CHAPTER I INTRODUCTION Gastr

CHAPTER 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 or intestinal flu, although the influenza virus is not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications such as dehydration. 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 Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeriamonocytogenes 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.
Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms in the United States annually. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.
Gastroenteritis is a general term referring to inflammation or infection of the gastrointestinal tract, primarily the stomach and intestines. It can be caused by infection with bacteria, viruses, or other parasites, or less commonly reactions to new foods or medications. It often involves stomach pain (sometimes to the point of crippling), diarrhea and/or vomiting, with non inflammatory 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. As such, this has a relationship on the concept fluids and 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.

In doing this case study the group was guided by the following patient and family centered objectives.
* The patient will receive efficient and quality nursing care interventions by the HCP to achieve his needs in collaboration with the other members of the health team.
* The patient will have improved health condition through appropriate nursing care.
* The patient will have controlled manifestations of the disease.
* The family will gain information and knowledge about the current disease (acute gastroenteritis) of their family member and how they can cope with it.
* The family will be able to learn more about the proper management of cases such as the acute gastroenteritis.

CHAPTER II
NURSING HEALTH HISTORY

I. Biographic Data
Patient RJV a 1 year old and 6 months female, resided ay Dalangaya Este, San Fernando City La Union. She was born on July 20,2009.She is a Filipino citizen and is affiliated with the Roman Catholic religion. She is the only child of Mr. AV and Mrs. JV.
II. Reason for Health concern
On Jan.28, this year, patient started to have cough. Patient was self medicated with guaifenesin sodium citrate dextromethphamHBr and cefalexic 1 teaspoon a day. On feb. 3 due to persistent cough with diarrhea ,patient brought to emergency of Ilocos Training and Regional Medical Center. It was managed as AGE and was given. Patient was admitted in this day.
III. History of Present Condition
On Jan.28,2011 patient RJV stared to have cough after few days she have diarrhea. Then as day passes by, her cough and diarrhea becomes persistent. She loss her appetite and she experienced nausea and vomiting.
IV. Past Health History
Patient RJV had never been sick and never seek medical attention before the recent hospitalization.
V. Family Health History
Patient RJV’s father has a history of anemic and Heart disease in their family. On the other hand, patient RJV’s mother has a history of hypertension and diabetic in their family.
VI. Life Style and Health Practice
According to his Father , Patient RJV usually wakes up at 6 or 7 am. Then, she will eat her breakfast of fried egg with rice or pandesal dipped in milk and sometimes a noodles that is prepared by his mother. After than, her mother will take her to have a bath. Then, she will play with her auntie at their house. Her mother will encourage her to sleep for about 2-3 hours. When she wake up, She will again play with auntie in their house. During the evening after eating her dinner, she will watch her favorite show in the television until 8 pm. After that, her mother will take her to bed and sleep.
Patient RJV’sdiet is mainly composed of egg, noodles, vegetable, rice, biscuits and junk foods. She eat at least four times a day.
According to his father, they using herbal plants like urigano and pinggapinga. In times of serious idleness, they usually seek health care at their Barangay Heath Center and at ITRMC.

VII. Developmental Task
According to Erick Ericson’s theory of psychosocial developmental, patient RJV is under Autonomy vs. Shame. In this stage, the patient his here we have the opportunity to build self-esteem and autonomy as we gain more control over our bodies and acquire new skills, learning right from wrong. If we’re shamed in the process of toilet training or in learning other important skills, we may feel great shame and doubt of our capabilities and suffer low self-esteem as a result.
CHAPTER III
PHYSICAL ASSESSMENT

I. General Appearance
Upon assessment, which was performed on February 5, 2011 at 1:30 pm, patient is seen cuddled by mother, irritable with an IVF of D5W 500 ml on her right hand. Patient appears to be weak. The patient cannot communicate verbally and often cries . Thus, the patient expresses himself with non-verbal hand signals and facial expressions. The client needs full support in caring for herself.
A. Vital signs
BP- 90/60
PR- 140 bpm
TEMP- 37.5°C
RR- 33
II. Integument
1. Skin
The skin of the client is light brown, tanned skin (vary according to race).
Head and Neck
A. Head
The client’s head is normocephalic and symmetrical. There were no lesions seen and palpated. The hair is well distributed, no nits and lice observed.

B. Eyes
Eyes are parallel to each other but slightly sunken.Pupils equally round, reactive to light and accommodation . Eyebrows are symmetrical in size, extension,hair texture and movement.Conjunctiva are transparent with light pink color. Pupils are black and constrict.
C. Ears
The ears are symmetrically aligned and the color is same as the facial skin, it is firm and not tender. No serum and discharges noted and the patient hear the normal voice.
D. Nose
The nose is symmetrically aligned with the face, no discharges or flaring nares. It is the same color with the face. It is not tender and no lesions present. The mucosa is pink.
E. Mouth and Pharynx
The Lips are pink , moist and symmetric.
F. Neck
Neck is slightly hyper extended without masses or asymmetry.
2. Thorax and Lungs
The chest contour is symmetrical, the spine is vertically aligned. The chest wall is intact, no tenderness or no masses noted. No lesions were noted. Upon auscultation, there were no crackles, wheezes, and heart murmurs heard.
3. Heart
There are no palpitations noted. There is no presence of abnormal pulsations when the heart was auscultated. No murmurs and friction rubs heard upon auscultation.
4. Upper Extremities
Upper extremities are symmetrical. No lesions noted. The skin is warm to touch. The phalanges are prominent. Nails are transparent , smooth and convex. Uncut and dirty. White color of nail bed under pressure returned to pink within 3 seconds.
5. Lower Extremities
Lower extremities are symmetrical. There is a dark-brown color on his both lower legs observed. No lesions noted. Skin is warm to touch. Peripheral pulses are equal. No bipedal edema noted.
6. Abdomen
The abdomen is intact with dark-brown color on epigastria. With normal bowel sound heard upon auscultation. No pain or rebound tenderness noted during palpation.

7. Genitalia
Not assessed
8. Neurological Evaluation
Fully conscious , respond quickly to stimulus.

CHAPTER IV
ANATOMY AND PHYSIOLOGY
ANATOMY OF 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 the windpipe 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 small intestine. 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 the intestinal 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 the large 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
CHAPTER V

PATHOPHYSIOLOGY

Pathophysiology of Acute Gastroenteritis
At risk factors:
* Young children
* Elderly

CHAPTER VI
LABORATORY RESULT
Name: RJV Created: February 3, 2011
Ward: Pediatric ward Sex: Female Age: 1 year and 6 months

TEST RESULT/UNIT REFERENCE RANGE FLAG INTERPRETATION HEMOGLOBIN 11.8 g/L 12.0-18.0 L Dehydration and polycythemia RBC COUNT 3.66 3.50-5.60×106/ul NORMAL WBC COUNT 8.8 5.0-10.0×103/L NORMAL SEGMENTERS 74 45.0-70% H LYMPHOCYTES 26 25-45% NORMAL
CHAPTER IX
EVALUATION
Before any nursing intervention, we made it a point that we were able to understand the disease itself and its proper management. Rendering health teaching to the mother is one of the important tools to help promote the health of the patient. We established a trusting relationship with the patient which enable us to provide efficient nursing care. A good nurse-patient interaction plays a vital role in meeting the objective.
We the student discussed about the disease of the patient and how it is acquired. Upon discharge, R.J.V was still advised to increase fluid intake and periodic complete emptying of urinary bladder and thorough handwashing.Proper hygiene of both child and parent are very important as defense from infection.Proper and strict supervision of child until balance, gait, and coordination is gained.Advised to restrict child from handling items or objects especially if unfamiliar and not edible.Emphasize importance of handwashing and nail care.
Client was discharge on February 5, 2011.Last advises and follow up check ups were reminded.
A Case Study
On
Acute Gastroenteritis
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Presented to:
Ms. Charina Posadas
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In Partial Fulfillment of the Requirements
In
Related Learning Experience

Presented by:
Agapinan,Maria Angelica
Antonio,Julie Ann
Bermio, Jhiee Ann
Bistoyong, Ellaine
Caasi, Michael
Liclican, Danessa
Obrero,Mary June
Paguirigan,Michelle
Parrocha,Marie Joy
Parrocha,Ayra Zalea
Valdez, Rachel Anne
Villaruz, Marjorie