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Case Presentation

Case Presentation. A cute Gastro Enteritis (A.G.E) PREPARED BY: MARIAMMA JOHN STAFF NURSE, PEDIA WARD. DEMOGRAPHIC DATA:. Name: Case no.2 MR No.: 195077 Diagnosis: Acute Gastroenteritis Age: 1 year Gender: Female D.O. A: 23/01/2013 D.O.D: 25/01/2013.

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Case Presentation

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  1. Case Presentation Acute Gastro Enteritis (A.G.E) PREPARED BY: MARIAMMA JOHN STAFF NURSE, PEDIA WARD

  2. DEMOGRAPHIC DATA: • Name: Case no.2 • MR No.: 195077 • Diagnosis: Acute Gastroenteritis • Age: 1 year • Gender: Female • D.O. A: 23/01/2013 • D.O.D: 25/01/2013

  3. PHYSICAL ASSESSMENT: General Assessment: • Chief complaint: Febrile, Lethargic and decreased Activity • Skin: Dehydrated, Dry, Pale and mottled, Cold extremities, capillary refill > 3 sec • Head and Neck: Neck Veins Flattened, Sunken Eyes, Fontanel Sunken • Thorax: Normally symmetrical in size • Cardiovascular: Tachycardia present, no tachypnoea • Genitourinary: Redness of the perineal area, urine concentrated and dark color • Gastrointestinal: Abdomen is hyperactive and distended. Loose stools more than 7 times per day • Musculoskeletal: No deformities Noted. No joint or muscle pain noted during examination • Neurology: Growth and development is normal according to Erikson’s Psychosocial Stage

  4. PATIENT HISTORY: Past Medical History : There is no past medical history of any illness Present Medical History: Now the baby is admitted with the complaints of loose stool, vomiting and fever

  5. MILES STONE CHART: 0-1 YEAR CHILD’S AGE and MASTERED SKILLS 1 MONTH • Lifts head when lying on tummy. Respond to sound. Stares at faces. 2 MONTHS • Vocalizes: gurgles and coos. Follows objects across field of vision. Notices his hands. Holds head up for short periods. 3 MONTHS • Recognizes your face and scent. Holds head steady. Visually tracks moving objects. 4 MONTHS • Smiles, laughs. Can bear weight on legs. Coos when you talk to him. 5 MONTHS • Distinguishes between bold colors. Plays with his hands and feet. 6 MONTHS • Turns toward sounds and voicesImitates soundsRolls over in both directions 7 MONTHS • Sits without support. Drags objects toward herself. 8 MONTHS • Says ‘mama’ or ‘dada’ to parents. Passes objects from hand to hand. 9 MONTHS • Stands while holding onto something. Jabbers or combines syllables. Understands object permanence. 10 MONTHS • Waves good bye. Picks things up with pincer grasp. Crawls well, with belly off the ground. 11 MONTHS • Says ‘mama’ or ‘dada’ to the correct parent. Plays patty- cake and peek-a-boo. Stands alone for a couple of seconds. 12 MONTHS • Imitates others activities. Indicates wants with gestures.

  6. TOPIC PRESENTATION: GASTROENTERITIS Definition; Gastroenteritis is an upset stomach. It causes nausea and vomiting. It is sometimes called stomach flu, caused by viruses and bacteria.

  7. ANATOMY AND PHYSIOLOGY: The gastrointestinal tract is a muscular tube made by epithelial cells. The individual components of the gastrointestinal system are oral cavity, salivary glands, esophagus, stomach, small intestine and large intestine.

  8. PHYSIOLOGY: • ORAL CAVITY: Mechanical breakdown of food occurring in mouth. Insalivations and absorption of small molecules such as glucose and water are the functions of oral cavity • SALIVARY GLANDS : 3 pairs of salivary glands present ,which produce saliva • ESOPHAGUS : It is a muscular tube which extend from pharynx to stomach .It acts as a transport medium between compartments. • STOMACH : Stomach is a “j” shaped bag located just left of the midline between the esophagus and small intestine. Its functions are • The short term storage of ingested food • Mechanical breakdown of food • Chemical digestion of proteins by acids, enzymes

  9. ETIOLOGY: • VIRAL: E.g.; Rotavirus , Adenoviruses, Norovirus , Parvovirus and Astroviruses • BACTERIAL; E.g.; Salmonella, Shigella, E- coli, Clostridium deficit • PARASITES AND PROTZOANS: E.g.; Giardia, Cryptosporidium

  10. Predisposing Factors • Age • Malnutrition • Precipitating Factors • Contaminated • Food and Water PATHOPHYSIOLOGY ACUTE GASTROENTERITIS Direct Invasion of the bowel wall Ingestion of fecally contaminated food and water Endotoxins are released Stimulation and Destruction of mucosal lining of the bowel wall Attempted Defecation Excessive gas formation Digestive and Absorptive Malfunction Secretion of food and electrolytes in the intestinal lumen GI Distention

  11. Mild Diarrhea Increase Peristaltic Movement Fluid and Electrolytes Imbalance Increased Protein in the Lumen LI is overwhelmed and unables to reabsorb the lost food Intense diarrhea >10times watery stool Serious Fluid Volume Deficit Hypovolemic Shock Death

  12. SIGNS AND SYMPTOMS: Book Based • Diarrhea • Nausea • Crampy abdominal pain • Vomiting Patient Manifested • Nausea • Diarrhea • Vomiting • Fever • Dehydration • Tachycardia

  13. INTERVENTION: • Maintain hydration • Promoting intake of nutrients • Reduce hyperthermia • Monitoring and preventing potential complications • Promoting family knowledge

  14. TREATMENT: BOOK BASE • A.G.E is usually an acute and self limiting disease that does not require medication • The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy, metaclopromide or ondansteron if needed • If it is viral : • soft anti diarrheal diet • Oral rehydration • IV Fluids • Bacterial: Antibiotics PATIENT TREATMENT • Treated with • IV Fluids, • ORS solution, • Inj. Perfalgan 200mg iv prn, • Voltaren suppository 12.5mg prn

  15. COMPLICATIONS: • Pseudomembraneousenterocolitis ( usually only seen in those who are taking antibiotics)  • Gastro intestinal bleeding  • Dehydration • Electrolyte Imbalance (Hypokalemia, Hypernatremia)  • Shock  • Sepsis ( secondary bacterial infection )

  16. PRIORITIZATION OF NURSING PROBLEMS: • Altered fluid volume deficit due to diarrhea and vomiting • Altered electrolyte imbalance due to diarrhea and vomiting • Imbalanced nutrition less than body requirement due to less food intake • Hyperthermia related to infection • Lack of skin integrity due to severe loose stool

  17. NURSING CARE PLAN: NURSING care plans

  18. NURSING HEALTH TEACHING: • Encourage the mother to feed the baby with a nutritious diet which is not harmful to the stomach • Advise to increase the activities gradually • Advise the mother to prepare the food in a hygienic manner • Advise the mother to maintain the personal hygiene of the baby • Encourage rest to the baby

  19. CONCLUSION: • Patient relieved from signs and symptoms. Discharge medications: Pedialyte and voltarin suppository 12.5mg prn. Review after 1 week

  20. BIBLIOGRAPHY • Brunner & Suddarth’s. Test book of Medical Surgical Nursing. 12thEdition. • Lippincott Manual of Nursing Practice. 9th Edition.

  21. KHALAS Shukran for listening…

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