UNION CHRISTIAN COLLEGE

Bachelor of Science in Nursing

City of San Fernando
Province of La Union
Philippines

CASE STUDY: ACUTE

GASTROENTIRISTIS WITH
DEHYDRARTION

Submitted by:
BSN-II
Acena, Jobelle C.
Caluza, Zhyraine Iraj D.
Cristino, Lynn Holly B.
Corpuz, Kristine Casandra Y.
Estrañero, Ma. Freda R.
Gagarin, Jervin John I.
Guarin, Krishia Nel L.
Manalastas, Noime Ivory M.
Mariñas, Jasmin S.
Naga, Abdul Jalil S.
Velasco, Janelle Mica S.D.

Submitted to:
 Mrs. Ester A. Fangonil, RN, MAN
Clinical Instructor
I. INTRODUCTION

Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach
and intestine. It is frequently referred to as the stomach or intestinal flu, although the influenza virus is
not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal
cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteritis
typically lasts about three days. Adults usually recover without problem, but children, the elderly, and
anyone with an underlying disease are more vulnerable to complications such as dehydration.
Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that has spoiled may
also cause illness. Certain medications and excessive alcohol can irritate the digestive tract to the point of
inducing gastroenteritis. Regardless of the cause, the symptoms of gastroenteritis include diarrhea, nausea
and vomiting, and abdominal pain and cramps. Sufferers may also experience bloating, low fever, and
overall tiredness. Typically, the symptoms last only two to three days, but some viruses may last up to a
week. A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medical treatment is
essential if symptoms worsen or if there are complications. Infants, young children, the elderly, and
persons with underlying disease require special attention in this regard. The greatest danger presented by
gastroenteritis is dehydration. The loss of fluids through diarrhea and vomiting can upset the body's
electrolyte balance, leading to potentially life-threatening problems such as heart beat abnormalities
(arrhythmia). The risk of dehydration increases as symptoms are prolonged. Dehydration should be
suspected if a dry mouth, increased or excessive thirst, or scanty urination is experienced. If symptoms do
not resolve within a week, an infection or disorder more serious than gastroenteritis may be involved.
Symptoms of great concern include a high fever (102 ° F[38.9 °C] or above), blood or mucus in the
diarrhea, blood in the vomit, and severe abdominal pain or swelling. These symptoms require prompt
medical attention. Gastroenteritis is a self-limiting illness which will resolve by itself. However, for
comfort and convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve
the symptoms. These medications work by altering the ability of the intestine to move or secrete
spontaneously, absorbing toxins and water, or altering intestinal micro flora. Some over-the-counter
medicines use more than one element to treat symptoms.

II. PATIENT’S PROFILE

Name: R.E.P.
Age: 9 months
Sex: Male
 Birth Date: May 14, 2018
Civil Status: Single
Birth Place: San Fernando City, La Union
Address: Catbangen, San Fernando City, La Union
Religion: Roman Catholic
Nationality: Filipino
Date Admitted: February 9, 2019 3:32PM
Admitting Impression: LBM and vomiting; Acute Gastroenteritis (AGE)

PHYSICAL ASSESMENT

Date Assessed: February 9, 2019

Vital Signs as follows:

T˚ - 36.4˚C CR – 114 bpm

RR - 31/min O2Sat – 98%

Family History:

No one in the family had any respiratory illness or allergies. On her father’s side almost all have
hypertension. One member of their family died on heart attack.

Medical History:

She was admitted for having LBM and vomiting for 3 days.

Present History:

R.E.P. was only admitted to the hospital due to gastrointestinal problem and was also suspected of
urinary tract infection by Dra. Hipol. Aside from the diagnosis, no other disease or complication was seen
or diagnosed.

Past History:

Last year he was diagnosed with the same disease. He has same chief complaint of LBM and vomiting.

Mrs. P says “ito ung 2nd time niya ma-confine, ganun din ang ngayri sa kanya. Kumain din siya ng ice
cream tapos sumakit na ang tiyan nya”. She says that maybe because of the “dirty icecream”. She
completed all vaccinations including BCG, DPT, Oral Polio Vaccine 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. She does not have allergy in any food or drug.

III. ANATOMY AND PHYSIOLOGY

The Gastro-Intestinal System

The gastro-intestinal system is essentially a long tube running right through the body, with specialized
sections that are capable of digesting material put in at the top end and extracting any useful components
from it, then expelling the waste products at the bottom end. The whole system is under hormonal control,
with the presence of food in the mouth triggering off a cascade of hormonal actions; when there is food in
the stomach, different hormones activate acid secretion, increased gut motility, enzyme release etc. etc.
 Nutrients from the GI tract are not processed on-site; they are taken to the liver to be broken down
further, stored, or distributed.

Mouth and Salivary Glands

Digestion begins in the mouth, where chemical and mechanical
digestion occurs. Saliva or spit, produced by the salivary glands
(located under the tongue and near the lower  jaw), is released
into the mouth. Saliva begins to break down the food, moistening
it and making it easier to swallow. A digestive enzyme (called
amylase) in the saliva begins to break down the carbohydrates
(starches and sugars). One of the most important functions of the
mouth is chewing. Chewing allows food to be mashed into a soft
mass that is easier to swallow and digest later.

Pharynx

Muscular walls of pharynx function in the process of

swallowing, and it serves as a pathway for the movement of
food from the mouth to the esophagus.

Esophagus

Once food has been chewed and mixed with saliva in the mouth, it is swallowed and passes down the
esophagus. The esophagus has a stratified squamous epithelial lining (SE) which protects the esophagus
from trauma; the submucosa (SM) secretes mucus from mucous glands (MG) which aid the passage of
food down the esophagus. The lumen of the esophagus is surrounded
by layers of muscle (M)- voluntary in the top third, progressing to
involuntary in the bottom third- and food is propelled into the
stomach by waves of peristalisis.

Stomach
The stomach is a 'j'-shaped organ, with two openings- the esophageal and the duodenal- and four regions-
the cardia, fundus, body and pylorus. Each region performs different functions; the fundus collects
digestive gases, the body secretes pepsinogen and hydrochloric acid, and the pylorus is responsible for
mucus, gastrin and pepsinogen secretion.

The stomach has five major functions;

 Temporary food storage

 Control the rate at which food enters the

duodenum

 Acid secretion and antibacterial action

 Fluidization of stomach contents

 Preliminary digestion with pepsin, lipases etc.

Small
Intestine
The small
intestine is the
site where most of the chemical and mechanical digestion is
carried out, and where virtually all of the absorption of useful
materials is carried out. The whole of the small intestine is
lined with an absorptive mucosal type, with certain
modifications for each section. The intestine also has a smooth
muscle wall with two layers of muscle; rhythmical
contractions force products of digestion through the intestine (peristalsis). There are three main sections
to the small intestine;

 The duodenum forms a 'C' shape around the head of the pancreas. Its main function is to
neutralize the acidic gastric contents (called 'chyme') and to initiate further digestion; Brunner's
glands in the submucosa secrete an alkaline mucus which neutralizes the chyme and protects the
surface of the duodenum.

 The jejunum

 The ileum. The jejunum and the ileum are the greatly coiled parts of the small intestine, and
together are about 4-6 meters long; the junction between the two sections is not well-defined. The
 mucosa of these sections is highly folded (the folds are called plicae), increasing the surface area
available for absorption dramatically

Pancreas
The pancreas consists mainly of exocrine glands that
secrete enzymes to aid in the digestion of food in the
small intestine. The main enzymes produced are lipases,
peptidases and amylases for fats, proteins and
carbohydrates respectively. These are released into the
duodenum via the duodenal ampulla; the same place that
bile from the liver drains into. Pancreatic exocrine
secretion is hormonally regulated, and the same hormone
that encourages secretion (cholesystokinin) also
encourages discharge of the gall bladder's store of bile. As
bile is essentially an emulsifying agent, it makes fats
water soluble and gives the pancreatic enzymes lots of
surface area to work on. Structurally, the pancreas has
four sections; head, neck, body and tail; the tail stretches back to just in front of the spleen.
Large Intestine
By the time digestive products reach the large intestine, almost all of the nutritionally useful products
have been removed. The large intestine removes water from the remainder, passing semi-solid faces into
the rectum to be expelled from the body through the anus. The
mucosa (M) is arranged into tightly-packed straight tubular
glands (G) which consist of cells specialized for water
absorption and mucus-secreting goblet cells to aid the passage
of feces. The large intestine also contains areas of lymphoid
tissue (L); these can be found in the ileum too (called Peyer's
patches), and they provide local immunological protection of
potential weak-spots in the body's defenses. As the gut is
teeming with bacteria, reinforcement of the standard surface
defenses seems only sensible.

Rectum and Anus

The remaining contents of the large intestine are moved toward the rectum,
where feces are stored until they leave the body through the anus as a bowel
movement.
 IV. INITIAL ASSESSMENT

Date Assessed: February 11, 2019

Latest Vital Signs as follows:

T˚ - 36.4˚C CR – 114 bpm

RR - 31/min O2Sat – 98%

Area Assessed Techniques Used Findings

SKIN
>color Inspection Brown skin
>moisture Palpation Skin normally dry
>texture palpation Smooth, soft and flexible palms and
soles
EYES inspection Sunken eyeballs, weak looking
>eyebrows Inspection Symmetrical in size extension and hair
texture and movement
>eyelashes Inspection Distributed evenly and long curved
outward
>eyelids Inspection Same color as the skin
>ability to blink Inspection Blinks involuntarily and bilaterally up
to 20 times per minute
>conjunctiva Inspection Transparent with light pink color
>cornea Inspection Transparent shiny
>pupils inspection Black, constrict briskly

NOSE
>symmetry,shape,size and color Inspection Smooth, symmetric with same color
>nasal septum as the face
Inspection Close to midline, thicker anteriorly
>nares than posteriorly
inspection Oval, symmetric and without
discharge
MOUTH
>lips Inspection Pink moist symmetric
 >gums Inspection Slightly pink color,moist and tightly
fit against each tooth
>buccal mucosa Inspection Glistening pink soft moist
>tongue Inspection Moist,slightly rough on dorsal surface
medium or dull red
>teeth Inspection Firmly set shiny
THYROID GLAND palpation Rises freely with swallowing

THORAX AND LUNGS

>lung/breath sounds auscultation Clear breath sounds

ABDOMEN
>contour Inspection Globular skin same color with the rest
of the body
>texture Palpation Soft
>bowel sounds auscultation Clicks or gurling sounds occur
irregularly and range from 5-35 per
minute

NAILS
>color of nail bed Inspection Pinkish
>nail base inspection firm

HAIR
>distribution Inspection Evenly distributed
NEUROLOGIC
>level of consciousness inspection Fully conscious/awake
HEAD inspection Sunken fontanelles