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Acute Gastroenteritis

(also known as gastric flu, stomach flu, gastro and stomach virus, although unrelated to influenza) is marked by inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in diarrhea, vomiting and abdominal cramps. The majority of cases in children globally are caused by rotavirus, while in adults norovirus is more common, at least in the United States. Less common causes include bacteria or their toxins, and parasites. Transmission may occur due to improperly prepared foods, contaminated water or close contact with those who are infectious. The foundation of management is adequate hydration. For mild or moderate cases this can typically be achieved via oral rehydration solution. For more severe cases intravenous fluids may be needed. Gastroenteritis primarily affects children and those in the developing world.

Gastroenteritis is typically diagnosed based on a person's symptoms. Determining the exact cause is usually not needed as it does not alter management. As hypoglycemia may occur in ~10% of children measuring serum glucose is recommended. Diagnostic testing may be done for surveillance. Electrolytes and kidney function should also be checked when there is a concern for severe dehydration. Stool cultures should be performed in those with blood in the stool, who might have been exposed to food poisoning, and those who have recently traveled to the developing world.

Management Fluids
It is imperative that the patient's input and output be monitored and documented at regular intervals. He should be encouraged to take as many fluids as he can, since this will help flush the illness out of his system and prevent dehydration, which is a risk of acute gastroenteritis. The patient should sip fluids slowly as to not upset the stomach. Avoid giving her sugary drinks, instead offering water, Powerade or something similar.

If the patient is able to keep fluids down, he might try eating something small, like a saltine cracker. Keep track of what he eats and what he can and cannot keep down. The patient should eat slowly at first, gradually increasing the amount. As her condition improves, she may be able to eat soups or soft, pureed foods that don't have a lot of spices in them.

It's important to follow doctor's orders with all medications. If the doctor prescribes PRN (as-needed) medications for the nausea, these can be given to the patient. Medications that might be prescribed by the physician include Compazine, Phenergan, Reglan, Emetrol, Tigan, and Zofran. These medications might give the patient some relief from the nausea and vomiting. If the diarrhea is not resolved, other medications may also be prescribed, such as dicyclomine, Lomotil and Imodium .

If the patient becomes dehydrated, he may require IV fluids, which the nurse should closely monitor. The doctor should be informed if the patient's urine output is below 500 milliliters per day or serum electrolyte levels are abnormal. The patient may be very weak if dehydrated, so she should be helped in getting out of bed to go the bathroom, since she could become dizzy and fall.

Make sure the patient's room has a restful mood by keeping noise to a minimum and maintaining the patient's privacy. This can be difficult in a hospital setting, but even closing his curtains or the door might help. He might try methods such as visual imagery to help focus on things besides his illness and pain. For example, he could visualize being in Hawaii with the waves lapping at his feet, making a gentle, soothing sound. This kind of visualization may help relieve his symptoms. The nurse can talk him through this visualization the first few times .

Nursing Responsibilities
Plan care to allow uninterrupted rest periods for the patient. If the patient is nauseated, advise him to avoid quick movements, which can increase the severity of nausea. If the patient can tolerate oral fluids, replace lost fluids and electrolytes with broth, ginger, ale, and lemonade, as tolerated. If dehydration occurs, administer oral and I.V. fluids as ordered. To ease anal irritation caused by diarrhea, clean the area carefully and apply repellent cream, such as petroleum jelly. Wash hand thoroughly after giving care to avoid spreading of infection, and use standard precaution whenever handling vomitus or stools. Monitor the patients fluids status carefully. Assess vital signs at least every 4 hours, weigh him daily, and record intake and output. Teach the patient about gastroenteritis, describing its symptoms and varied causes. Teach the patient the proper preventive measures