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University of Perpetual Help Dr. Jose G. Tamayo Medical UniversitySto.Nio, Bian, Laguna
College of Nursing
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Presented by:Group 21(BSN IV-5)Arreola, Jorge C.
Azuela, Irene D.
Claros, Danie T.
Cometa, Maclyn Rose M.
De Grano, Marie Kathleen Rose S.
Dizon, Lorenzo B.
Libiran, Paul Michael
Obado, Angelique C.
Padrid, Shirley A.
Palacios, Alexander D.Ponay, Irene Fe A.
Roxas, Rafael Conrado J.
Mrs.Renello Bautista, RN
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Gastroenteritis is an inflammation of the mucosa of
the stomach and the small intestine. Clinical
manifestations includes nausea, vomiting, diarrhea,
abdominal cramping and distention, Fever, increased
WBC, and blood or mucus in the stool may be present.
Causative agent are varied, Most cases are self limiting
and do not require hospitalization. However, older adults
and chronically ill patients maybe unable to consume
sufficient fluids orally to compensate for fluid loss. Until
vomiting has ceased, I.V replacement of fluids maybe
necessary. As soon as tolerated, fluids containing
glucose and electrolytes should be given. If the causative
agent is identified, appropriate antibiotic, antimicrobial, or
antiinffective drugs are given.
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PERSONAL DATA
PATIENT PROFILEName: C.D.I
Age: 1year old
Address: Mercedes Homes, Binan,Laguna
Birth Date: July 18, 208Religion : Baptist
Nationality: FilipinoCivil Status: single
Fathers Name:Antonio IlaoMothers Name: Laila Ilao
Admission Date: November 30 2009Admission Time: 5:30 pm
Initial Diagnosis:Age with somesigns of Dehydration
Chief Complain: fever and chills
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One day prior to admission the patient was apparently wellwhen he suddenly experience eight episodes of loss bowel
movement (LBM) of yellow pasty mucoid, non bloody streaked stool.Associated with undocumented fever. Patient was given
paracetamol120mg per 5 ml TID which afforded temporary relief.On the day of admission , still with persistence of fever
associated with 5 to 6 episodes of vomiting of previously ingestedfood, non mucoid, non blood streaked. This was also associated with
chills . this promoted consult and subsequently admitted.
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General:Awake active in cardio respiratory distress
Vital signs:Blood pressure: 90 / 60 mmHg
Cardiac Rate: 125 bpmRespiratory Rate: 28 cpm
Temperature: 38.5 C
Anthropometric MeasurementsHeight : 85 cmWeight : 13.4 kg
No stunting and no wastingSkin :
Warm to touch with poor skin turgor with rashesHEENT:
Pink palpebral conjctivae anicteric sclerae. No nasoaural discharges and no CLAD.C/L:
Symmetrical chest expansion ,no retractions clear breath soundsCV: > (-) murmur regular rhythm
Abdomen:Slightly globular soft (+) hyperactive bowel sounds no tender, no organomegaly
Extremities :
No gross depormity no edema no cyanosis capillary refill less than 2 secs.
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HEMATOLOGY
Dec. 01,2009
NORMAL FINDINGS RESULT
Hemoglobin 120-150gm/l 130gm/l
Hematocrit 0.40-0.54 0.39
RBC 4-5.6*10(12)/l 4.4*10(12)/l
WBC 5.0-10.0*10(9)L 12.1*10(9)/l
Platelets 150-400*10(9)/l 224*10(9)/l
DIFFERENTIAL COUNTSegmenters 0.50-0.70 0.63
lymphocytes 0.20-0.40 0.33
Monocytes 0-0.05 0.04
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URINALYSIS
Dec.01,2009
NORMAL FINDINGS RESULT
Color Strawto DarkYellow Yellow
Transparency Clear Hazy
Reaction(pH) 5.5-7.0 5.0
Protein None Trace
Glucose Negative Negative
Specific Gravity 1.010-1.025 1.025
Pus cells 0-3/hpf 3-7/hpf
RBC 0-3/hpf 0-2/hpf
Epithelial cells Small amounts
Hyaline,coarse,Fine granular
RBC,WBC,waxycasts.
Moderate
Mucus Threads Moderate
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FECALYSIS
Nov.30,2009
NORMAL FINDINGS RESULT
Color Brown Yellowish
Consistency Formed Soft
OVA/Parasites Negative None Found
FECALYSISNov.01,2009
NORMAL FINDINGS RESULT
Color Brown Gr eenish brown
Consistency Formed Watery
OVA/Parasites Negative None Found
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TEST NORMAL FINDINGS RESULT
Sodium 135.0-148.0 139.8mmol/l
Potassium 3.50-5.30 4.10mmol/l
BLOOD CHEMISTRY REPORT
Nov.30,2009
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HEMATOLOGY
Dec.02,2009
NORMAL FINDINGS RESULT
Hemoglobin 120-150gm/L 110gm/L
Hematocrit 0.40-0.54 0.33RBC 4-5.6*10(12)/L 3.8*10(12)/L
WBC 5.0-10.0*10(9)L 8.4*10(9)/L
Platelets 150-400*10(9)/L 208*10(9)/L
DIFFERENTIAL COUNT
Segmenters 0.50-0.70 0.60
lymphocytes 0.20-0.40 0.35
Monocytes 0-0.05 0.05
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URINALYSIS
Dec.02,2009
NORMAL FINDINGS RESULT
Color Strawto DarkYellow Light YellowTransparency clear SlightlyHazy
Reaction(pH) 5.5-7.0 5.0
Protein Negative Negative
Glucose Negative Negative
Specific Gravity 1.010-1.025 1.020
Pus cells 0-3/hpf 1-3/hpf
RBC 0-3/hpf 0-2/hpf
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FECALYSIS
Dec.02,2009
NORMAL FINDINGS RESULT
Color Brown Gr eenish Yellow
Consistency Formed Mushy
OVA/Parasites Negative None Found
Others (yeast cell) Few
FECALYSISDec.03,2009
NORMAL FINDINGS RESULT
Color Brown YellowConsistency Formed Mucoid
OVA/Parasites Negative None Found
Others (Yeast cell) Few
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HEMATOLOGY
Dec.04,2009
NORMAL FINDINGS RESULT
Hemoglobin 120-150gm/L 110gm/L
Hematocrit 0.40-0.54 0.33RBC 4-5.6*10(12)/L 4.2*10(12)/L
WBC 5.0-10.0*10(9)L 8.4*10(9)/L
Platelets 150-400*10(9)/L 232*10(9)/L
DIFFERENTIAL COUNT
Segmenters 0.50-0.70 0.60
lymphocytes 0.20-0.40 0.35
Monocytes 0-0.05 0.05
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URINALYSIS
Dec.04,2009
NORMAL FINDINGSRESULT
Color Strawto DarkYellow Yellow
Transparency Clear Clear
Reaction(pH) 5.5-7.0 6.0
Protein Negative +1
Glucose Negative Negative
Specific Gravity 1.010-1.025 1.030
Pus cells 0-3/hpf 0-1/hpf
RBC 0-3/hpf 1-2/hpf Epithelial cells Small amounts
Hyaline,coarse,fine granular
RBC,WBC,waxycasts
Occasional
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HEMATOLOGY
Dec.05,2009
NORMAL FINDINGS RESULT
Hemoglobin 120-150gm/l 117gm/L
Hematocrit 0.40-0.54 0.35
RBC 4-5.6*10(12)/l 4.0*(12)/L
WBC 5.0-10.0*10(9)L 4.11*10(9)/L
Platelets 150-400*10(9)/l 356*10(9)L
DIFFERENTIAL COUNT
Segmenters 0.50-0.70 0.48
lymphocytes 0.20-0.40 0.45
Monocytes 0-0.05 0.07
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ANATOMY OF THE GASTROINTESTINAL TRACT
The GI tract is the pathway food takes from the mouth, through the esophagus,stomach, small and large intestine within where the nutrients are extracted for the needs
of the body. The residue then passes to the rectum where it is evacuated.The first part of the pathway is the esophagus, which is a conduit that guides food
from the mouth, where it is prepared by chewing, down to the stomach where it is stored.The stomach is both a storage space, holding as much as a quart and a half of ingestedfood, and a secretory organ that produces the gastric, acid necessary for digestion.However, the stomach does not absorb food. When food enters the stomach from theesophagus it remains for a short period while it is mixed wfth gastric. acid. The stomachthen by involuntary muscle contractions (peristalsis) empties the food gradually into the
duodenum, the first part of the small intestine.The small intestine consists of three parts: the duodenum, the jejunum and the
ileum. In these three parts, certain digestive secretions are mixed with food, and thenutrients are absorbed into the blood stream.
The duodenum treats the food it receives with bile from the liver and enzymes fromthe pancreas. It also adds liquid duodenal fluid that comes from the wall of the duodenumitself. The food, bile, enzymes and liquids brought together in the duodenum are thenpassed into the jejunum.
The jejunum or second portion of the small intestine, is approximately 10 feet long.It lies immediately behind the duodenum and continues the process of digestion, breakingdown food into essential elements.
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The ileum, or third portion of the small Intestine, like the jejunum, is about 10 feetlong. It is here that a major part of the absorption of food products and liquidsoccurs. Waste products of the digestive process are passed from the small intestineor terminal ileum, into the large Intestine, also known as the colon. The beginning ofthe colon is in the right lower quadrant of the abdomen, near the appendix The colonmoves waste products through about four feet by the continuing process of undulating motions or peristalsis, which is common to all parts of the gastrointestinaltract. The primary function of the colon is to store waste products of digestion priorto evacuation. The colon absorbs small amounts of water and electrolytes.
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PHYSIOLOGY OF THE GASTROINTESTINAL TRACTTHE DIGESTION PROCESS
Digestion is the process by which food broken down so that it can be used by the body. Whenyour digestive system functions properly you are rarely aware of it. Your digestion system begins in
your mouth. The digestive tract is a long tube running from the mouth to the anus. In a living body it iscontracted to twelve to fourteen feet. This tube is divided into certain specialized compartments, eachwith a more or less different function.
Digestion begins in the mouth. Your teeth and tongue break down or masticate food and yoursalivary glands break it down further with liquid enzymes. Saliva is a watery tasteless liquid mixture thatmoistens chewed food and begins chemical digestion. The salivary glands produce this saliva. Salivacontains an enzyme that begins the breakdown of starches into sugars. Saliva contains amylase that isan enzyme that begins the chemical digestion of complex carbohydrates, such as the sweet potatoes
and stuffing in your dinner.Once the food is chewed and
softened in the mouth, the tongue rolls it into a ball or bolus and then pushes the bolus to the throat tobe swallowed. During swallowing, a small flap of tissue called the epiglottis prevents food from enteringthe windpipe. The food then passes into the esophagus.
The esophagus is a muscular tube connecting the mouth with the stomach. The esophagusmoves the food to the stomach by a serious of muscular contractions called peristalsis. Peristalsis is thewavelike contraction of muscles that move food through the digestive system.
As the food is swallowed, the food travels through your esophagus to your stomach. The stomachis a saclike organ of digestion and has walls made of layers of muscle, each arranged on a differentangle. As the food enters the stomach, muscle contractions begin to twist, turn, and churn the food.The twisting, turning, and churning of food in the stomach is part of mechanical digestion. The stomachproduces gastric juice and mixes it with the food. This gastric juice contains enzymes that begin thedigestion of proteins. Proteins are the only substances digested in the stomach. Proteins are onlypartially digested in the stomach. The food is churned and mixed with stomach fluids until a thick paste
called chyme is produced. The chyme passes through the stomach into the small intestine.
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The small intestine is a long, coiled organ about one inch in diameter. The small intestine may be 7.5to 9 meters in length. Digestion is completed in the small intestine. The liver releases bile into thesmall intestine. Bile prepares the fats for digestion. Pancreatic juice contains enzymes that digestcarbohydrates and fats. It also contains enzymes that continue the digestion of proteins. The wallsof the small intestine release enzymes that complete the digestion of all three basic nutrients. In the
walls of the small intestine are millions of small projections called villi. These villi contain many smallblood vessels. Digested food is absorbed into these blood vessels and carried to all body cells.
The material that has not been absorbed moves into the large intestine, or colon. Here water andsalts are absorbed, and the remaining solid waste goes out of the body through the anus.
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DOCTORS ORDER RATIONALE07 / 27 / 09
Time
IVF: PNSS 1L x 6 hours - To maintain electrolyte balance in the body.- To prevent dehydration
IVF: PLR 1L x hoursFast drip
- To maintain electrolyte balance in the body.- To prevent dehydration
MEDICATIONRanitidine
(1 mg x IV stat)
Plasil (Metoclopramide)
(1 mg x IV prn)
CefuroximedosageIV .
-
-Prevention of nausea, vomiting, and
delayed gastric emptying
-Inhibits Bacterial cell wall synthesis fromurinary tract and skin infection
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DRUGS CLASSIFICATION MECHANISMOF
ACTION
INDICATION CONTRAINDICA
TIONS
NURSING
CONSIDERATIONS
Generic Name:
Carbamazepine
Brand Name:
Carbatrol, Epitol
DOSAGE:
100mg/5ml TID
AnticonvulsantChemicallysimilar to thecyclicantidepressants.Also manifestantimanic,antineuralgic,
antidiuretic,anticholinergic,antiarrythmic andantipsychotic
effects.
History of bonemarrowdepression,acute intermittentporphyria.Hypersensitivityto drug ortricyclic
antidepressant.Concomitant useof MAO inhibitor.Lactation. Use
for relief ofgeneral achesand pains.
List reason for therapy withseizures; describe
types, frequency,characteristics.
Assess for psychosis mayactivate
symptoms.Do baseline hematologic,
renal and LFTs;assess for
dysfunction. Withhigh doses, get
weekly CBC first 3
months, thenmonthly: assessextent of bone
marrowdepression. At first
sign blooddyscrasia, stop
drug.Obtain eye exams; assess
for opacities, IOPs.Obtain ECG during therapy.
Use seizureprecautions with
quick withdrawal;may precipitate
status epilepticus.
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Patients Name: CDI
Medical Diagnosis:Acute Gastroenteritis with some signs of DehydrationNursing Diagnosis: Fluid Volume Deficit related to excessive gastrointestinal losses in stoolShort term goal:At the end of the eight hour shift, the patient will regain normal bowel functioning.
Long term goal:At the end of the hospitalization, the patient willl exhibit signs of rehydration and maintain adequate hydration.
Cues Problem Scientific reason Nursing intervention Rationale Evaluation
Subjective:
Ilang beses nasiyang dumumingaung araw asstated by themother.
Objective:
>dry lips
>poor skin turgor
>crying at times
Fluid Volume
Deficit
Decreased
intravascular,
interstitial andintracellular fluid.This refers todehydration withchanges insodium.
Reference:
Nurses PocketGuide Edition-10
>Vital Signsmonitored andrecorded
>Maintained strictrecord of Intake and
Output
>Assessed Skinturgor, mucousmembranes andmental status asindicated
>Encouragedincreased oral fluid
intake
>Instructed family inproviding appropriatediet
>Observed andrecorded response to
feedings
>To obtain baselinevalues forcomparison
>to evaluateeffectiveness of
interventions
>To assess statusof hydration
>For rehydration
>To GainCompliance withtherapeutic regimen
>To assess feeding
tolerance
Goal Met.
The patientexhibited signs ofrehydration. TheChilds bowelmovementdecreased from 8times to 2, mucousmembranes are
moist.
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Medical diagnosis:Acute Gastroenteritis with some signs of DehydrationNursing Diagnosis: Hyperthermia r/t present illness as evidenced by temperature of 38.8OCShort term goal:At the end of my 8hr shift, the patients body temperature will decrease from 38.8OC to 37.5OC.Long term goal:At the end of hospitalization, the patient will be able to maintain core temperature within normal range.
Cues Problem Scientific reason Nursing
intervention
Rationale Evaluation
Subjective:
Nilalagnat siya,as verbalized bythe mother of thepatient.
Objective:
-Febrile with VS asfollows:
T- 38.9OC
P- 150 bpm
R- 50 cpm
-Flushed skin;Warm to touch
-Pale looking
-Poor skin turgor
-Dry skin
Hyperthermia
Body temperature
elevated above
normal range.
Reference:Nurses PocketGuide: 10thEdition
-Provided a calm andwell -ventilatedenvironment.
-Encouragedopportunities for rest.
-Tepid Sponge Bathrendered and keptclothes light & clean.
-Encouraged toincrease oral fluid
intake.
-To promote betterquality of rest.
-To prevent / lessenfatigue.
-To promotecomfort and surfacecooling. In
pediatrics, tepidwater is preferred
because, cold-watersponges canincrease shivering.
-To promotehydration
Goal Partially
Met.
The patientmanifesteddecrease of bodytemperature from
38.8OC to 37.5OC
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Admitting diagnosis:Acute Gastroenteritis with some signs of Dehydration
Nursing Diagnosis:
Short term goal:
Long term goal:
Cues Problem Scientific reason Nursing
intervention
Rationale Evaluation
Subjective:
Objective:
Goal Partially Met.