contains enzymes that digestcarbohydrates and fats. It also contains enzymes that continue the digestion of proteins. The wallsof the small intestine release enzymes that complete the digestion of all three basic nutrients. In the

    walls of the small intestine are millions of small projections called villi. These villi contain many smallblood vessels. Digested food is absorbed into these blood vessels and carried to all body cells.

    The material that has not been absorbed moves into the large intestine, or colon. Here water andsalts are absorbed, and the remaining solid waste goes out of the body through the anus.

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    DOCTORS ORDER RATIONALE07 / 27 / 09

    Time

    IVF: PNSS 1L x 6 hours - To maintain electrolyte balance in the body.- To prevent dehydration

    IVF: PLR 1L x hoursFast drip

    - To maintain electrolyte balance in the body.- To prevent dehydration

    MEDICATIONRanitidine

    (1 mg x IV stat)

    Plasil (Metoclopramide)

    (1 mg x IV prn)

    CefuroximedosageIV .

    -

    -Prevention of nausea, vomiting, and

    delayed gastric emptying

    -Inhibits Bacterial cell wall synthesis fromurinary tract and skin infection

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    DRUGS CLASSIFICATION MECHANISMOF

    ACTION

    INDICATION CONTRAINDICA

    TIONS

    NURSING

    CONSIDERATIONS

    Generic Name:

    Carbamazepine

    Brand Name:

    Carbatrol, Epitol

    DOSAGE:

    100mg/5ml TID

    AnticonvulsantChemicallysimilar to thecyclicantidepressants.Also manifestantimanic,antineuralgic,

    antidiuretic,anticholinergic,antiarrythmic andantipsychotic

    effects.

    History of bonemarrowdepression,acute intermittentporphyria.Hypersensitivityto drug ortricyclic

    antidepressant.Concomitant useof MAO inhibitor.Lactation. Use

    for relief ofgeneral achesand pains.

    List reason for therapy withseizures; describe

    types, frequency,characteristics.

    Assess for psychosis mayactivate

    symptoms.Do baseline hematologic,

    renal and LFTs;assess for

    dysfunction. Withhigh doses, get

    weekly CBC first 3

    months, thenmonthly: assessextent of bone

    marrowdepression. At first

    sign blooddyscrasia, stop

    drug.Obtain eye exams; assess

    for opacities, IOPs.Obtain ECG during therapy.

    Use seizureprecautions with

    quick withdrawal;may precipitate

    status epilepticus.

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    Patients Name: CDI

    Medical Diagnosis:Acute Gastroenteritis with some signs of DehydrationNursing Diagnosis: Fluid Volume Deficit related to excessive gastrointestinal losses in stoolShort term goal:At the end of the eight hour shift, the patient will regain normal bowel functioning.

    Long term goal:At the end of the hospitalization, the patient willl exhibit signs of rehydration and maintain adequate hydration.

    Cues Problem Scientific reason Nursing intervention Rationale Evaluation

    Subjective:

    Ilang beses nasiyang dumumingaung araw asstated by themother.

    Objective:

    >dry lips

    >poor skin turgor

    >crying at times

    Fluid Volume

    Deficit

    Decreased

    intravascular,

    interstitial andintracellular fluid.This refers todehydration withchanges insodium.

    Reference:

    Nurses PocketGuide Edition-10

    >Vital Signsmonitored andrecorded

    >Maintained strictrecord of Intake and

    Output

    >Assessed Skinturgor, mucousmembranes andmental status asindicated

    >Encouragedincreased oral fluid

    intake

    >Instructed family inproviding appropriatediet

    >Observed andrecorded response to

    feedings

    >To obtain baselinevalues forcomparison

    >to evaluateeffectiveness of

    interventions

    >To assess statusof hydration

    >For rehydration

    >To GainCompliance withtherapeutic regimen

    >To assess feeding

    tolerance

    Goal Met.

    The patientexhibited signs ofrehydration. TheChilds bowelmovementdecreased from 8times to 2, mucousmembranes are

    moist.

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    Medical diagnosis:Acute Gastroenteritis with some signs of DehydrationNursing Diagnosis: Hyperthermia r/t present illness as evidenced by temperature of 38.8OCShort term goal:At the end of my 8hr shift, the patients body temperature will decrease from 38.8OC to 37.5OC.Long term goal:At the end of hospitalization, the patient will be able to maintain core temperature within normal range.

    Cues Problem Scientific reason Nursing

    intervention

    Rationale Evaluation

    Subjective:

    Nilalagnat siya,as verbalized bythe mother of thepatient.

    Objective:

    -Febrile with VS asfollows:

    T- 38.9OC

    P- 150 bpm

    R- 50 cpm

    -Flushed skin;Warm to touch

    -Pale looking

    -Poor skin turgor

    -Dry skin

    Hyperthermia

    Body temperature

    elevated above

    normal range.

    Reference:Nurses PocketGuide: 10thEdition

    -Provided a calm andwell -ventilatedenvironment.

    -Encouragedopportunities for rest.

    -Tepid Sponge Bathrendered and keptclothes light & clean.

    -Encouraged toincrease oral fluid

    intake.

    -To promote betterquality of rest.

    -To prevent / lessenfatigue.

    -To promotecomfort and surfacecooling. In

    pediatrics, tepidwater is preferred

    because, cold-watersponges canincrease shivering.

    -To promotehydration

    Goal Partially

    Met.

    The patientmanifesteddecrease of bodytemperature from

    38.8OC to 37.5OC

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    Admitting diagnosis:Acute Gastroenteritis with some signs of Dehydration

    Nursing Diagnosis:

    Short term goal:

    Long term goal:

    Cues Problem Scientific reason Nursing

    intervention

    Rationale Evaluation

    Subjective:

    Objective:

    Goal Partially Met.