PAPER OF MEDICAL SURGICAL NURSING

GASTROENTERITIS

Created by
Ahmad Fauzan
Ervina Martha
Marifatulloh A.A
Risma Yunita
Tiara Uswatun

SUPERIOR PROGRAM
HEALTH POLYTECHNIC OF JAKARTA III
2013
1

Contains
Chapter I
1.1.

Background

3
1.2.
Purpose
.3
1.3.
Scope

of

writing..3
1.4.
Writing
Methodology..4
1.5.
Writing
Systematic....4

Chapter II
2.1 Definition
.5
2.2 Anatomy and
physiology..5
2.3 Pathophysiology
/Etiology..6
2.4 Pathologic
Changes.6
2.5 Type of
Gastroenteritis.7
2.6 Signs and
Symptoms..7
2.7 Incidence
/Prevalence7

2.8 Diagnostic
Examination..8
2.9 Medical
Treatment...8
2.10
Pharmacology...8
2.11 Nursing Care
Plan...9

Chapter III
3.1
Conclusion15

CHAPTER I
INTRODUCTION

1.1

Background
Gastroenteritis or infectious

diarrhea is

medical

condition

characterized by inflammation ("-itis") of the gastrointestinal tract that

involves

both

the stomach ("gastro"-)

intestine ("entero"-),

resulting

of diarrhea, vomiting,

and

[1]

in

and
some

abdominal pain

the small
combination

and

cramping.

Gastroenteritis has also been referred to as gastro, stomach bug,

and stomach virus. Although unrelated to influenza, it has also been

called stomach flu and gastric flu.

1.2

Purpose

1.2.1 To fulfill the task from Medical Surgical Nursing 1 subjects.

3

1.2.2 Discuss the anatomy and physiology.

1.2.3 Define the role of Gastroenteritis
1.2.4 Identify the signs, symptoms, laboratory values, and clinical
images of Gastroenteritis
1.2.5 State the principles underlying

emergency

treatment

of

Gastroenteritis.
1.2.6 Summarize prevention measures for Gastroenteritis
1.2.7 Define the nursing care plan for client with Gastroenteritis

1.3

Scope of writing
Writer describe this paper with the scope of

Gastroenteritis

including the anatomy, physiology, and pathophysiology, kinds of

Gastroenteritis, and continue to the nursing part, which are the
assessment of client with Gastroenteritis, the physical assessment to
client with Gastroenteritis s, the nursing care plan for client with
Gastroenteritis, and the laboratory test needed to client with
Gastroenteritis.

1.4

Writing Methodology
The author uses the literature method which is a method that

performed by studying and collecting data from the literature related

to the tasks, either from books, booklets, and information on the
internet. We Also the discussion method which is obtaining data by
directly asking the Responsible consultation and friends who know
about the necessary information in making this paper.

1.5

Writing Systematic
This paper consists of 4 chapters, the 1 st chapter is the

introduction, the 2nd chapter is about the theoretical background, and

the 3rd chapter is the practice, 4th treatment and Nursing Care Plan,
and the last chapter is the conclusion. And we also add some
attachment

to

this

paper

about

Gastroenteritis.

the

Nursing

Diagnosis

of

CHAPTER II
THEORY
2.1 Definition
Gastroenteritis (GE) is an inflammation of the mucous membranes of the
stomach and intestinal tract .It primarily affects the small bowel and can be
of either viral or bacterial origin.Both the viral and bacterial forms have
similar manifestations and are considered self-limiting in their course unless
complications occur.All organisms that are implicated in gastroenteritis cause
diarrhea

2.2 Anatomy and physiology

 The intestines are a long, continuous tube running from the stomach to
the anus. Most absorption of nutrients and water happen in the
intestines. The intestines include the small intestine, large intestine,
and rectum.
The small intestine (small bowel) is about 20 feet long and about an
inch in diameter. Its job is to absorb most of the nutrients from what
we eat and drink. Velvety tissue lines the small intestine, which is
divided into the duodenum, jejunum, and ileum.
The large intestine (colon or large bowel) is about 5 feet long and
about 3 inches in diameter. The colon absorbs water from wastes,
creating stool. As stool enters the rectum, nerves there create the urge
to defecate.

2.3 Pathophysiology /Etiology

Both viral and bacterial organisms entering the intestinal tract cause an
inflammatory response and the resulting symptoms of gastroenteritis in one
of following ways :
The organism releases enterotoxin ,which acts on the small intestine
,causing local inflammation ,which results in diarrhea (e.g,some
shigella forms and enterotoxigenic E.coli)
The organism penetrates the intestine,causing cellular
destruction,necrosis,and a potential for ulceration.Diarrhea

occurs,often with white blood cells or red blood cells (e.g.,Shigella and
campylobacter).
The organism attaches to mucosal epithelium but does not penetrate
it.Cells of the intestinal villi are destroyed,and malabsorption results
(e.g rotavirus).

2.4 Pathologic Changes

Both viral and bacterial organisms entering the intestinal tract cause an
inflammatory response and the resulting symptoms of gastroenteritis in one
of following ways :

The organism releases enterotoxin ,which acts on the small intestine

,causing local inflammation ,which results in diarrhea (e.g,some
shigella forms and enterotoxigenic E.coli)
The organism penetrates the intestine,causing cellular
destruction,necrosis,and a potential for ulceration.Diarrhea
occurs,often with white blood cells or red blood cells (e.g.,Shigella and
campylobacter).
The organism attaches to mucosal epithelium but does not penetrate
it.Cells of the intestinal villi are destroyed,and malabsorption results
(e.g rotavirus).

All of these situations result in increased gastrointestinal (GI)motility,with

fluidsband electrolytes being secreted into the intestine at fast
rates.Invading organisms have increased capabilities of attaching to the
intestinal mucosa if the normal flora is altered.This can occur in clients who
are receiving antibiotics,who are malnourished and who are debilitated.

2.5 Type of Gastroenteritis

Viral Gastroenteritis .Viral Gastroenteritis can be an epidemic viral type or a
rotavirus type.

Epidemic viral gastroenteritis can be caused by many types of parvovirus-like

organisms.The reservoir of these viruses is humans,and the viruses are
transmitted via the fecal-oral route in food and water .
Bacterial Gastroenteritis.There are three general types of bacterial
gastroenteritis :

Campylobacter enteritis
E.coli diarrhea
Shigellosis

2.6 Signs and Symptoms

Symptoms depend on the type of bacteria that caused the sickness. All types
of food poisoning cause diarrhea. Other symptoms include:

Abdominal cramps

Abdominal pain

Bloody stools

Loss of appetite

Nausea and vomiting

The main symptom is diarrhoea, often with vomiting as well. Diarrhoea

means loose or watery stools (faeces), usually at least three times in
24 hours. Blood or mucus can appear in the stools with some
infections.

Crampy pains in your abdomen (tummy) are common. Pains may ease
for a while each time you pass some diarrhoea.

A high temperature (fever), headache and aching limbs sometimes

occur.

If vomiting occurs, it often lasts only a day or so, but sometimes longer.
Diarrhoea often continues after the vomiting stops and commonly lasts for
several days or more. Slightly loose stools may persist for a week or so
further before a normal pattern returns. Sometimes the symptoms last
longer.
2.7

Incidence /Prevalence
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Epidemic viral gastroenteritis occurs throughout the world and is very

common.As its name suggests,this disease often occurs in epidemic
outbreaks among groups of people.Campylobacter enteritis occurs
worldwide ,commonly in epidemic outbreak.Its incidence is highest during
warm months.
Diarrhea caused by E.Coli also occurs worldwide,commonly in epidemics.The
highest incidence is in areas of poor sanitation during warm months.
Shigellosis occurs worldwide in every age group but is most frequent in
children under the age of 10 years.Children and the elderly are more
susceptible to shigella because of their immature or depressed immune
systems.Outbreaks of shigellosis are common in areas with crowded living
conditions.

2.8 Diagnostic Examination

Laboratory tests include:
Feces examination
Macroscopic and microscopic.
pH and sugar content in feces with litmus paper and tablets dinistest, if there
is suspected glucose intolerance.
If necessary, perform the examination culture and resistance testing.
Blood Examination
blood pH and reserve multiplied and electrolytes (sodium, potassium,
calcium and phosphorus) in serum to determine the Asama-base balance.
Levels of urea and kreatmin to determine kidney function.
Doudenal Intubation
To know the micro-organism or parasite qualitatively and quantitatively,
especially done in patients with chronic diarrhea.

2.9 Medical Treatment

Giving fluids.
Diatetik: provision of food and special drinks on patients with the aim
of healing and maintaining health as for things to note: Provide food
that contains calories, protein, vitamins, minerals and food clean.

2.10 Pharmacology
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Organism

Antibiotic

Vibrio cholerae

Ciprofloxacin, Doxycycline, TMP/SM

Clostridium difficile

Metronidazole, Vancomycin, Fidaxo

Shigella

Ciprofloxacin, TMP/SMX

Giardia intestinalis (lamblia)

Metronidazole, Nitazoxanide

Entamoeba histolytica

Nitazoxanide

Campylobacter jejuni

Azithromycin, Ciprofloxacin

2.11 Nursing Care Plan

A. Assessment
The identity of the client :

anxiety
increased body temperature(fever)
anorexia
diarrhea.
nausea,
vomiting,
weight loss
The pattern of sleep and rest will be disturbed because of abdominal
distension that would cause discomfort.
Pattern hygiene: bathing habits every day.
Activities: will be disturbed because the body is very weakness and the
pain due to abdominal distension.
The main complaint:

the more liquid Faeces,

vomiting,
if losing a lot of water and electrolytes occur symptoms of dehydration,
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body weight decreased.

In infants :

sunken fontanel large,

tone and reduced skin turgor,
mucous membranes of the mouth and lips dry,
defecation frequency more than 4 times with watery consistency.
Past medical history :

History of the illness,

history of immunization.
Family psychosocial history.
Treated will be a stressor for the child itself and for the family, the
anxiety increases if the parents do not know the procedure and
treatment of children, after realizing her illness, they will react with
anger and guilt.
Basic needs.
The pattern of elimination: will change the defecation more than 4
times a day, urinate few or rare.
Physical examination.
Psychological examination: general condition seemed weak,
composmentis to coma, high body temperature, rapid and weak pulse,
breathing rather quickly.
Systematic examination:

Inspection: sunken eyes, large fontanel, mucous membranes, mouth

and dry lips, weight loss, anal redness.
Percussion: presence of abdominal distension.
Palpation: less elastic skin turgor.
Auscultation: bowel sounds hearing.

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B. Nursing Diagnosis
Volume of fluid and electrolyte deficit is less than body
requirements related to excessive fluid output.
Impaired nutritional needs less than the body needs related with
nausea and vomiting.
Impaired skin integrity related to the irritation, the frequency of
excessive.
Impaired sense of comfort pain associated with abdominal
distension.
Lack of knowledge related to the lack of information about
illness, prognosis and treatment.
Anxiety associated with separation from parents, a scary
procedure.

C. Intervention
Diagnosis 1.
Volume of fluid and electrolyte deficit is less than body requirements
related to excessive fluid output.
Objectives:
Devisit fluid and electrolyte resolved
Criteria results:
Signs of dehydration are not available, oral mucosa and lips moist, wellbalanced fluid balan
Intervention
Observation of vital signs. Observation for signs of dehydration. Measure
input and output of fluid (balaningg fluid). Provide and encourage families
to provide drinking a lot less than 2000 - 2500 cc per day. Collaboration
with physicians in providing therapy fluid, electrolyte lab examination.
Collaboration with the nutrition team in the provision of low-sodium fluids.

Diagnosis 2.
Impaired nutritional needs less than the body needs related with nausea
and vomiting.
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Objectives:
Impaired nutritional needs resolved
Criteria results:
Clients increased nutritional intake, diet out 1 portion of which is provided,
nausea, vomiting does not exist.
Intervention:
Assess client's nutritional patterns and changes that occur. Weigh weight
loss clients. Assess the factors causing the fulfillment of nutritional
disorders. Perform physical examination of the abdomen (palpation,
percussion, and auscultation). Give a warm conditions and diet in small
portions but frequently. Collaboration with a team of nutrition in
determining the client's diet.

Diagnosis 3.
Impaired skin integrity related to the irritation, the frequency of excessive
defecation .
Objectives:
Impaired skin integrity resolved
Criteria results:
Skin integrity returns to normal, no irritation, signs of infection does not exist
Intervention:
frequent stools that are rich in electrolytes and enzymes,and frequent wiping
and washing of the anal region can irritate the skin.The nurse teaches the
client to avoid toilet paper,washcloths,towels and harsh soaps.Ideally,the
client can gently clean the area with warm water or absorbent
cotton,followed by thorough,drying with absorbent cotton.If stool sticks to
excoriated skin ,the client can apply a cream oil or gel on a damp,warm
washcloth to facilitate removal of stool hydrocortisone cream or protective
barrier cream should be applied to the skin between stools.

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Diagnosis 4.
Impaired sense of comfort pain associated with abdominal distension.
Objectives:
Pain can be resolved
Criteria results:
Pain can be reduced , calm facial expression
Intervention:
Observation of vital signs. Assess the level of pain. Set a comfortable
position for the client. Give a warm compress on the area abdoment.
Collaboration with physicians in providing therafi analgesics as indicated.
Diagnosis 5.
Lack of knowledge related to the lack of information about illness, prognosis
and treatment.
Objectives:
Increasing family knowledge
Criteria results:
Client families with the disease process client horrible, calm facial
expression, many families are not asked again about the client's disease
process.
Intervention:
Assess client's level of family education. Assess the level family knowledge
about the disease process client. Explain about the disease process with the
client through health education. Provide opportunities for families when there
is not incomprehensible. Involve families in the provision of action on the
client.
D. Evaluation
The volume of fluid and electrolytes returned to normal as needed.
Nutritional needs are met in accordance to basic human needs.
Skin integrity back normal.

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Sense of comfort are met.

Knowledge ancestry increases.

Health Teaching
The nurse teaches the client and the family about the importance of
minimizing the risk of transmission of gastroenteritis.Clients are advised to

Wash their hands meticulously with an antibacterial soap,especially

after bowel movements.
Restrict the useof glasses,dishes,eating utensils,and tubes of
toothpaste to themselves only
Maintain clean bathroom facilities to avoid exposure to stool.
Maintain good personal hygiene.

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CHAPTER III
CONCLUSION
3.1

Conclusion

A self-limiting disorder,gastroenteritis (also called intestinal flu,traveler

diarrhea ,viral enteritis ,food poisoning)is an inflammation of the stomach
and small intestine.The bowel reacts to any of the varied causes of
gastroenteritis with hypermotility ,producing severe diarrhea and secondary
depletion of intrcellular fluid.
A major cause of morbidity and mortality in developing
nations,gastroenteritis occurs in people of all ages.This disorder ranks
second to the common cold as a cause of lost work time and fifth as the
cause of death among young children.It can also be lifethreatening in elderly
and debilitated patients.

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