TABLE OF CONTENTS

 Dedication i

 Acknowledgement ii

 Introduction 5-6

 Review of Related Literature 7-31

 Nursing Health History 32-33

 Client Health History 34

 Treatments/ Medications 34

 Past Illness/Hospitalization 34

 Allergies 34

 Developmental History 34

 Nutritional Metabolic Pattern 35

 Elimination Pattern 35

 Activity Exercise Pattern 36

 Sexuality Reproduction Pattern 36

 Sleep-Rest Pattern 36

 Sensory-Perceptual Pattern 37

 Cognitive Pattern 37

 Role Relationship Pattern 37

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  Self-Perception-Self-Concept Pattern 38

 Coping Stress Tolerance 38

 Value Belief Pattern 38

 Health History 38

 History of Present Illness 38

 Past History 39

 Physical Examination 40

 General Physical Survey 40

 Mental Status Examination 40

 Skin 40

 Head and Face 40

 Eyes 41

 Ears and Nose 41

 Mouth and Throat 41

 Neck 42

 Arms, Hands and Fingers 42

 Posterior and Lateral Chest 42

 Anterior Chest 42

 Breasts (Male) 43

 Heart 43

 Abdomen 43

 Legs, Feet and Toes 43

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  Genitalia (Male) 43

 Musculoskeletal and Neurologic Examination 44

 Cranial Nerve Assessment 45-46

 Review of System 47

 General Survey 47

 Integumentary System 47

 EENT 47

 Gastrointestinal System 48

 Musculoskeletal System 48

 Neurologic System 48

 Urinary System 48

 Reproductive System 48

 Hematologic 49

 Endocrine 49

 Psychiatric 49

 Laboratory Results 50

 Hematology 50-51

 Blood Chemistry 52-53

 Urinalysis 54

 Stool Exam 55-56

 Anatomy and Physiology 57-70

 Pathophysiology 71-74

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 Drug Study 75-84

 Nursing Care Plan 85-97

 Discharge Plan 98-99

 Appendices 100

 IVF Chart 100

 Daily Weight 100

 Vital Signs 101

 I and O Sheet 102

 CFAC 103

 Genogram 104

 References 105

4
 INTRODUCTION

According to World Health Organization 2005( A manual for Physicians and other

Senior Health Workers by Ellis D. Avner, MD page 40-41 Chapter 3 Vol. 1 15th edition). Acute

diarrhea or gastroenteritis is the passage of loose stools more frequently than what is normal for

that individual. This increased frequency is often associated with stools that are watery or

semisolid, abdominal cramps and bloating. Acute watery diarrhea is an extremely common

problem, and can be fatal due to severe dehydration, in both adults and children, especially in the

very young and the old or in those who have poor immunity such as individuals with HIV

infection or patients who are using certain medications that suppress the immune system.

Gastroenteritis means inflammation of the stomach and small and large intestines. Viral

gastroenteritis is an infection caused by a variety of viruses that result in vomiting or diarrhea or

both. It is often called the "stomach flu," although it is not caused by the influenza viruses.

Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella,

Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Each

organism causes slightly different symptoms 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 problematic. Persons can reduce their chance of getting infected by frequent

hand washing, prompt disinfection of contaminated surfaces with household chlorine bleach-

based cleaners, and prompt washing of soiled articles of clothing.

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 If food or water is thought to be contaminated, it should be avoided. Since most cases

of acute watery diarrhea are infectious, especially in developing countries, the majority of such

illnesses can be prevented by drinking water or eating foods that are not contaminated with

infectious agents. Washing hands frequently with non-contaminated water, when caring for a

patient with diarrhea as also always before eating is important. Proper storage of food and water

is also important to prevent harmful bacteria from contaminating them. Other symptoms include

nausea, vomiting, loss of appetite, belching, and bloating. Occasionally, acute abdominal pain

can be a presenting symptom. Dehydration is a common complication of diarrhea. children,

though it is certainly possible for adults to suffer from it as well. While most cases of

gastroenteritis last a few days, acute gastroenteritis can last for weeks and months.

P. Y. a one year old and eight months child residing in Barangay Rizal, Surigao City,

Surigao del Norte was admitted at Surigao Medical Center last January 24, 2019 at exactly 8:54

am with chief complain of loss bowel movement and vomiting for further management. Patient

P. Y was diagnosed ACUTE GASTROENTERITIS with Moderate Dehydration.

The second year students chose the case of Patient P. Y to gain more knowledge and

experience in the field of nursing to establish holistic approach to the S.O and to the patient

promoting for optimal health of the patient’s condition. Enhance critical thinking and skills that

can be useful in the future as to provide appropriate nursing care to our clients. Also this output

will be useful for future purposes related to the case ACUTE GASTROENTERITIS with

Moderate Dehydration.

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 REVIEW OF RELATED LITERATURE

According to the Centers for Disease Control and Prevention or CDC(Gastroenteritis

outbreaks in Health Care Settings by Kurt B. Stevenson, MD page 55-58 Chapter 22 volume 1

7th Edition) Gastroenteritis, also known as infectious diarrhea, is inflammation of the

gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea,

vomiting and abdominal pain, lack of energy and dehydration may also occur. This typically lasts

less than two weeks. It is not related to influenza, though it has been called the "stomach flu".

Gastroenteritis is usually caused by viruses. However, bacteria, parasites and fungus can

also cause gastroenteritis. In children, rotavirus is the most common cause of severe disease. In

adults, norovirus and Campylobacter(is a genus of Gram-negative bacteria, Campylobacter

typically appear comma- or s-shaped, and are motile) are common causes. Eating improperly

prepared food, drinking contaminated water or close contact with a person who is infected can

spread the disease. Treatment is generally the same with or without a definitive diagnosis, so

testing to confirm is usually not needed.

Prevention includes hand washing with soap, drinking clean water, proper disposal of

human waste and breastfeeding babies instead of using formula. The rotavirus is recommended

as a prevention for children. Treatment involves getting enough fluids. For mild or moderate

cases, this can typically be achieved by drinking oral rehydration solution(a combination of

water, salts and sugar).In those who are breastfed, continued breastfeeding is recommended. For

more severe cases, intravenous fluids may be needed. Antibiotics are recommended for young

children with a fever, diarrhea, vomiting and abdominal pain. Vectors such as cockroaches, flies,

and rodents can also transmit the infection.

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 In 2015, there were two billion cases of gastroenteritis, resulting in 1.3 million deaths

globally. Children and those in the developing world are affected the most. In 2011, there were

about 1.7 billion cases, resulting in about 700,000 deaths of children under the age of five. In the

developing world, children less than two years of age frequently get six or more infections a

year. It is less common in adults, partly due to the development of immunity.

Gastroenteritis may also be a symptom of another infection such as influenza, when the

infecting bacteria may spread to the bowel via the bloodstream. When vomiting and diarrhea

accompany flu symptoms, this is often referred to as “gastric flu”. Gastroenteritis in babies is

most common in bottlefed babies and is usually the result of poor sterilization of feeding

equipment

What should you do first?

First, stop all foods and milk and give your child only water in small amounts every 15

minutes. Next, put your child to bed with a bowl by the bed in case he vomits. Lastly, make sure

he washes his hands after going to the toilet to prevent the spread of the infection.( Baby and

Child Health Care by Dr. Miriam Stoppard page 140 volume 1 3rd edition)

Classification and Types of Gastroenteritis or Gastric Flu or Tummy Bug or Gastro

Viral Gastroenteritis is highly contagious in nature and is most common form of

gastroenteritis. It could spread with close interaction with infected people, contaminated food,

contaminated water, the sharing of eating utensils, poor hygiene habits, the elderly living in

nursing homes, students living in student halls and even children in nurseries and preschools all

may be at higher risk of developing viral gastroenteritis due to the close proximity in which they

breathe and interact. This virus is truly responsible for the infection and could easily spread

8
through the air or through close contact. Bacterial Gastroenteritis is uncommon and generally

very serious in nature. The infection in bacterial gastroenteritis could spread through poor

hygiene habits, contact with infected people, the sharing of eating utensils, contaminated water

and contaminated food. The reason behind parasitic infections could spread through a contact

with infected human or animal wastes, drinking of contaminated water and ingestion of raw

seafood. Eosinophilic Gastroenteritis is also quite less common. Both adults and young

children could be affected with it. The signs of this gastroenteritis are inclusion of other organs in

the body aside from the gastrointestinal tract, lack of known cause for eosinophilia, and pain in

the abdomen. Cryptosporidiosis Gastroenteritis is caused by the parasite named

Cryptosporidium. The reason behind Cryptosporidiosis could be the parasites taken in by mouth

through infected water and food, or from individual to individual or animal to individual. This

disease is mild, but can seriously affect the individuals with weak immune system. Major sources

of cryptosporidiosis could be contaminated water supplies, public swimming pools and child

care centers.

Signs and Symptoms

Gastroenteritis usually involves both diarrhea and vomiting. Sometimes, only one or the

other is present .This may be accompanied by abdominal cramps. Signs and symptoms usually

begin 12–72hours after contracting the infectious agent. If due to a virus, the condition usually

resolves within one week. Some viral infections also involve fever, fatigue, headache and muscle

pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial.

Some bacterial infections cause severe abdominal pain and may persist for several weeks.

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Risk Factors

Close interaction with infected people, Contaminated food, Contaminated water, The

sharing of eating utensils, Poor hygiene habits, the Elderly living in nursing homes, students

living in student halls and even children in nurseries and preschools, contact with infected human

or animal wastes, drinking of contaminated water and ingestion of raw seafood all may be at

higher risk. (The 5-Minute Pediatric Consult by Pramod Kerkar,MD,FFARCSI page 60-64

Chapter 50 Volume 1 8th Edition)

Complications

Electrolyte disturbance is impairment in the level of electrolytes in the body.

Dehydration is an abnormal condition in which the body's cells are deprived of an adequate

amount of water. Dehydration can be the result of conditions that cause the body to lose too

much water, such as excessive heat, sweating, illness, low humidity, medication side effects, and

high elevation, such as in the mountains. Dehydration can also be the result of not drinking

enough water and fluids. Dehydration can be mild, moderate or severe and life-threatening.

Infants, children, athletes and the elderly are particularly prone to dehydration and severe

complications, although dehydration can occur in any age group or population. In an otherwise

healthy person, dehydration can be prevented by drinking about eight eight ounce glasses of

water per day. Shock is a severe condition from reduced blood circulation. Delirium is a severe

state of mental confusion. Metabolic acidosis is a condition that occurs when the body produces

excessive quantities of acid or when the kidneys are not removing enough acid from the body. If

unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to

increased production of hydrogen ions by the body or the inability of the body to form

bicarbonate(HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious,

10
including coma and death. Together with respiratory acidosis, it is one of the two general causes

of acidemia. Ketosis - is a nutritional process characterized by serum concentrations of ketone

bodies over 0.5mM, with low and stable levels of insulin and blood glucose. It is almost always

generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood

throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are

depleted (or from metabolizing medium-chain triglycerides. Ketones can also be consumed in

exogenous ketone foods and supplements. Renal failure - is a serious medical condition

affecting the kidneys. When a person suffers from this condition, their kidneys are not

functioning properly or no longer work at all. Renal failure can be a progressive disease or a

temporary one depending on the cause and available treatment options.(Gastroenteritis by

Elizabeth Jane Elliott page 40 Chapter 4 volume 1 7th edition)

Prognosis:

Prognosis is usually excellent if an appropriate state of hydration is kept. Rapid

dehydration and difficult rehydration may be an issue in children, old people and those that are

immunodeficient or suffer from other comorbidities. Intravenous rehydration is often required in

these cases. Prognosis worsens significantly with the inability to compensate for fluid loss

sustained through vomitus and diarrhea. (https://www.symptoma.com/en/info/acute-

gastroenteritis. Amador JJ, Vicari A, Turcios-Ruiz RM, et al. Outbreak of rotavirus

gastroenteritis with high mortality, Nicaragua, 2005. Rev Panam Salud Publica. 2008; 23(4):277-

284.)

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Prevention:

There are some actions people can do to prevent or reduce the chance of getting

gastroenteritis including wash hands thoroughly, do not eat undercooked foods especially meats,

do not eat or drink raw foods, boil untreated water, do not drink untreated or unpasteurized

fluids, especially milk, thoroughly wash any produce (e.g. fruits, vegetables) before eating, drink

only well-sealed bottled or carbonated water, avoid ice cubes, because they may be made from

contaminated water, use bottled water to brush your teeth, avoid raw food including peeled

fruits, raw vegetables and salads (which has been touched by human hands), and avoid

undercooked meat and fish. (Gastroenteritis Care by Hal B. Jenson, MD page 20 Chapter 1

volume 1 2nd Edition )

Test and Diagnosis:

Diagnosis of AGE is based on the patient's medical history and clinical examination.

Additional diagnostic measures are rarely required but may be carried out in more severe cases

to assess water and electrolyte imbalances. Also, if diarrhea persists for more than four days,

stool samples may be obtained for further analysis as to the cause of the disease. (Chhabra P,

Payne DC, Szilagyi PG, et al. Etiology of viral gastroenteritis in children.

https://www.symptoma.com/en/info/acute-gastroenteritis)

Stool Exam - A stool analysis is a series of tests done on a stool (feces) sample to help diagnose

certain conditions affecting the digestive tract. These conditions can include infection (such as

from parasites, viruses, or bacteria), poor nutrient absorption, or cancer.

For a stool analysis, a stool sample is collected in a clean container and then sent to the

laboratory. Laboratory analysis includes microscopic examination, chemical tests, and

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microbiologic tests. The stool will be checked for color, consistency, amount, shape, odor, and

the presence of mucus. The stool may be examined for hidden (occult) blood, fat, meat fibers,

bile, white blood cells, and sugars called reducing substances. The pH of the stool also may be

measured. A stool culture is done to find out if bacteria may be causing an infection (Bacterial

Infection of the Gastrointestinal tract by Wolters Kluwer Health/Lippincott Williams & Wilkins,

2009. page 3500 Chapter 300 volume 2 3rd Edition)

Culture - Cultures can be performed either with fecal or rectal biopsy specimens or with liver

abscess aspirates. Culture has a success rate of 50-70%, but it is technically difficult. Overall,

culture is less sensitive than microscopy.

Xenic cultivation, first introduced in 1925, is defined as the growth of the parasite in the

presence of an undefined flora. This technique is still in use today, using modified Locke-egg

media. Axenic cultivation, first achieved in 1961, involves growing the parasite in the absence of

any other metabolizing cells. Only a few strains of E dispar have been reported to be viable in

axenic cultures.

Medication/Treatment

Several antibiotics are available to treat acute gastroenteritis. Treatment must be

prescribed by a physician. You probably will be treated with three antibiotics if your infection

has made you sick.

Acute Gastroenteritis with Moderate dehydration is treated with Erceflora contributes to

the recovery of the intestinal microbial flora altered during the course of microbial disorders of

diverse origin, produces various vitamins, particularly group B vitamins thus contributing to

correction of vitamin disorders caused by antibiotics & chemotherapeutic agents, and promotes

13
normalization of intestinal flora. Acute diarrhea with duration of ≤14 days due to infection, drugs

or poisons.

Chronic or persistent diarrhea with duration of >14 days. Cefexime is a third general

cephalosporin that inhibits cell wall synthesis, promoting osmotic instability usual bactericidal.

Metoclopramide prevention of chemotherapy-induced emesis, treatment of postsurgical and

diabetic gastric stasis, facilitation of small bowel intubations in radiographic procedures,

management of esophageal reflux, treatment and prevention of postoperative nausea and

vomiting when nasogastric suctioning is undesirable. Ranitidine is for treatment and prevention

of heartburn, acid indigestion, and sour stomach and prophylaxis of GI hemorrhage from stress

ulceration. Children should be given rehydration solutions through oral route such as Rehydrate,

Pedialyte, Resol, and Rice-Lyte. Fruit juice, tea, cola and sports drinks may not be able to replace

fluid or electrolytes lost from vomiting or diarrhea correctly nor will the plain water. Intestines

irritated due to gastroenteritis do not even absorb plain water quite well, also that fact that plain

water will not aid in replacing electrolytes. Following each loose stool, children less than two

years of age should be given one to three ounces of rehydration solution. Older children should

drink as much as three to eight ounces of rehydration solution and adults as much as possible. In

regions where pediatric drinks are not available, a common homemade recipe for rehydration is

being used where two tablespoons of sugar mixed with a quarter teaspoon of table salt and

quarter teaspoon of baking soda or table salt is mixed in 1 liter of clean or already boiled water.

After 24 hours, bland diet should be started with BRAT diet i.e., bananas, rice, applesauce

without sugar, toast, pasta, or potatoes. For adults, initial intake of ice chips and clear, nondairy,

noncaffeinated liquids such as fruit juices, ginger ale, Gatorade, and Kool-Aid or other

commercial drink mixes. A soft bland diet such as the BRAT diet may be started after successful

14
24 hours of fluid diet without vomiting. Medical Treatment: If the patient is not able to take

fluids by mouth because of vomiting, an IV may be inserted to restore fluids back into the body

for rehydration. A surgeon, toxicologist, gastroenterologist, or other specialist's evaluation may

be required for severe symptoms. Antibiotics are generally not given until a specific bacteria has

been identified as using wrong antibiotics can worsen some of the infections or prolong their life.

Drinking fluids may help to avoid dehydration and relieve the symptoms. Fluid replacement

helps in correcting electrolyte imbalance, which in turn may aid to stop vomiting.

Prevalence:

Rotavirus in children under the age of 5 causes about 110 million cases of gastroenteritis

worldwide every year and nearly half a million deaths. Another significant viral agent which

causes gastroenteritis is adenovirus. Of these, about 82% deaths occur in the world's poorest

countries.

The incidence in the developed countries is about 1 to 2.5 cases per child per year and this has

been a major cause for hospitalization. The most important factors are age, hygiene, living

conditions and cultural habits. Most cases of gastroenteritis occur during summer in the tropics

and in the temperate climates during winter.(Gastroenteritis Epidemiology, Management and

Prevention by Madeleine Stuart, 2014 page 250 Chapter 8 volume 1 4th edition)

Epidemiology

Acute gastroenteritis diarrhea or vomiting (or both) of more than seven days duration

may be accompanied by abdominal pain , LBM and vomiting . Diarrhea is the passage of

excessively liquid or frequent stools with increased water content. Patterns of stooling vary

widely in young children, and diarrhea represents a change from the norm. Worldwide, 3-5

15
billion cases of acute gastroenteritis and nearly 2 million deaths occur each year in children

under 5 years. In the United States, gastroenteritis accounts for about 10% (220,000) of

admissions to hospital, more than 1.5 million outpatient visits, and around 300 deaths in children

under 5 annually. In the same age group in Australia, about 10, 000 hospital admissions, 22, 000

visits to emergency departments, and 115 000 general practice consultations occur annually for

rotavirus alone. In the United Kingdom, 204 of 1000 consultations with general practitioners in

children under 5 are for gastroenteritis, and the annual hospital admission rate in this group is

about seven per 1000 children. Children in childcare settings are often infected but asymptomatic

and may unwittingly transmit infection.

Children with poor nutrition are at increased risk of complications. In the north end of Australia,

Aboriginal and Torres Strait Islander children have increased rates of admission for

gastroenteritis, malnutrition, comorbidity, and electrolyte disturbance (especially hypokalaemia)

and a longer hospital stay than their non-indigenous counterparts. The cost of gastroenteritis to

the community is huge but often underestimated if costs to the family, including lost time at

work, are not considered. (Ham EB, Nathan R, Davidson GP, Moore DJ et al Bowel Habits of

Healthy Australian children aged 0-2 years. J Paediatr Child Health 1996; 32:504-7

https://emedicine.medscape.com/article/964131-overview)

Etiology

The two basic types of acute infectious diarrhea are noninflammatory and inflammatory.

Enteropathogens elicit noninflammatory diarrhea through enterotoxin production by some

bacteria, destruction of villus(surface) cells by viruses, adherence by parasites, and adherence or

translocation by bacteria. In contrast, inflammatory diarrhea usually is caused by bacteria that

invade the intestine directly or produce cytotoxins. Some enteropathogens possess more than one

16
virulence property. Acute diarrhea or diarrhea of short duration may be associated with any of the

recognized bacterial, viral, or parasitic causes of enteritis. Chronic or persistent diarrhea lasting

14 days or more may be due to (1) an infectious agent such as Giardia lamblia, Cryptosporidium

parvum, and enteroaggregative or enteropathogenic Escherichia coli; (2) any enteropathogen that

infects an immunocompromised host; or (3) residual symptoms due to damage to the intestine by

an enteropathogen after an acute infection. There also are many noninfectious cases of diarrhea

in children.(Nelson Textbook of Pediatrics by Richard E. Behrman, MD page 1272 Chapter 321

volume 2 17th Edition)

Bacterial enteropathogens may cause either inflammatory or noninflammatory diarrhea,

and specific enteropathogens may be associated with either clinical form. Generally,

inflammatory diarrhea is associated with Aeromonas, Campylobacter jejuni, Clostridium

difficile, enteroinvasive E.coli, Shiga toxin producing E.coli, Plesiomonas shigelloides,

Salmonella, Shigella, Vibrio parahaemolyticus, and Yersinia enterocolitica. Noninflammatory

diarrhea may be caused by enteropathogenic E.coli, enterotoxigenic E.coli, Vibrio cholera, and

several of the pathogens associated with inflammatory diarrhea. Viral enteropathogens the main

causes of viral gastroenteritis include rotavirus, enteric adenovirus, astrovirus, Norwalk agent

like virus, and calicivirus. Cytomegalovirus and herpes simplex virus have been associated with

diarrhea and other gastrointestinal tract signs and symptoms, generally in immunocompromised

hosts. Parasitic enteropathogens G. lamblia is the most common parasitic pathogens include

Entamoeba histolytica, Strongyloides stercoralis, Balantidium coli, and spore-forming protozoa

which include Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli,

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Enterocytozoon bieneusi, and Encephalitozoon intestinalis. (Atlas of Infectious Diseases by

Robert M. Kliegman, MD page 1900 Chapter 300 volume 2 16th edition)

Gastroenteritis And Home Care Management Of Mothers Among Marginalized

Communities In Catbalogan City, Philippines b Rheajane A Rosales

International Journal of Applied Research 2016; 2(3): 581-585

Abstract

Gastroenteritis is a serious problem existing globally and continues to be an important

cause of morbidity and mortality. In fact, there is new shift of numbers of deaths from 7,000 to

17,000 per year according to WHO (2011). Hence incur great attention from all health sector

should be set to prevent direct consequences. This study assessed the maternal knowledge on

gastroenteritis, and home care management among marginalized communities in Catbalogan

City province of Samar, Philippines. This investigation utilized a descriptive correlational

design. The study revealed an alarming result that out of 342 mothers who participated in the

study, 52.33% demonstrated “poor knowledge” and 11.40% only have “very good knowledge”

on gastroenteritis. Moreover, the result of this study suggest that there is a significant

relationship between the respondents educational attainment and number of children to their

knowledge on gastroenteritis. Coordinating with DOH and WHO must be set for intensifying

their programs to be more effective in increasing mothers’ knowledge and home care

management on gastroenteritis. Hence, will lessen the number of mortality and morbidity rates of

18
children. Furthermore, extension services focusing on health education regarding prevention and

management on gastroenteritis is also recommended.

Keywords: Gastroenteritis, Diarrhea, Oral rehydration solution, Dehydration

Introduction

Gastroenteritis also called “stomach flu” results from an inflammation of the

gastrointestinal tract commonly caused by viral pathogens and less frequently by bacterial or

parasitic organisms. Until a study that examined data on the deaths attributed to gastroenteritis,

the disease was considered to be relatively benign (in most developed countries), but deaths have

more than doubled since 1999 through 2007 . In fact, there is new shift of numbers of deaths

from 7000 to 17,000 per year . Despite the fact that gastroenteritis can be prevented, the disease

still affects children, predominantly under the age of five who are not yet capable of managing

their own health. Annually about two billion cases of diarrheal diseases occur among children

under the age of five globally. Though often considered a benign disease, gastroenteritis

represents a major cause of pediatric morbidity and mortality worldwide. Every year about 1.5

million children die from diarrheal diseases, mostly in developing countries. In fact, according to

WHO survey, Gastroenteritis is the second cause of mortality worldwide comprising 18% out of

73% of the 10.6 million yearly deaths in children. In the Philippines, Gastroenteritis continues to

be an important cause of illness and death, having consistently ranked fourth- and second-leading

cause of death for all age groups and for children, respectively. At present time, it is the third

leading cause of regional morbidity in region 8 according to the 2009 Philippine Health

Statistics. While in Samar Provincial Hospital, Gastroenteritis remains to be the number one

reason for children’s admission for 3 consecutive years. In just a span of 19 months (May-

19
November, 2015), Emergency Room records 2,378 cases already of gastroenteritis with signs of

dehydration. Although the burden of gastroenteritis among children under the age of five is

heavy, improved prevention is achievable. Personal and food hygiene, including the use of clean

water sources, are key measures to prevent transmission of these diseases. Breastfeeding,

especially under 6 months of age, also effectively protects infants, and Rotavirus vaccination has

been widely available for children since 2006 and is now recommended

Worldwide moreover, the use of Oral Rehydration Salt to prevent dehydration is

encouraged by the UNICEF, DOH, and WHO. However, Studies show that though most of the

mothers were familiar with the term oral rehydration salt (ORS), there were knowledge gaps as

regards its correct preparation and administration. While improved medical treatment combined

with the programs of DOH to prevent and manage Gastroenteritis at home, many of these

children continuously die endlessly. Many of these children were never seen at a health facility

because services don’t exist, because their families lack access to these services or mothers do

not recognize the warning signs of this life threatening complication like dehydration. Reflecting

on this record, the researchers were then motivated to undertake a study on the existence of such

a record. Saving the lives of millions of children at risk of death from gastroenteritis is possible

with a comprehensive strategy that ensures all children in need to receive critical prevention and

treatment measures even at home. Hence, this study was conducted.

Research Objective

This investigation assessed the maternal knowledge on gastroenteritis and home care

management among marginalized communities in Catbalogan City, Philippines.

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Methodology

A Descriptive research design was adopted for this investigation. This design was used

to determine the knowledge of mothers on gastroenteritis and home care management in

marginalized communities in Catbalogan City, Philippines. Furthermore, relationships between

respondents profile and their knowledge on gastroenteritis, home care management,

manifestations of dehydration and oral rehydration therapy were also identified.

Participants

This study utilized convenience sampling to mothers living in marginalized communities

in Catbalogan City, Philippines. A total of 342 mothers consented to fully participate in the

investigation.

Instrumentation

The investigators utilized a questionnaire composed of 4 parts. Part I is a checklist that

described the profile of mother respondents. Part II of the questionnaire were questions based on

causes, signs and symptom, prevention and transmission modes. Part III assessed the knowledge

of the respondents about the Home Care Management for Gastroenteritis, Part IV were questions

assessing the knowledge of the mother respondents on manifestations of dehydration secondary

to gastroenteritis while the last part of the questionnaire were questions about Oral Rehydration

Solution. Part II- IV has possible responses of “yes” and “no”. ‘Yes’ is given a value of 1 point,

and ‘no’ with 0 points; the maximum possible score is 15. The higher the score, the greater the

assumed knowledge about gastroenteritis. Result of test was interpreted as follows; 11 – 15 as

“Very good knowledge”, 6 – 10 as “Fair Knowledge”, and 0 – 5 as “Poor Knowledge”. The

21
questionnaire was validated for its reliability resulting in statistical value of 0.89 (Cronbach’s

alpha). Meanwhile, The last part of the questionnaire utilized a filtering question in assessing the

knowledge of the respondents on ORS.

Ethical Considerations

The study protocol was approved and reviewed by the Health Ethics Committee of Samar

State University, Philippines. The investigators made sure that the respondents included are

willing to fully participate the study by signing the consent. Furthermore, Confidentiality and

anonymity of the respondents were maintained by only a code number on the questionnaire.

Data Analysis

The data collected were coded and entered into a computerized data base and was

analyzed using the Statistical Package of the Social Science Program (SPPS, version 19).

Descriptive statistics such as the, frequency, percentage, and standard deviation was used to

quantify the profile of the patients. To test for the significance of the coefficient of correlation

between a set of paired variables, Fisher’s T-test and Pearson r were used.

22
 Results

Variables n(342) Result

Age 78-85 2 0.59
70-77 9 2.64
62-69 16 4.67
54-61 35 10.23
46-53 59 17.25
38-45 74 21.63
30-37 67 19.59
22-29 68 19.88
14-21 12 3.51
Marital Status Single 134 39.18
Married 147 42.98
Widow/er 56 16.37
Separated 5 1.46

Educational Attainment Post-graduate level 15 4.39

College Level 77 22.51
High school level 120 35.09
Elementary Level 130 38.01

Monthly Income More than Php 20,000 22 6.4

Php 16,000-20,000 17 5.0
Php 11,000-15,000 41 12.1
Php 5,000-10,000 85 24.9

Less than Php 5,000 177 51.4

Number of Children More than 5 70 18.4

5 39 11.4
4 49 14.3
3 69 19.9
2 62 20.2
1 53 15.6

As shown in the table, majority of the mother respondents are within the age bracket of

38-45 year old or 74 (21.63%) and Married 147 (42.98), but it is worth noting that 134 mothers

or 39.18% are still single. Findings also suggest that majority of the respondents 130 (38.01%)

23
 were not able to reach high school level. When it comes to monthly income, 51.4% of the

mothers are earning less than 5,000 php only and most of them 70(18.4%) have more than 5

children.

Table II. Responses to Questions on Gastroenteritis

Indicators Statement Correct Yes No

Answer n(%) n(%)
A. Causes of 1. Viral pathogens can cause gastroenteritis Yes 139(40.6) 203(59.4)
Gastroenteritis
2. Bacterial or parasitic organisms Yes 234(68.4) 108(31.6)

B. Signs and 3. Diarrhea is a sign gastroenteritis Yes 215(62.9) 127(37.1)

Symptoms of
Gastroenteritis
4. Abdominal pain and cramping are signs of Yes 206(60.2) 136(39.8)
gastroenteritis
5. Nausea is a sign of gastroenteritis Yes 145(42.8) 197(57.6)

6. Vomiting is a sign of gastroenteritis Yes 197(57.6) 145(42.4)

7. Fever is a sign of gastroenteritis Yes 168(49.1) 174(50.9)

8. Weight loss is a sign of gastroenteritis Yes 161(47.1) 181(52.9)

9. Distention is a sign of gastroenteritis Yes 153(44.7) 189(55.3)

10. Hyperactive bowel sounds is a sign of Yes 132(38.6) 210(61.4)

gastroenteritis
C. Prevention of 11. Proper hand washing techniques after Yes 243(71.1) 99(28.9)
Gastroenteritis defecation and before handling food
12. Obtaining available vaccinations against Yes 143(41.8) 199(58.2)
bacterial and viral gastroenteritis
13. Cleanliness and sanitation as well as proper Yes 217(63.5) 125(36.5)
handling, preparation and storage
techniques
14. Not to eat food containing raw eggs and to Yes 154(45) 188(55)
refrain from buying cans or boxes or jars
that are damaged
D. Mode of 15. Gastroenteritis can be transmitted through Yes 157(45.9) 185(54.1)
Transmission Fecal-Oral route
of
Gastroenteritis

24
 Table 2 presents the mother respondents answers on the questions about the causes, signs

and symptoms, prevention, and mode of transmission of gastroenteritis. It can be seen in the

table that majority of the participants (n= 203, 59.4%) do not know that viral pathogens can also

cause gastroenteritis but majority of them (n=234, 68.4%) got the correct answer that bacteria or

parasitic organisms is a one cause of gastroenteritis. Meanwhile, majority of the respondents

agreed that diarrhea (26.9%), abdominal pain and cramping (60.2%), and vomiting (57.6%) are

manifestations of gastroenteritis. However, it is alarming that out of 8 enumerated

manifestations, majority of the mothers are not knowledgeable of the 5 signs and symptoms.

Moreover, 243 (71.1%) of the mothers agreed that proper hand washing techniques after

defecation and before handling food, and cleanliness and sanitation as well as proper handling,

preparation and storage techniques (n=217 (63.5%) are measures to prevent gastroenteritis. On

the other hand, they need to be corrected that obtaining vaccinations and not to eat food

containing raw eggs and refraining from buying cans or boxes that are damaged can also help in

preventing such medical condition. Finally, it is disturbing that majority of these mothers (n=185,

54.1%) are unaware that gastroenteritis can be transmitted through Fecal-Oral route.

Table III Knowledge of Mothers on Gastroenteritis

Score Range Frequency Percentage Interpretation

(n=342) (%)
11-15 47 13.74 Very good knowledge

6-10 117 34.21 Fair knowledge

0-5 148 43.27 Poor knowledge

Table 3 Illustrates the distressing result of this study, that majority of the mothers (n=148

05 43.27%) got answers within the score range of 0-5 which is interpreted to have “poor

25
knowledge” on gastroenteritis. This is followed by mothers with “fair knowledge” (n=117 or

34.21%), while only 47 respondents or 13.74% were considered to have “very good knowledge

on gastroenteritis”.

Table IV Knowledge of Mothers on the Home Care Management of Gastroenteritis

Indicators Correct Answer Yes n (%) No n (%)

ORS is one of the Yes 201(58.8) 141(41.2)

management of
gastroenteritis at home
Increase fluid intake Yes 211(61.69) 131(38.30)

Increase Banana intake Yes 157(45.9) 185(54.1)

Increase Vegetable intake Yes 157(45.9) 185(54.1)

Zinc can be given to a patient Yes 135(39.5) 206(60.2)

with gastroenteritis
Vitamin A every 6 months Yes 97(28.36) 215(62.86)

It can be gleaned in the table the information obtained from the respondents regarding their

knowledge on home care management of gastroenteritis. As reflected on the table, most of the

respondents are aware that ORS is one of the management of gastroenteritis at home (n=201,

58.8%) and to increase fluid intake (n=211, 61.69%). However, more than half of the

respondents are not aware that increasing banana (54.1%) and vegetable intake (54.1%), giving

zinc (60.2%), and vitamin A (62.86%) every 6 months are home care management of

gastroenteritis.

Table V Knowledge on Manifestations of Dehydration

Indicators Correct Answer Yes n (%) No n(%)

Sunken eyes is a Yes 194(56.72) 148(43.3)

manifestation of
dehydration
Poor skin turgor is a Yes 142(41.5) 200(58.5)
manifestation of

26
dehydration
Restless and irritable Yes 124(36.26) 218(37.43)
is a manifestation of
dehydration
Drinks eagerly or Yes 122(35.67) 220(64.33)
thirsty is a
manifestation of
dehydration

Table 5 presents the cumulative scores of the respondents on the question about the

manifestations of dehydration. Out of the four manifestations of dehydration, only one

manifestation garnered the highest number of mothers who got the correct answer. While, most

of the mothers did not know that poor skin turgor (n=200, 58.5%), restless and irritable (n=218,

37.43%) and drinks eagerly or thirsty (n=220, 64.33%) are manifestations of dehydration.

Table VI Respondents who have heard about Oral Rehydration Solution (ORS)

Indicator Yes n(%) No n(%)

Have you heard about Oral 201(58.8%) 141(41.2%)

Rehydrating Solution?

Table 5 shows the number of respondents who have heard about oral rehydration

solution. Out of 342 respondents 201 or 58.8% have heard about oral rehydration solution.

While, 141 or 41.2% hasn’t heard ORS yet.

Table VII Respondents’ answer on the correct ingredients of Oral Rehydrating Solution

Indicator Correct Answer A B C D

n (%) n (%) n (%) n
(%)
Which among the C
following is the correct (Water, Salt and Sugar 13(6.47) 100(49.75 88(43.78) 0(0)
ingredients for ORS?

27
 Table 8 illustrates the respondents’ answer on the correct ingredients of oral rehydrating

solution. Out of 201 respondents who claimed that they have heard oral rehydrating solution,

only 88 mothers or (43.78%) got the correct answer. Majority of the respondents (n=100,

49.75%) answered the option letter B which is water and salt only.

Discussions

This study highlights the result that mothers from marginalized communities have “poor

knowledge” on gastroenteritis. This result is consistent to the findings of Bachrach & Gardner on

their study in Nepal that mothers demonstrated limited knowledge on gastroenteritis . Though

most of them are aware that bacteria and other parasitic organisms can cause gastroenteritis,

educating them that viral pathogens can also cause gastroenteritis is necessary. In fact, Rotavirus

is the leading cause of severe gastroenteritis in children and it can also infect adults who are

exposed to children with the virus. Meanwhile, aside from diarrhea, abdominal pain and

cramping, and vomiting, it is vital that mothers should be aware of other manifestations of

gastroenteritis such as fever, nausea, weight loss, distention and hyperactive bowel signs. The

researchers believe that if only the mothers are aware of these manifestations, early management

will then be taken, thus, lessen the chances of increasing the mortality rate of children.

Furthermore, prevention of gastroenteritis is necessary to lessen the number of morbidity rate of

children that will be affected by gastroenteritis. The findings of this study may prove that the

programs of World Health organization and Department of Health have been effective in

increasing awareness that proper hand washing techniques after defecation and before handling

food, and cleanliness and sanitation as well as proper handling, preparation, and storage

techniques are important measures to prevent gastroenteritis. However, these mothers should be

28
aware that presently, available vaccines are already existing to prevent children from acquiring

such condition. This vaccine is called the “rotavirus vaccine”. There are two brands of the

rotavirus vaccine, the Rota Teq (RV5) and Rotarix (RV1). Both vaccines are given orally, not as a

shot. The only difference is the number of doses that need to be given. In addition, not to eat

food containing raw eggs and to refrain from buying cans or boxes or jars that are damaged is

also an important measure to the prevention. Lastly, it is very alarming that these mothers do not

know that gastroenteritis can be transmitted through Fecal-Oral-Route. This result suggests that

better education on the mode of transmission of gastroenteritis should also be emphasized.

Mothers and other caregivers play a critical role in the effective management of gastroenteritis

by correctly recognizing its manifestations, and taking appropriate action. The result of this study

depicts that mothers are aware that ORS and increasing the fluid intake are appropriate actions

for managing gastroenteritis at home. These two home care management are helpful in flushing

the toxins and in replacing the fluid and electrolyte lost. On the other hand, mothers should be

adequately educated that increasing banana which contain little fiber but are high in potassium,

an electrolyte that helps with mineral and fluid balance in the body. Furthermore, increasing

vegetable intake, giving of zinc and vitamin A every 6 months can also help in managing this

illness. Caregivers or mothers are the ones who decide if a child's episode of gastroenteritis

warrants a visit to a health facility or if they can manage the episode themselves at home. In this

study, is worrisome that majority of the mothers cannot recognize the signs of dehydration.

When adequately educated, caregivers can start fluid replacement early in the course of a child's

illness in order to prevent dehydration. Therefore, manifestations of dehydration must also be

stressed out by health educators to all caregivers and mothers. The findings of this study is quite

confusing that although most mothers had heard of ORS, the vast majority of them did not get

29
the correct ingredients of ORS. Also of concern was that majority of the mothers who claimed to

have heard ORS reported giving their children a mixture of table salt and water, presumably

intending to substitute for oral rehydration salts. This substitution is dangerous because it can

lead to hypernatremic dehydration. There has been much debate about the relative merits of

teaching caregivers to make sugar-salt solution for ORT versus using prepackaged ORS.

Conclusion

It could be inferred from this investigation that the level of knowledge on gastroenteritis,

home care management, and manifestations of dehydration among the study population is

“poor”. The finding also concludes that mothers do not know the correct ingredients and

proportion of ORS that should be given. Therefore, the researchers suggest that the World Health

Organization and Department of Health should strengthen their programs on the proper

education of the causes, manifestations, prevention and mode of transmission of gastroenteritis.

Furthermore, extension activities to these marginalized communities in Catbalogan City,

Philippines should be conducted, specifically seminar-workshop and return demonstration of the

correct preparation of Oral rehydrating Solution.

Acknowledgement

Investigator would like to express gratitude to all individuals who contributed to the

forecasting and directing of this study. Special thanks to all the mothers who participated in this

study.

Conflict of Interest

The author declare no conflicting interests

(Gastroenteritis And Home Care Management Of Mothers Among Marginalized Communities In
Catbalogan City, Philippines by Rheajane A Rosales page 581-585 World Health Organization.
World Health Statistics, 2013. http://www.who.int/gho/publications/world_health_stati
stics/EN_WHS2013_Full.pdf .)

30
General Approach to Children with Acute Diarrhea

Enteric infections cause gastrointestinal tract signs and symptoms as well as

extraintestinal complications, including neurologic manifestations. Gastrointestinal tract

involvement may include diarrhea, abdominal cramps, and vomiting. Systemic manifestations

are varied and associated with a variety of causes. Extraintestinal infections related to bacterial

enteric pathogens include vulvo vaginitis, urinary tract infection, endocarditis, osteomyelitis,

meningitis, pneumonia, hepatitis, peritonitis, chorioamnionitis, soft tissue infection, and septic

thrombophlebitis. The main objectives in the approach to a child with acute diarrhea are to (1)

assess the degree of dehydration and provide fluid and electrolyte replacement, (2) prevent

spread of enteropathogen, and (3) in select episodes determine the etiologic agent and provide

specific therapy if indicated. (Pediatric Gastrointestinal Disease by Joann L, Ater, MD page 4000

Chapter 350 Volume 2)

31
NURSING HEALTH HISTORY

Biographic Data:

Hospital : Surigao Medical Center

Case No. : 86633

Ward : Pediatric Ward

Name of Patient : Patient Y

Age : 1 year and 8 months old

Sex : Male

Civil Status : Child

Address : BRGY RIZAL, SURIGAO CITY, SURIGAO

DEL NORTE

Occupation : NONE

Date of Birth : May 6, 2017

Religion : ROMAN CATHOLIC

Height : 79cm

Weight : 10kg

Father’s name : Roel A. Ruaza

Mother’s name : Josephine T. Ruaza

Admission Data:

Mode of Transmission : Wheelchair

Date and Time of Admission : January 24, 2019 8:54AM

32
Vital Signs upon admission

 Heart Rate : 135bpm

 Respiratory Rate : 35cpm

 Body Temperature : 37 degree celsius

Admitting Physician : Stephanie Grace D. Edrial, MD

Attending Physician : Nora Liza Polvorosa Mira, MD

Chief Compliant : LBM , Vomiting

Impression : AGE with Moderate Dehydration

Final Diagnosis : AGE with Moderate Dehydration

33
CLIENT HEALTH HISTORY

Client Profile

Patient Y is a 1 year and 8 months old boy, catholic, Filipino child, born on May

6, 2017. An only child and currently living with his family at Barangay Rizal, Surigao

City, Surigao del Norte,. Major reason for seeking health care is due to vomiting and loss

of bowel movement on the morning of January 24, 2019.

Treatments/Medications:

Prescribed: No prescribed medications

OTC: No over the counter drugs

Past Illness/Hospitalization

No known past illness

Allergies

No known food allergies and drug allergies

DEVELOPMENTAL HISTORY

Developmental Task Theory of Robert Havighurst

A developmental task is a task which arises at or about a certain period in the life of an

individual. Havighurst has identified six major age periods: infancy and early childhood

(0-5 years), middle childhood (6-12 years), adolescence (13-18years), early adulthood

(19-29 years), middle adulthood (30-60 years), and later maturity (61+).

Basing on Havighurst’s Theory, our patient belongs in the infancy and early childhood

stage(Autonomy vs. Shame and Doubt according to Erik Erikson's stages of psychosocial

development.) wherein he is learning to distinguish right from wrong and developing a

conscience.

34
NUTRITONAL METABOLIC PATTERN

Before hospitalization: The client eats four times a day including breakfast, lunch,

merienda and dinner. According to the significant other, he always eats rice and soup. He

can drink 4 glasses of water in a day. He has no eating discomforts. Develops 8 teeth .

During Hospitalization: The client seldom eats at the hospital. He does not have appetite

for eating. He seldom drinks water or fluids.

ELIMINATION PATTERN

Before Hospitalization:

Bowel habits: The client defecates everyday and his stool is soft, formed and its color is

brown and has a foul odor. He has no discomfort in defecating

Bladder habits: He urinates 5-6 times per day and is yellowish in color. Doesn’t have

current problems like dysuria, hematuria, incontinence and he has no discomfort in

urinating.

During Hospitalization:

Bowel habits: The client defecates 4 times a day. His stool is watery and yellowish in

color.

Bladder Habits: He urinates twice a day and it is yellowish in color.

35
ACTIVITY EXERCISE PATTERN

Before Hospitalization: Arises at 6 am in the morning. Eat breakfast and watch

television with his father. In early afternoon eats lunch together with his family. Takes

nap in the afternoon. During evening he would have dinner with his family at 6:30 pm.

The client sleeps from 8pm to 6am

Hygiene: showers and washes hair everyday in assistance with his mother or father

Occupational activities: none

During Hospitalization: Arises at 6am in the morning. The client seldom eats at the

hospital. He does not have appetite for eating. He does not takes nap in the afternoon.

The client sleeps from 8pm to 6am. Unable to take a bath.

SEXUALITY-REPRODUCTION PATTERN

Before and during Hospitalization: The client can identify the difference of external

organ between girl or boy.

SLEEP-REST PATTERN

Before Hospitalization: The client sleeps about 10 hours a day. From 8pm to 6am. He

has no problem falling asleep and does not take sleep medications. His sleep is always

continuous especially when he is tired. He takes a nap during afternoon. From 12:30pm

to 3pm.

36
During Hospitalization: The client still sleeps 10 hours a day. Continuous. He only

wakes up when his medications are due. He has no problem falling asleep and does not

take any sleep medications. He does not take naps.

SENSORY-PERCEPTUAL PATTERN

Before and during Hospitalization:

Vision: Doesn’t have any difficulty in his vision

Hearing: Doesn’t have any difficulty in hearing

Smell: Doesn’t have difficulty with smell, pain, postnasal drip, sneezing and nosebleed

Touch: no difficulty in touching

Taste: no difficulty tasting foods

COGNITIVE PATTERN

Before Hospitalization: The client does not have difficulty in hearing and has no hearing

aid. According to the significant others, If ever the client get sick, they immediately go

to Barangay health center

During Hospitalization: The client takes the prescribed medications for recovery.

ROLE-RELATIONSHIP PATTERN

Before Hospitalization: The client lives with his mother and father. His mother and

father is taking care of him and supportive . His parents loves him

During Hospitalization: The family of the patient especially his parents are supportive

and more caring.

37
SELF-PERCEPTION-SELF-CONCEPT PATTERN

Before and during Hospitalization: The mother said that her son is a happy child and

likes playing toys and watching television with his father . He likes to hold utensil while

eating sometimes using hands while eating. He enjoys showers and washes his hair with

assistance of his father or mother.

COPING-STRESS TOLERANCE

The mother said that her son experiencing adjustment because it was a first time admitted

on the hospital. He copes up with his stress through playing toys and watching television.

VALUE-BELIEF PATTERN

A Roman Catholic child and attended mass every sunday with his family.

HEALTH HISTORY

A. History of Present Illness

Prior to admission, the client was vomiting and defecating. His stool was color yellow 4

times defecating and the amount is medium and it was watery . At first, they go to the

Barangay Rizal Health Center and the midwife gave them medication. According to the

midwife, the medication is for LBM, but after taking the medication, the client was still

defecating and vomiting so the family decided to rush the client at Surigao Medical

Center the next day January 24, 2019.

38
B. Past History

No past history. He had completed all vaccinations including BCG, DPT, Oral Polio

Vaccine, MMR and Hepatitis B vaccine. The patient had never been any of the childhood

disease such as measles, mumps and chicken pox. The patient had no history of accident

or any injury. He does not have allergy in any food

39
 PHYSICAL EXAMINATION

General Physical Survey

Properly groomed. Lying comfortably on bed conscious, with sunken eyeballs, appears

fatigue, thin and has dry skin. With an ongoing IVF of D5 IMB 500cc @ 30gtt/min hooked at

right cephalic vein infusing well . Ht: 2’7’’ Wt: 22lbs, Apical pulse: 135, Resp: 35, Temp: 37

degree celcius, BMI: 17.25

Mental Status Examination

Alert and awake with eyes open and looking at examiner; client responds appropriately

Skin

Skin is brown, warm and dry to touch. Poor skin turgor noted. No edema. No scalp

lesions or flaking.

Head and Face

No scalp lesions or flaking. Head symmetrically rounded upon palpation. Function of CN

V, pt. identifies light touch and sharp touch to forehead, cheek and chin. Bilateral corneal reflex

40
intact. Masseter muscles contract equally and bilaterally. Function of CN VII pt. smiles, frowns,

shows teeth, blow cheeks, and raises eyebrows as instructed.

Eyes

Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness. Lids brown,

without edema, nor lesions. Sclera without increased vascularity nor lesions. Palpebral and

bulbar conjunctiva pale without lesions. Irises uniformly black. Pupils are round and react to

light and accommodation.

Ears and Nose

Auricle without deformity, lumps nor lesions. Auricles and mastoid processes non-tender.

Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is

folded.

Whisper test: Client identifies words clearly. Nose is symmetrical and straight upon palpation.

Nares patent. No tenderness, masses, and displacement of bone cartilages. No redness, swelling,

and abnormal discharge on the nasal mucosa.

Mouth and Throat

Lips are pale and dry to touch, cracked lips. Develops 8 teeth and no teeth anomalies

upon inspection. Tonsils appear to be normal. No swelling on uvula.

41
Neck

Neck symmetrical without masses and scars. Lymph nodes are non-palpable. Trachea is

in center placement in midline of neck.

Arms, Hands, and Fingers

Arms are equal in size and symmetry bilaterally; brown; cool and dry to touch without

edema. No lesions and bruising on hands. Three flexion creases present in palm. Fingernails are

finely cut, clean and clear. No clubbing.

Posterior and Lateral Chest

Posterior lateral diameter is 1:2 ratio. Respiration rate is 30 cpm. Symmetrical expansion

on posterior thorax.

Anterior Chest

Chest symmetry is equal. Anterior lateral diameter is 1:2 ratio. Shape and position of

sternum is level with ribs. Position of trachea is in midline. No pain nor tenderness in the anterior

thorax. Symmetrical expansion on anterior thorax.

42
Breasts (Male)

Skin is the same color as the abdomen/back. No swelling, ulcerations, or nodules noted.

Flat disk of undeveloped breast tissue under nipple noted.

Heart

Apical pulse rate is 130 bpm. No gallops nor murmurs, nor rubs.

Abdomen

Vomits 2 times(projectile) and visceral pain in the umbilical region . Abdomen is uniform

in color upon inspection. No rashes or lesions. No evidence of enlargement of liver and spleen

upon inspection and palpation. Navel is protruding. Hyperactive sounds were heard due to GI

disturbance(above 35 times/min). Abdominal distention noted.

Legs, Feet and Toes

Legs has no abrasion and wound. Skin intact, brown, warm and dry to touch without

edema. Lymph nodes are non-palpable. No edema palpated. Toenails are finely cut, clean and

clear. No clubbing.

Genitalia (Male)

No bulging or masses in inguinal area. No discharge. No pubic hair. Not yet circumcised

43
Musculoskeletal and Neurologic examination

Muscle strength 4/5. No edema noted at both lower extremities. Active resistive range of

motion against some resistance noted. No deviations, inflammations, nor bony deformities.

Moves upper and lower extremities freely against gravity and against resistance. Patient is

conscious; responses in calling the client’s name. Can recall his name. .

The Glasgow Coma Scale (GCS) is scored between 3 and 15, with 3 being the worst and 15 the

best

Best Eye Response Best Verbal Response Best Motor Response

No eye opening: 15 No verbal Response:15 No motor response:15

Eye Opening to pain:15 Incomprehensive sounds:15 Extension to pain:15

Eye opening to verbal command:15 Confused:15 Withdrawal from pain:15

Eyes open spontaneously:15 Oriented: 15 Localizing pain:15

Obeys command:15

Sensory status: Superficial light- and deep-touch sensation intact on arms, legs, neck, chest, and

back. Position sense of toes and fingers intact bilaterally

44
Cranial Nerve Assessment

Cranial Nerve Name Result

I Olfactory Identifies scent correctly with

each nostril

II Optic Light falls symmetrically within

each pupil

III Occulomotor Pupils are round and react to

light and accommodation.

IV Trochlear Both eyes are well coordinated

and moves in unison without

tenderness felt when left and

right eyes moves. Patient lids

close symmetrically.

V Trigeminal Eyelids blink bilaterally

VI Abducens Can move left and right eyeballs

in a moderate manner.

VII Facial Raises his left and right

eyebrows whenever you say

something to him. Can close his

both eyes.

VIII Acoustic Can clearly hear normal voice

45
 tone.

IX Glossopharyngeal Positive gag reflex

X Vagus Positive swallowing reflex

XI Spinal Accessory Patient can move his neck

XII Hypoglossal Can protrude tongue

46
 REVIEW OF SYSTEMS

General Survey

The usual weight of the client is 10.5kg upon hospitalization, the patient’s weight

decreased to 10kg. Sunken eyeballs, appears fatigue, thin and dry skin noted upon assessment.

Integumentary System

Patient has no history of edema, skin allergies, burns, No history of scalp lesions or flaking,

pigmented lesions, jaundice, cellulitis, adenopathy.

Head, Eyes, Ears, Nose, and Throat (EENT)

Head: Patient has no history of head injuries, lightheadedness, vertigo

Eyes: Patient has no history of conjunctivitis, visual problems, edema, lesions, scaliness, sore

eyes. No history of double vision ( Diplopia )

Ears: Patient has no history of ear infection, draining ears, lumps or lesions. No discharged

( Otorrhea ). No history of ear pain ( Otalgia ) .Ear Ringing ( Tinnitus )

Nose: Patient has no history of Nasal Bleeding (epistaxis), nasal stuffiness. No nasal discharge

( Rhinorrhea ), laryngitis

47
Throat: Patient has no history in swelling on uvula, tonsillitis, sore throats bleeding gums

( Gingival Hemorrhage )

Gastrointestinal System

Patient has no history of Nausea, diarrhea, constipation. No history of bright red stools

( Hematochezia ). No history of black tarry stools ( melana ), stool incontinence ( Encopresis )

Musculoskeletal System

No history of edema at both lower extremities. No deviations, inflammations, or bony

deformities. No joint pain . No muscle pain.

Neurologic System

Patient has no history of memory loss, seizure, dizziness, sensation changes such as numbness

and coldness.

Urinary Systems

Patient has no history of any urinary tract infection. No pain in urination. No discharge.

Reproductive System (Male)

No history of bulging or masses in inguinal area. No discharge. No pubic hair. Not yet

circumcised.

48
Hematologic or Lymphatic

Patient has no history of lymph node enlargement. No history of easy bleeding or bruising.

Endocrine

No history of Diaphoresis . No polyuria.

Psychiatric

No history of depression, memory change, or suicide attempts.

49
 LABORATORY RESULTS

HEMATOLOGY

COMPLETE BLOOD COUNT

January 24, 2019

TEST RESULT NORMAL UNIT SIGNIFICANT RATIONALE

VALUES

RED BLOOD 4.82 4-6 x10^12/L Normal

CELL

HEMOGLOBIN 13.7 12-17 g/dL Normal

HEMATOCRIT 40.7 37-54 % Normal

MCV 84.5 87 ± 5 Fl Normal

MCH 28.4 29 ± 2 Pg Normal

PLATELET 388 150-450 x10^9/L Normal

COUNT

RDW 13.3 11.6-14.6 % Normal

WHITE BLOOD 8.5 4.5-10 10^9/L Normal

CELLS

SEGMENTERS 47.2 50-70 % Normal

LYMPHOCYTE 46.2 20-40 % Increased Lymphocytosis

MID CELL 6.6 1.0-7.0 % Normal

ANALYSIS:

Lymphocyte count increased that may indicate lymphocytosis it respond to a bacterial

infection

50
 HEMATOLOGY

COMPLETE BLOOD COUNT

January 25, 2019

TEST RESULT NORMAL UNIT SIGNIFICANT

VALUES

RED BLOOD 4.82 4-6 10^12/L Normal

CELL

HEMOGLOBIN 13.7 12-17 g/dL Normal

HEMATOCRIT 40.7 37-54 % Normal

MCV 84.5 87 ± 5 Fl Normal

MCH 28.4 29 ± 2 Pg Normal

PLATELET 388 150-450 10^9/L Normal

COUNT

RDW 13.3 11.6-14.6 % Normal

WHITE 8.5 4.5-10 10^9/L Normal

BLOOD

CELLS

LYMPHOCYTE 39 20-40 % Normal

SEGMENTERS 47.2 50-70 % Normal

MID CELL 6.6 1.0-7.0 % Normal

ANALYSIS:

All CBC results are normal

51
 BLOOD CHEMISTRY

January 24, 2019

TEST RESULT NORMAL SIGNIFICANT RATIONALE

VALUES

SODIUM 132.4 135-146 mmol/L Decreased Hyponatremia

POTASSIUM 3.35 3.50-5.30 mmol/L Decreased Hypokalaemia

IODIZED 0.98 1.37-1.35 Decreased Hypocalcemia

CALCIUM

CHLORIDE 104.8 97-107 mmol/L Normal

Analysis

The result shows decreased sodium counts of 132.4, for the amount of fluid contains is less or

the sodium in the body may be diluted because often the body retains more fluid than sodium,

which means the sodium is diluted. The patient is having diarrhea that causes its potassium level

decreased to 3.35 lost in the digestive tract. Iodized calcium decreased to 0.98 because of

abnormal level in the blood protein malabsorption of calcium, vitamin d, phosphorous and

magnesium deficiency.

52
 BLOOD CHEMISTRY

January 25, 2019

TEST RESULT NORMAL SIGNIFICANT RATIONALE

VALUES

SODIUM 138 135-146 mmol/L Normal

POTASSIUM 3.55 3.50-5.30 mmol/L Normal

IODIZED 1.37 1.37-1.35 Normal

CALCIUM

CHLORIDE 104.8 97-107 mmol/L Normal

Analysis:

All Blood chemistry results are normal.

53
 URINALYSIS

JANUARY 24, 2019

TEST RESULT NORMAL SIGNIFICANT RATIONALE

VALUES

SPECIFIC 1.025 1.025 Normal

GRAVITY

COLOR Yellow Normal

TRANSPARENCY Slightly Hazy Normal

GLUCOSE Negative Normal

PROTEIN Negative Normal

pH 6.0 6.0 Normal

WBC 9-11/hpf 9-11/hpf Normal

RBC 0-2/hpf 0-2/hpf Normal

Analysis

Urinalysis shown normal urine color yellow and slightly hazy

54
 STOOL EXAM

January 24, 2019

RESULT SIGNIFICANT RATIONALE

COLOR YELLOW Normal

CONSISTENCY WATERY WITH NO Abnormal Indicates diarrhea
BLOOD STREAK caused by intestinal
infections
RBC 0-1/hpf 0-1/hpf
WBC 0-1/hpf 0-1/hpf
BACTERIA FEW Has presence of
bacteria

Analysis:

Watery with no blood streak is abnormal associated with diarrhea caused by certain intestinal

infections. WBC and RBC is normal within normal values

55
 STOOL EXAM

January 25, 2019

RESULT SIGNIFICANT RATIONALE

COLOR BROWN Normal

CONSISTENCY SOFT WITH NO Normal

BLOOD STREAK

RBC 0-1/hpf Normal

WBC 0-1/hpf Normal

BACTERIA None Normal

Analysis:

All stool exam results are normal

56
 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.

57
The Normal 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).

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.

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.

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 (bacteria like Bacteroides, Lactobacillus acidophilus,

Escherichia coli, and Klebsiella) 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

58
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.

The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.

Digestive System Glossary:

Anus - the opening at the end of the digestive system from which feces (waste) exits the body.

Appendix - a small sac located on the cecum.

Ascending colon - the part of the large intestine that run upwards; it is located after the cecum.

Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted

into the small intestine.

Cecum - the first part of the large intestine; the appendix is connected to the cecum.

Chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes

on to the small intestine for further digestion.

59
Descending colon - the part of the large intestine that run downwards after the transverse colon

and before the sigmoid colon.

Duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the

jejunum.

Epiglottis - the flap at the back of the tongue that keeps chewed food from going down the

windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe,

the epiglottis opens so that air can go in and out of the windpipe.

Esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle

movements (called peristalsis) to force food from the throat into the stomach.

Gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a

digestive chemical which is produced in the liver) into the small intestine.

Ileum - the last part of the small intestine before the large intestine begins.

Jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and

the ileum.

Liver - a large organ located above and in front of the stomach. It filters toxins from the blood,

and makes bile (which breaks down fats) and some blood proteins.

Mouth - the first part of the digestive system, where food enters the body. Chewing and salivary

enzymes in the mouth are the beginning of the digestive process (breaking down the food).

Pancreas - an enzyme-producing gland located below the stomach and above the intestines.

Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small

intestine.

60
Peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into

the stomach. Peristalsis is involuntary – you cannot control it. It is also what allows you to eat

and drink while upside-down.

Rectum - the lower part of the large intestine, where feces are stored before they are excreted.

Salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that

break down carbohydrates (starch) into smaller molecules.

Sigmoid colon - the part of the large intestine between the descending colon and the rectum.

Stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and

mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in

a bath of acids and enzymes.

Transverse colon - the part of the large intestine that runs horizontally across the abdomen.

PHYSIOLOGY

Transverse colon- is the lengthy, upper part of the large intestine, ingested food exits the small

intestine and enters the cecum. As digestion continues, the ingested matter moves up the

ascending colon and into the transverse colon. The transverse colon performs several critical

functions, including moving waste material forward and the absorption of key components for

proper body functioning.

Stomach- the stomach will provide a place for varied amounts of swallowed food to rest and

digest in. Hence, the stomach is a storage site. The stomach will also introduce our swallowed

food to essential acids. The cells in the stomach’s lining will excrete a strong acidic mixture of

hydrochloric acid, sodium chloride, and potassium chloride. This gastric acid, or colloquially

61
known as gastric “juice,” will work to break down the bonds within the food particles at the

molecular level. Pepsin enzyme will have the unique role of breaking the strong peptide bonds

that hold the proteins in our food together, further preparing the food for the nutrient absorption

that takes place in the small (mainly) and large intestines. This brings us to the third task the

stomach has, which is to send off the churned watery mixture to the small intestine for further

digestion and absorption. It takes about three hours for this to occur once the food is a liquid mix.

Sigmoid colon- Its major function is to transport the fecal matters to rectum and anus. It

eliminates all the solid waste and forms of gaseous waste down the gastrointestinal tract. All the

body waste finds its way to get stored in the sigmoid colon until it the time when it can come out

of the body through the anal canal.

Salivary glands- As the only secretion of our salivary glands, it is helpful in creating the food

bolus, or the finely packed ball of food that we roll inside our mouths. This shape facilitates its

safe passage through our alimentary canal. Saliva has lubricating properties that are protective,

as well. Saliva protects the inside of our mouths, our teeth, and our throats as we begin to

swallow the bolus. It also cleanses the mouth after a meal and dissolves food into chemicals that

we perceive as taste.

Rectum- The role of the rectum is to temporarily store feces until defecation.

The food that one consumes is first chewed in the mouth and as a part of the digestion process,

has to pass through the stomach, small intestine, and lastly the large intestine. The undigested

food and waste products that are accumulated during the digestion process, move into the rectum

in the form of fecal matter. It is the function of the rectum to receive this fecal matter and hold it

till one defecates. Thus, the rectum stores fecal matter until defecation, during which the feces

are eliminated from the body through the anus.

62
Peristalsis- Peristalsis is a series of wave-like muscle contractions that moves food to different

processing stations in the digestive tract. The process of peristalsis begins in the esophagus when

a bolus of food is swallowed. The strong wave-like motions of the smooth muscle in the

esophagus carry the food to the stomach, where it is churned into a liquid mixture called chime.

Peristalsis concludes in the large intestine where water from the undigested food material is

absorbed into the bloodstream. Finally, the remaining waste products are excreted from the body

through the rectum and anus.

Pancreas- The pancreas serves two primary functions, according to Jordan Knowlton, an

advanced registered nurse practitioner at the University of Florida Health Shands Hospital. It

makes "enzymes to digest proteins, fats, and carbs in the intestines" and produces the hormones

insulin and glucagon.

Mouth- in the mouth itself, the tongue and teeth help to get the process started by chewing and

chopping the food so it's small enough to be swallowed. Salivary glands secrete saliva, releasing

an enzyme that changes some starches into simple sugars and softens the food for swallowing.

Liver- The liver regulates most chemical levels in the blood and excretes a product called bile.

Bile helps to break down fats, preparing them for further digestion and absorption. All of the

blood leaving the stomach and intestines passes through the liver. The liver processes this blood

and breaks down, balances, and creates nutrients for the body to use. It also metabolized drugs in

the blood into forms that are easier for the body to use.

Jejunum- responsible for absorbing nutrients from digested food into the bloodstream. The

jejunum is able to absorb these nutrients because it is lined with finger-like projections that are

called villi. The villi absorb nutrients in the form of minerals, electrolytes, and carbohydrates,

proteins, and fats that were consumed in the form of food. The nutrients are absorbed into the

63
bloodstream where they can be utilized for energy by the entire body.The jejunum, as well as the

rest of the small intestine, make it possible to change food into energy, powering the body for

daily activities. Without the small intestine, food would pass through the body but we would gain

no nutrients, and would quickly starve.

Ileum- absorb the nutrients from the chyme, or digested food. This is done with the help of villi,

which are finger-like projections found in the inner wall.There are lymph vessels called lacteals

in the villi which absorbs fat in the lymphatic system. This digested fat is then drained into the

bloodstream, which is transported along with other nutrients, to the liver through the hepatic

portal vein. Detoxification takes place and the nutrients are assimilated by the body.

Gall bladder- serves as a reservoir for bile while it’s not being used for digestion. The

gallbladder's absorbent lining concentrates the stored bile. When food enters the small intestine,

a hormone called cholecystokinin is released, signaling the gallbladder to contract and secrete

bile into the small intestine through the common bile duct.The bile helps the digestive process by

breaking up fats. It also drains waste products from the liver into the duodenum, a part of the

small intestine.

Esophagus- The esophagus is an important connection to the digestive system through the

thoracic cavity, which protects the heart and lungs. The esophagus carries food through this

cavity, keeping it separate and moving it through with muscular contractions. Two sphincters on

either side of the esophagus separate food into small units known as a bolus. The size and

complexity of the esophagus varies by species.

Epiglottis- The main function of the epiglottis is to seal off the windpipe during eating, so that

food is not accidentally inhaled. The epiglottis also helps with some aspects of sound production

in certain languages.

64
Duodenum- The duodenum is the first and shortest segment of the small intestine. It receives

partially digested food (known as chyme) from the stomach and plays a vital role in the chemical

digestion of chyme in preparation for absorption in the small intestine. Many chemical secretions

from the pancreas, liver and gallbladder mix with the chyme in the duodenum to facilitate

chemical digestion.

Descending colon - primarily serves to absorb water from fecal matter. It also stores food

particles that are to be emptied into the rectum. While working in a downward movement, this

organ continues to push the digested waste products. The wastes move downwards from the

transverse colon to the sigmoid colon. They ultimately enter the rectum to be expelled during

excretion. While moving the waste material, the descending colon also continues to take out any

remaining nutrients and water from them.

Chyme - There are two major functions of chyme – the first is to increase the surface area of

food to allow digestive enzymes to complete their work, and the second is to stimulate various

digestive glands to release their secretions.The action of enzymes requires direct contact with the

molecules of the substrate. When food is first ingested, it is in the form of large chunks. Such

particles have a very low surface area for their volume, and therefore, enzymes will only have

access to a small proportion of the molecules in the substrate. Mastication of food, and the

subsequent churning through the muscles of the stomach and small intestine repeatedly break

down food through mechanical processes.

Cecum- absorb fluids and salts that remain after completion of intestinal digestion and

absorption and to mix its contents with a lubricating substance, mucus. The internal wall of the

cecum is composed of a thick mucous membrane, through which water and salts are absorbed.

65
Bile- lows into the duodenum and mixes with food contents. Bile has two important functions: It

assists in the digestion and absorption of fats, and it is responsible for the elimination of certain

waste products from the body, particularly hemoglobin from destroyed red blood cells and excess

cholesterol.

Ascending colon- The ascending colon carries feces from the cecum superiorly along the right

side of our abdominal cavity to the transverse colon. In the ascending colon, bacteria digest the

transitory fecal matter in order to release vitamins. The intestinal wall absorbs water, nutrients,

and vitamins from the feces and deposits these materials into our bloodstream.

Appendix- appendix acts as a storehouse for good bacteria, “rebooting” the digestive system

after diarrheal illnesses.

Anus- An aperture for defecation the primary anus function is to serve as an aperture for

defecation. After defecation, the colon and rectum prepare themselves to receive and store the

digestive wastes descending along the alimentary canal .Regulation of excretory process the

internal and external sphincters play a key role in the regulation of excretory process. The

internal involuntary sphincter operates under the command of autonomous nervous system,

voluntary control over feces removal holding feces back for a certain duration is a very important

anus function. Otherwise, you won’t be able to hold the bowels for some time in order to reach

the place of defecation and triggering need for removal of feces sexual arousal.

small intestine- The small intestine is the part of the intestines where 90% of the digestion and

absorption of food occurs, the other 10% taking place in the stomach and large intestine. The

main function of the small intestine is absorption of nutrients and minerals from food.

Digestion involves two distinct parts. The first is mechanical digestion by chewing, grinding,

churning and mixing that takes place in the mouth and the stomach. The second part of digestion

66
is the chemical digestion that uses enzymes, bile acids etc. in order to break down food material

into a form that can then be absorbed, then assimilated into the tissues of the body. Chemical

digestion occurs in the small intestine (and, to a lesser extent, also in some other part of the

gastrointestinal tract.

Large intestine- absorbing water and electrolytes, producing and absorbing vitamins, and

forming and propelling feces toward the rectum for elimination. By the time indigestible

materials have reached the colon, most nutrients and up to 90% of the water has been absorbed

by the small intestine. The role of the ascending colon is to absorb the remaining water and other

key nutrients from the indigestible material, solidifying it to form stool. The descending colon

stores feces that will eventually be emptied into the rectum. The sigmoid colon contracts to

increase the pressure inside the colon, causing the stool to move into the rectum. The rectum

holds the feces awaiting elimination by defecation.

The Abnormal Digestive Process:

The start of the process - the mouth: The digestive process begins in the mouth. Contaminated

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).

On the way to the stomach: the esophagus - After being chewed and swallowed, the

contaminated 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

67
from the throat into the stomach. This muscle movement gives us the ability to eat or drink even

when we're upside-down.

In the stomach - Direct invasion and by endotoxin being released by the organism and the

action of the hydrochloric acid of the stomach. As the protective coating of the stomach erodes

the digestive capabilities of the acid helps in destroying the stomach lining

In the small intestine - Stimulation and destruction of mucosal lining of the bowel wall

continues the mucosal lining erodes due to toxin and followed by increasing lymphocytes.

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 (bacteria like Bacteroides, Lactobacillus acidophilus,

Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. As the bowel

is stimulated by the organism and its toxin, the intestinal tract secretes water and electrolytes in

the intestinal lumen. The body secretes and therefore lost chloride and bicarbonate ions the

bowel as the body try to get rid of the organism by increasing peristalsis and number of

defecation.

The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.

68
Digestive System Glossary:

Anus - the opening at the end of the digestive system from which feces (waste) exits the body.

Appendix - a small sac located on the cecum.

Ascending colon - the part of the large intestine that run upwards; it is located after the cecum.

Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted

into the small intestine.

Cecum - the first part of the large intestine; the appendix is connected to the cecum.

Chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes

on to the small intestine for further digestion.

Descending colon - the part of the large intestine that run downwards after the transverse colon

and before the sigmoid colon.

Duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the

jejunum.

Epiglottis - the flap at the back of the tongue that keeps chewed food from going down the

windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe,

the epiglottis opens so that air can go in and out of the windpipe.

Esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle

movements (called peristalsis) to force food from the throat into the stomach.

Gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a

digestive chemical which is produced in the liver) into the small intestine.

Ileum - the last part of the small intestine before the large intestine begins.

Jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and

the ileum.

69
Liver - a large organ located above and in front of the stomach. It filters toxins from the blood,

and makes bile (which breaks down fats) and some blood proteins.

Mouth - the first part of the digestive system, where food enters the body. Chewing and salivary

enzymes in the mouth are the beginning of the digestive process (breaking down the food).

Pancreas - an enzyme-producing gland located below the stomach and above the intestines.

Enzymes from the pancreas help in thedigestion of carbohydrates, fats and proteins in the small

intestine.

Peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into

the stomach. Peristalsis is involuntary – you cannot control it. It is also what allows you to eat

and drink while upside-down.

Rectum - the lower part of the large intestine, where feces are stored before they are excreted.

Salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that

break down carbohydrates (starch) into smaller molecules.

Sigmoid colon - the part of the large intestine between the descending colon and the rectum.

Stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and

mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in

a bath of acids and enzymes.

Transverse colon - the part of the large intestine that runs horizontally across the abdomen.

70
 PATHOPHYSIOLOGY

Precipitating factors:
Predisposing factors:
Ingestion of contaminated food and drinks
Age: 1 year old & 8 mos.
Unsanitary food handling
Impaired immune system
Poor environmental sanitation
Malnourished
Socioeconomic status
BMI : 10.5kgs
Poor hygiene
Sunken eyes Hyper active-
Dry skin bowel sounds
Dry lips Watery stool
Poor skin turgor
Ingestion of fecally contaminated food and
water

Direct invasion and by endotoxin

being released by the organism

Attempted defecation Stimulation and destruction of mucosal Digestive and

(tenesmus) lining of the bowel wall absorptive malfunction

Inflammation of bowel Increased lymphocytes Lymphocytosis

Infection

Tergecef

Excessive gas formation

Abdominal pain
Irritation of the Gastric lining Decrease integrity of the
intestinal wall

Face 4 hurts a whole lot

Vomiting

Ranitidine
Metoclopramide

Mild Diarrhea Deficient fluid volume

Dehydration
Increase peristaltic movement Electrolytes imbalance

Erceflora
Hydration (IVF D5IMB 500ml)
71
If Left Untreated If Left treated

72
LEGEND:

= Disease Process

= Client Manifestation

= Clinical Manifestation

= Treatment/management

= Signs and Symptoms

= If Left Untreated

= If Left Treated

= Well

= Death

PATHOPHYSIOLOGY:

The predisposing factor of patient P.P are the age, impaired immune system and

malnourished. The precipitating factors are the ingestion of contaminated food and drinks,

unsanitary food handling, poor environmental sanitation and socioeconomic status and poor

hygiene

The pathologic process starts with ingestion of fecally contaminated food and water. The

organisms affects the body through direct invasion and by endotoxin being released by the

organism. Through these two processes the bowel mucosal lining is stimulated and destroyed the

eventually lead to attempted defecation or tenesmus as the body tries to get rid of the foreign

organism in the stomach the client with acute gastroenteritis with mild dehydration may also

report excessive gas formation that may lead to abdominal distention and passing of flatus due to

73
digestive and absorptive malfunction in the system . As the destruction of the bowel continues

the mucosal lining erodes due to toxin, direct invasion of the organism and the action of the

hydrochloric acid of the stomach. As the protective coating of the stomach erodes the digestive

capabilities of the acid helps in destroying the stomach lining. Pain or tenderness of the abdomen

is then felt by the patient with a pain scale 4 out of 5 which means it hurts whole lot based from

Wong-Baker FACES. When the burrows or ulceration reaches the blood vessels in the stomach

bleeding will be induced. Treatment are metoclopramide and ranitidine.

Feeling of fullness and the increase motility of the gastrointestinal tract may progress to

vomiting. As the bowel is stimulated by the organism and its toxin, the intestinal tract secretes

water and electrolytes in the intestinal lumen. The body secretes and therefore lost chloride and

bicarbonate ions the bowel as the body try to get rid of the organism by increasing peristalsis and

number of defecation. Sodium and water reabsorption in the bowel is inhibited with the lost of

the two electrolytes. Mild diarrhea is characterized by 2-3 stools associated with watery stool and

borborygmi ( hyperactive bowel sounds), fluid and electrolyte imbalance and hypernatremia

associated with sunken eyes, dry skin and lips, and poor skin turgor. Treatment are erceflora and

hydration ( IVF D5IMB 500 ml ). Increase lymphocytes leads to infection treatment is tergecef.

74
 Drug Study No. 1

Generic name:

Metoclopramide

Brand name:

PLASIL

Dosage:

2mg/ampoule

Route:

IV

Frequency:

q 8hr

Classification

Anti-emetics

Mechanism of action

It blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine, leading to

increased GI activity and rapid movement of food through the upper GI tract.

75
Indications

Prevention of chemotherapy-induced emesis, treatment of postsurgical and diabetic gastric stasis,

facilitation of small bowel intubations in radiographic procedures, management of esophageal

reflux, treatment and prevention of postoperative nausea and vomiting when nasogastric

suctioning is undesirable

Contraindications

Hypersensitivity, possible obstruction or hemorrhage, history of seizure disorders,

pheochromocytoma, Parkinson’s disease

Adverse effect

CNS:

drowsiness, extrapyramidal reactions, restlessness, anxiety, depression, irritability, tardive

dyskinesia

CV:

arrhythmias, hypertension, hypotension

GI:

constipation, diarrhea, dry mouth, nausea

76
Endo:

Gynecomastia

Nursing Considerations

 Assess client for abdominal pain distention, bowel sound

 Assess client for extrapyramidal reaction

 Monitor for tardive dyskinesian

77
 Drug Study No. 2

Generic:

Cefixime

Brand:

TERGECEF

Classification:

Cephalosporin

Dosage:

3ml (susp 100mg/5ml )

Route:

Oral

Frequency:

2 x a day (BID)

Mechanism of Action:

A third general cephalosporin that inhibits cell wall synthesis, promoting osmotic instability

usual bactericidal

78
Indications

Used to treat infections caused by bacteria such as pneumonia, bronchitis, gonorrhea, throat,

bronchiectasis with infection, secondary infections of chronic respiratory tract diseases,

pyelonephritis, cystitis, gonococcal urethritis, cholangitis, scarlet fever, otitis media, and

sinusitis. Antibiotics will not work for colds, flu, or other viral infections

Contraindications

History of shock caused by cefixime . Hypersensitivity

Adverse Effect

Shock, hypersensitivity, hematologic disorder, GI disorder, Vit.K deficiency.

Nursing Considerations

 Obtain urine specimen for culture and sensitivity after first dose. Therapy may begin

pending results.

 To prepare oral suspension, add required amount of water to powder into two

portions. Shake well after each addition. After mixing, susp is stable for 14 days. No need

to refrigerate but keep tightly closed. Shake well before using.

 With large doses/prolonged therapy, monitor for superinfection, especially in

high-risk patients.

 Tell patient to take all the medication prescribed, even after he feels better.

 Assess patient for development of rash and occurrence of side effects

79
 Drug Study No. 3

Generic Name:

Bacillus Clausii

Brand Name:

ERCEFLORA

Dosage

1 vial

Route:

Oral

Frequency:

3 x a day

Classification:

Antidiarrheals

Mechanism of Action

 Contributes to the recovery of the intestinal microbial flora altered during the course of

microbial disorders of diverse origin.

80
  Produces various vitamins, particularly group B vitamins thus contributing to correction

of vitamin disorders caused by antibiotics & chemotherapeutic agents.

 Promotes normalization of intestinal flora.

Indication:

Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons.

Chronic or persistent diarrhea with duration of >14 days.

Contraindication

Not for use in immune compromised patients (cancer patients on chemotherapy, patients taking

immune suppressant meds)

Side/Adverse Effect

No known side/adverse effects

Nursing Consideration

 Shake drug well before administration.

 Monitor patient for any unusual effects from drug.

 Administer drug within 30 minutes after opening container.

 Dilute drug with sweetened milk, orange juice or tea.

 Administer drug orally.

81
BEFORE:

 Shake drug well before administration.

 Allows equal distribution of the drug in the fluid it is in.

DURING:

 Monitor patient for any unusual effects from drug.

 Monitoring allows detection of possible side effects of the drug since there

has been no known side effect of the drug.

AFTER:

 Administer drug within 30 minutes after opening container.

 To avoid contamination of the drug. Dilute drug with sweetened milk,

orange juice or tea.

 To allow easy administration of the drug. Administer drug orally.

 Proper administration allows better effects of the drug and prevent

possible complications

82
 Drug Study No. 4

Generic:

Ranitidine

Brand:

ZANTAC

Classification:

Anti-ulcer

Dosage:

14mg/ampoule

Route:

IVTT

Frequency:

q 8 hours

Mechanism of Action:

Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells,

resulting in inhibition of gastric acid secretion has some antibacterial action against H. pylori

83
Indications

Treatment and prevention of heartburn, acid indigestion, and sour stomach

Prophylaxis of GI hemorrhage from stress ulceration

Contraindications

Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be

avoided in patients with known intolerance

Nursing Intervention

Instruct patient not to take new medication w/o consulting physician

Instruct patient to take as directed and do not increase dose

Allow 1 hour between any other antacid and ranitidine

Avoid excessive alcohol

Assess patient for epigastric or abdominal pain and frank or occult blood in the stool,

emesis, or gastric aspirate

Nurse should know that it may cause false-positive results for urine protein; test with

sulfosalicylic acid

Inform patient that it may cause drowsiness or dizziness

Inform patient that increased fluid and fiber intake may minimize constipation

Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness;

rash; confusion; or hallucinations to health care professional promptly

Inform patient that medication may temporarily cause stools and tongue to appear gray

black

Instruct patients to monitor for and report occurrence of drug-induced adverse reaction

84
 NURSING CARE PLAN #1

Assessment

Subjective: “ Sakit ako tijan “ as verbalized by the patient

Objective:

Diaphoresis

Facial expression of pain ( e.g., grimace, eyes lack luster)

Wong Baker’s face rating scale is 4

Diarrhea

Vomiting

Cries more than usual

Irritable

Nursing Diagnosis: Acute pain related to biological injury agent ( e.g., Infection )

Planning: Within 2 hours of nursing intervention the patient will manifest pain is relieve or

controlled.

85
 Nursing Intervention Rationale

INDEPENDENT To fully understand client’s pain symptoms.

Obtained client’s or significant others or SO

assessment of pain to include location,

characteristics, onset, duration, frequency, quality,

intensity. Identify precipitating or aggravating and

relieving factors.

Evaluated pain characteristics and intensity Use pain rating scale appropriately for age and

cognition(e.g 0-10 scale)

Performed pain assessment each time pain occurs. To demonstrate improvement in status or to

Documented and investigate from previous reports identify worsening of underlying

and evaluate results of pain interventions. condition/developing complications.

Established collaborative approach for pain To assist client to explore methods for

management based on clients understanding about alleviation/control of pain.

and acceptance of available treatment options.

Acknowledged the pain experience and convey Reduces defensive responses, promotes trust, and

acceptance of clients response to pain enhances cooperation with regimen

Encouraged adequate rest periods To prevent fatigue that can impair ability to

manage or cope with the pain.

Identified specific signs/symptoms and changes in Provides opportunity to modify pain management

pain characteristics requiring medical follow-up. regimen and allows for timely intervention for

developing complications.

86
 DEPENDENT To eliminate the pain

Administered medications as prescribed

( Ranitidine 14 mg ampule)

Evaluation: Goal met within 2 hours of rendering my nursing intervention the patient

manifested pain is relieved and controlled.

87
 NURSING CARE PLAN #2

Assessment

Subjective: “sige man siya ug suka…” as verbalized by the SO

Objective:

Serum Na+ level of 132.4 mmol/L(Hyponatremia)

Decreased skin turgor

Nursing Diagnosis: Deficient Fluid Volume related to Hypertonic dehydration

Planning: After 1 day of thorough nursing intervention, the client will be able to:

a) Maintain body fluid levels.

b) Completely eliminate the occurrence of vomiting.

c) Increase serum Na+ level from 132.4 to 135

d) Improve skin turgor of the patient from poor to fair

Nursing Intervention Rationale

INDEPENDENT It serves as a baseline for doing such interventions

Maintained accurate intake and output, calculate

24-hour fluid balance and weigh daily

Promote a well-ventilated environment conducive To avoid the occurrence of vomiting

for eating

Provide frequent oral and skin care To prevent injury from dryness.

88
Changed position frequently. To promote proper circulation of blood, thus,

preventing fromfluid deficit

DEPENDENT

Administered medication(metoclopramide 1 To decrease the occurrence of vomiting

ampule IVTT),as ordered

Administered fluids and electrolytes(D5IMB 500 To gradually correct the deficient in fluid

cc), as ordered. (hypertonic)

Evaluation: Goals are met after 1 day of thorough nursing intervention, the client was able to

maintain body fluid levels, completely eliminate the occurrence of vomiting, increase serum Na+

level from 132.4 to 135 and improve skin turgor of the patient from poor to fair.

89
 NURSING CAREPLAN #3

Assessment

Subjective: “Kaluja tawon sa ako bata” as verbalized by the SO

Objective:

Lack of energy

Decrease activity performance

Weakness

Nursing diagnosis: Fatigue related to Physiological condition

Planning: Within 4-6 hours of rendering my nursing intervention, the client will be able to

perform ADLs and participate activities at the patient’s level of ability and will report an

improved sense of energy.

Nursing intervention Rationale

INDEPENDENT

Monitored vital signs. To evaluate fluid status and cardiopulmonary

response to activity

Planned interventions to allow patient adequate To maximize patient participation

rest periods, schedule activities for periods when

client has the most energy

90
Encouraged patient to do whatever possible such To manage patients limit of ability

as self-care, walking within ward premises and

interacting with family

Instructed methods to conserve energy such as To conserve and maximize patient’s energy

sitting when doing daily care or other activities,

combining and simplifying activities and taking

frequent short rest periods during activities

Assessed patient in self-care needs and with To protect client from injury

ambulation as needed

DEPENDENT To gradually correct the deficient in fluid

Provided supplement fluids as indicated D5IMB

Fluids may be given in this manner if patient is
500cc @ 30-35gtts
unable to take oral fluid

Evaluation:

Goal met within 4-6 of rendering my nursing intervention, the client was able to perform ADLs

and participate in activities at the patient’s level of ability and will report an improved sense of

energy.

91
 NURSING CARE PLAN #4

Assessment

Objective: Potassium 3.35 mmol/L

Hyponatremia (132.4 mmol/L)

Vomiting

Diarrhea

Dehyration

Nursing diagnosis: Electrolyte imbalance related to insufficient fluid volume

Planning: Within 6-8 of rendering my nursing intervention patient will be free of complication

resulting from electrolyte imbalance

Nursing intervention Rationale

INDEPENDENT Many factors, as inability to drink, diuresis or

Monitored fluid intake and output chronic kidney failure, trauma and surgery, affect

an individual’s fluid balance, disrupting

electrolyte transport, transport, function and

excretion.

Noted the client’s age and developmental level It includes the very young or the premature infant,

which may increase the risk electrolyte imbalance the elderly, or individuals unable to meet their

own needs or monitor their health status including

92
 the clients who are unconscious for an unknown

cause or period of time, a trauma victim, and so

on.

DEPENDENT To gradually correct the deficient in fluid

Administered fluids and electrolytes(D5IMB 500 (hypertonic)

cc), as ordered.

Evaluation: Goal met within 6-8 hours of rendering my nursing intervention the patient was

free of complication resulting from electrolyte imbalance

93
 NURSING CARE PLAN #5

Assessment

Subjective: “wala man siya’y gana mukaon tapos kung mukaon kay musuka man dayon” as

verbalized by the SO

Objective: consuming ¼ share

weight loss of .5kg after 2 days (from 10.5 kg to 10 kg)

Vomiting

Weakness ( Muscle strength 4/5 )

Decreased appetite

Normal BMI for 1 y/o: 19-27

Patient BMI: 17.25 (underweight)

Nursing Diagnosis: Imbalanced Nutrition: less than body requirements related to inability to

ingest or digest food and inability to absorb nutrients.

Planning: Within 2 hours of rendering my nursing intervention the patient will be able to: a)

Verbalize food preference which is not contraindicated to his underlying disease to promote good

appetite. b) Improve appetite from poor to fair by eating ½ share from ¼ share and reduce the

occurrence of vomiting.

94
 Nursing Intervention Rationale

INDEPENDENT

Use flavoring agents To determine enhance food satisfaction and

stimulate appetite

Encouraged client to choose foods. Have To stimulate appetite.

family members bring foods that seen

appealing (which are not contraindicated)

Promote pleasant, relaxing environment, To enhance food intake

including socialization when possible.

Prevent/minimize unpleasant odors To reduce the occurrence of nausea and

vomiting.

Dependent

Administered medication (metoclopramide 1 To decrease the occurrence of vomiting.

ampule IVTT), as ordered

1. Collaborative

Referred to dietician for modification of diet To gradually stimulate appetite for fast

(General Liquids) recovery

Evaluation: Goal met within 2 hours of rendering nursing intervention the patient was able to

verbalize food preference which are not contraindicated to hr underlying disease to promote

good appetite. b) Improve appetite from poor to fair by eating ½ share from ¼ share and reduce

the occurrence of vomiting.

95
 Nursing Care Plan # 6

Assessment

Objective:

Irritable

Fatigue

Itching

Anxiety

Nursing diagnosis: Self-Care Deficit related to in ability to perform activities of daily living

Planing: Within 2 hours of rendering my nursing intervention the patient will be able to perform

self-care activities within level of his own ability.

Nursing Intervention Rationale

Independent
Performed or assessed with meeting client’s Personal care assistance is part of nursing care and

needs should not be neglected while self care

independence is promoted and integrated.

Bathed or assessed client in bathing, providing for Type and purpose of bath is determined by

any or all hygiene needs as indicated individual need.

Obtained hygiene supplies for specific activity to To provide visual cues and facilitate completion of

be performed and place in the SO easy to reach activity.

Certain individuals ( especially infants, the

Provided for adequate warmth. elderly, and very thin or debilitated persons are

prone to hypothermia and can experience

evaporative cooling during and after bathing.

96
Determined that client can perceive water To prevent chilling and burns.

temperature, adjust water temperature safely.

Assessed client in and out of shower or tub as To promote safety of the patient

indicated

Use adaptive clothing as indicated ( e.g., clothing These may be helpful for client with limited arm

with front closure, wide sleeves and pant legs. or leg movement or impaired fine motor skills.

Evaluation: Within 2 hours of rendering my nursing intervention the patient was be able to

performed self-care activities within level of his own ability.

97
 DISCHARGE PLAN

MEDICATIONS:

Instruct the SO of the patient to take all the prescribed medications at the proper time and

dosage for the specific duration as the doctor has ordered.

 Inform the S.O about the possible side effects of the medications.

 Inform the S.O about the importance of compliance to prescribed medications and

consequences.

ERCEFLORA 1 vial 3x a day for three days

Cefexime(Tergecef) 3ml 2 times a day for 7 days

Hydrite Powder 1 sachet in 1 glass of water every 4 hours for 2days

ENVIRONMENT

 Wash hands with soap after going to the toilet and before eating or preparing food.

 Avoid contact with soil

 Avoid sharing towels with infected persons

TREATMENT

Treat AGE with moderate dehydration with ERCEFLORA 2 billion/5ml one respule three times

a day and Cefixime ( Tergecef )3 ml 2 times a day for 7 days it kills bacterial infection in

intestines and tissue. And also ERCEFLORA acts as prophylaxis.

98
HEALTH TEACHINGS.

Hygiene

 Cut and keep your nails clean

 Proper hand washing is necessary

 Take care of drinking water - either option for mineral water or water boiled for 20

minutes.

OPD- FOLLOW-UP:

 Instruct the SO of the patient together with his son to return to the Attending Physician

for follow up check-up and for emergency medical assistance.

DIET

 Diet as Tolerated

 Increase oral fluid intake: To prevent the dehydration.

 Avoid juices and coffee, To prevent abdominal pain

 Light soups, toast, rice and eggs are good foods; eat foods high in fiber and

carbohydrates.

SPIRITUAL

 Advise the patient to encourage praying to God as the Family does every day and to

strengthen their faith

99
 APPENDICES

IVF CHART

Date # of Bottle Solution Additive Rate of Drop Time

Volume

1/24/19 1 500 cc D5IMB 30-35 gtts 8:54 am

1/24/19 2 500 cc D5IMB 30-35 gtts 5:30 pm

1/24/19 3 500 cc D5IMB 30-35 gtts 2:35 am

1/25/19 4 500 cc D5IMB 30-35 gtts 11:30 am

DAILY WEIGHT

Date Weight

1/24/19 10.2kg

1/25/19 10kg

Usual weight 10.5kg

100
 Vital Signs

Date Time BP HR RR Temp

1/24/19 8 am - 135 35 37

12 nn - 130 32 36.5

4 pm - 136 35 36.6

8 pm - 131 36 37

12 am - 134 33 36.5

4 am - 136 37 37

1/25/19 8 am - 132 32 37

12 nn - 130 35 37

101
 I AND O SHEET

Date IVF Oral Total Urine Total Output

Credit Consumed fluid Taken Output Vomitus Bm

taken

1/24/19 200 300 60 360 1 2x 1x 1 unweight Diaper+2x

unweight vomitus+1xBM

Diaper

1/25/19 480 220 160 380 450 - 1x 450+1xBM

740 450+2xBM+2xVomitus

102
 CFAC

COLOR FREQUENCY AMOUNT CHARACTERISTICS

1/24/19 YELLOWISH 4X MEDIUM WATERY

(12PM)

1/25/19 BROWNISH 2X MEDIUM WATERY

(12AM)

1/25/19 BROWNISH 1X MODERATE SOFT

(12PM)

103
 GENOGRAM

80 y/o 80 y/o
78 y/o HTN
Deceased 70 y/o
Deceased 80 y/o
Deceased
A&W

37 y/o
35 y/o
A&W
A&W

1 yr and 8mos
AGE w/
Moderate
Dehydration

LEGENDS:

Patient, ACUTE GASTROENTERITIS

With Moderate Dehydration

Mother, alive and well Father, alive and well

Grandfather, HTN deceased Grandfather deceased

Grandmother deceased Grandmother, alive and well

104
References:

1. World Health Organization 2005( A manual for Physicians and other Senior Health Workers by
Ellis D. Avner, MD page 40-41 Chapter 3 Vol. 1 15th edition)
2. Centers for Disease Control and Prevention or CDC(Gastroenteritis outbreaks in Health Care
Settings by Kurt B. Stevenson, MD page 55-58 Chapter 22 volume 1 7th Edition)
3. Baby and Child Health Care by Dr. Miriam Stoppard page 140 volume 1 3rd edition

4. The 5-Minute Pediatric Consult by Pramod Kerkar,MD,FFARCSI page 60-64 Chapter 50

Volume 1 8th Edition
5. Gastroenteritis by Elizabeth Jane Elliott page 40 Chapter 4 volume 1 7th edition
6. https://www.symptoma.com/en/info/acute-gastroenteritis. Amador JJ, Vicari A, Turcios-Ruiz
RM, et al. Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005. Rev Panam
Salud Publica. 2008; 23(4):277-284.
7. Gastroenteritis Care by Hal B. Jenson, MD page 20 Chapter 1 volume 1 2nd Edition
8. Chhabra P, Payne DC, Szilagyi PG, et al. Etiology of viral gastroenteritis in children.
https://www.symptoma.com/en/info/acute-gastroenteritis
9. Bacterial Infection of the Gastrointestinal tract by Wolters Kluwer Health/Lippincott Williams &
Wilkins, 2009. page 3500 Chapter 300 volume 2 3rd Edition
10. .(Gastroenteritis Epidemiology, Management and Prevention by Madeleine Stuart, 2014 page 250
Chapter 8 volume 1 4th edition
11. Ham EB, Nathan R, Davidson GP, Moore DJ et al Bowel Habits of Healthy Australian children
aged 0-2 years. J Paediatr Child Health 1996; 32:504-7
https://emedicine.medscape.com/article/964131-overview
12. Nelson Textbook of Pediatrics by Richard E. Behrman, MD page 1272 Chapter 321 volume 2
17th Edition
13. Atlas of Infectious Diseases by Robert M. Kliegman, MD page 1900 Chapter 300 volume 2 16th
edition
14. Gastroenteritis And Home Care Management Of Mothers Among Marginalized Communities In
Catbalogan City, Philippines by Rheajane A Rosales page 581-585 World Health Organization.
World Health Statistics, 2013. http://www.who.int/gho/publications/world_health_stati
stics/EN_WHS2013_Full.pdf
15. Pediatric Gastrointestinal Disease by Joann L, Ater, MD page 4000 Chapter 350 Volume 2)

105