CHAPTER ONE

INTRODUCTION
This is a care study of Mrs. O.P. Aged 75, who was presented at the Accident and Emergency
Unit of seventh day Adventist Hospital, Ile-Ife on 02/04/24 on account of abdominal pain,
pain scale of 7, about two weeks, generalize body pain, nausea ,vomiting about 4 episode.
She hadwas stool watery stooling for about 5 episodes, vital signs was done and said,
temperature 370c, blood pressure 110/70mmhg, pulse 116 beats per minutes, Respiration
22cycle per minutes, Oxygen saturation 96%, having being seen by the physicians, blood and
urine samples were collected and taken to the laboratory for investigations which said thus;
Na+ 128mmol/L, K+ 2.5mmol/L, CL 96mEq/L, HCO 3, urine appearance pale yellow, PH,
3.0. A diagnosis of generalized acute gastroenteritis was later made by the physician.
O/E; an elderly woman, was dehydrated, weak, conscious and alert, nil pedal edema, not pale,
a febrile, not cyanosis, no injury to the head, no swelling, no rash on the scalp, the hair is
evenly distributed, black color, absence of alopecia, no tribal mark on the face, eyelids are
normal in shape, no obvious discharge, absence of jaundice.
She was reviewed and planned thus;
Admit to female medical ward 4
 IV Ciprofloxacin 400mg 12 hourly for 2 days
 IV Metronidazole 500mg 8hourly for 2 days
 IV Hyoscineyosine 20mg 8 hourly for I day
 IV Paracetamol 600mg 8 hourly for 2 days
 IV Metoclopramide 10mg 8 hourly for 1 day
 Tap slow k 600mg t. d. s for 2 weeks
 IV Fluid Ringers lactate 500ml 24 hourly for 1 day
 IV Normal Saline 500ml alternate with 5% dextrose water 4 hourly for 1 day, (add
5ce of intravenous vitamin B complex into each pant of intravenous fluid).
Gastroenteritis is inflammation of the gastrointestinal tract, involving the stomach and the
small intestine resulting to diarrhea.
Gastroenteritis can be transferred by contact with contaminated food and water. The
inflammation is caused most often by an infection from certain viruses or less often by
bacteria, their toxins, parasites, or an adverse reaction to something in the diet or medication.
Etiological agents can be viral, bacterial, or protozoa, and bacterial agents can be either enter
pathogenic, toxins, or both. The guidelines of the American College of Gastroenterology

1
recommended that stool cultures in adults are indicated in the presence of severe diarrhea, a
temperature> 38.5 (orally), passage of bloody stools, or persistent diarrhea.
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and the
intestine (gastrointestinal tract) (Bolukbas et al., 2004) Gastroenteritis has many causes. Virus
and bacteria are the most common causes, they are very contagious and can spread through
contaminated food or water. In up to 50% of diarrhea outbreaks, non- specific agent is found
improper hand washing following a bowel movement handling a diaper can spread the
disease from person to person(Truump et al,.1983).
Gastroenteritis caused by virus may last for 1-2 days, on the other hand, bacteria causes work
or more.

OBJECTIVES OF THE STUDY

This care study will help to:
 Enlighten the populace on the causes, prevention and management of
gastroenteritis.
 Prevent further complications that may arise from gastroenteritis.
 Improve interpersonal relationship between the patient and nurse, given
maximum nursing care to the patient which promotes recovery.
 Enable the patient to adapt to the therapeutic management even after he is
discharged.

SIGNIFICANCE OF THE STUDY

 This study will enlighten and broaden the knowledge of nurse about the
quality of care and treatment of gastroenteritis.
 It will help increase the knowledge of the patient on the cause and prevention
of gastroenteritis such as hand washing, good food and environmental hygiene
in order to reduce the rate of its incidence due to the high mortality and
morbidity rate attached to this disease.
 It serve as a reference purpose for student nurses in the management of
Gastroenteritis.

2
 PATIENT’S BIOGRAPHICAL DATA
Name: Mrs. O. P.
Age: 75 years old
Sex: Female
Occupation: Trader
Address: 14, odofin compound, Edo Abon
Religion: Christianity
Ethnicity: Yoruba
Marital status: Widow
State of origin: Osun state
Next of kin: Mr. O.S.
Address of next of kin: 14, odofin compound, Edo Abon
Medical diagnosis: Acute Gastroenteritis
Ward: Female Medical Ward 4
Bed number: Bed 16
Date of admission 2nd of April, 2024
Date of discharge: 8th of April, 2024
Informant: Mr. O.S.
Consultant: DR. W.
Allergy: Nil

3
 NURSING HISTORY/NURSING PROCESS

PAST MEDICAL HISTORY

Mrs. O. P. has been hospitalized in the hospital about 10 years ago on account of malaria and
vomiting about 3 episodes. Patient has never had any blood transfusion, nor had any surgery
done.

PRESENT MEDICAL HISTORY

Mrs. O. P. Was admitted on account of acute gastroenteritis she had 4 episode of vomiting,
which was about 300ml, the vomitus was brownish, she had also pass watery stool for about
5 times before hospitalization.

NUTRITION
Before the onset of the illness, patient tolerates all kinds of food e.g. Rice, beans, yam, amala,
semo. She eats about 3 times daily, but presently, She cannot tolerates all kinds of food that
she eat before, she only tolerate pap and moinmoin since the onset of the diseases, she barely
eat once daily, because she will end up vomiting and stooling.

ELIMINATION
She defecate watery stool frequently 5 times daily since the onset of the diseases, but before
the onset of diseases she only defecate once in a day.

ACTIVITY/EXERCISE
Patient cannot perform her daily activity and exercise since the onset of the diseases, because
she feel weak. Before the onset of the diseases she perceives her trading business as a form of
exercise because she work from morning till evening.

SLEEP AND REST

The present condition has altered her sleep, due to abdominal pain, she barely sleep about2-3
hours in the night. But before the onset of the disease she sleep about 6-7 hours in the night
without any interrupted.

COMMUNICATION/SPECIAL SENS
She communicate in Yoruba language, all her special senses are working perfectly.

4
FEELING ABOUT SELF
She does not feel good about herself because she is always feeling abdominal pain, vomiting
and always using the rest room more often than before.

FAMILY/ SOCIAL RELATIONSHIP

She is married into nuclear family with 5 children. She relates with her family and tolerate
anybody who comes her way.

SEXUALITY/REPRODUCTION
She was sexually active when her husband was alive.

COPING WITH STRESS

She sleeps anytime she is stressed. She also takes pain relief anytime she is feeling tired.

VALUES AND BELIEF

She is a devoted Christian, she beliefs in God.

HABITS
She does not drink or smoke. She spends most of her time on her business.

5
PHYSICAL ASSESSMENT
On inspection,
An elderly woman, had generalized body pain, dehydrated, conscious and alert, nil pedal
edema, nil jaundiced.
Head: No injury to the head, no swelling, no rash on the scalp, the hair is evenly distributed,
black color, absence of alopecia.
Face: no tribal mark on face and no swelling.
Eyes: eyelids are normal in shape, no obvious discharge, absence of jaundice.
Nose: no discharge from nose.
Mouth: there are no crack on lips, buccal fossa is intact, gums are pink, teeth are brownish in
color, roof of the mouth is pink and there is no lesion, tongue is placed centrally.
Ears: no discharge, no lesion, symmetrically placed.
Neck: no restriction in rotation, no enlargement of thyroid gland.
Chest: no pain and obstruction. There is equal expansion of the chest, not any obvious
respiration distress.
Abdomen: on inspection, there was pain in the abdomen, there is no scarification mark
noticed on the abdomen.
Palpation: there was pain on palpation of the abdomen, no displacement of any organ, no
mass noticed.
Percussion: no abnormally detected
Auscultation: there is high pitched sounds in the bowel.
Upper Extremities: equal arms and no extra digit.
Genitalia: no discharge from the vagina, no foul smell.
Lower Extremities: she can flex and extend the joint of her low limbs, no edema of the
lower extremities.
Back: no deformities noticed.

6
 VITALS SIGNS
INVESTIGATION NORMAL VALUE RESULTS REMARK

Temperature 36.50c - 37.20c 370c Normal

Blood pressure 120/80mmhg 50/70mmhg Abnormal
Pulse 60 - 100b/m 116b/m Abnormal
Respiration 16 - 24cm 22cm Normal
Apex beat 95 - 100% 96% Normal
Weight _ 42kg
Height _ 159cm

LABORATORY RESULTS
INVESTIGATIONS NORMAL VALUE RESULTS REMARK
WBC 4000 – 11,500/µL 5000/µL Normal
RBS 5.0 – 10 mmol 5.2 mmol Normal
Hepatitis Negative Negative Negative
XYZ Negative Negative Negative

7
URINALYSIS

8
 INVESTIGATIONS NORMAL VALUE RESULTS REMARK
Na+ 135 – 145mmol/L 128mmol/L Abnormal
K+ 3.5 - 5.0mmol/L 2.5mmol/L Abnormal
CL 96 - 106mEq/L 96mEq/L Normal
HCO3 22 – 28 mEq/L 18 mEq/L Abnormal
Creatinine 53 - 115mmol/L 72mmol/L Normal
Appearance Amber Pale yellow Abnormal
PH 4.5 – 8.0 3.0 Abnormal
Protein Negative Negative Normal
Glucose Negative Negative Normal

9
 CHAPTER TWO
LITERATURE REVIEW

ACUTE GASTROENTERITIS
Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and
the small intestine and resulting in acute diarrhea. It can be transferred by contact with
contaminated food and water. The inflammation is caused most often by an infection from
certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to
something in the diet or medication such as Antibiotics.
It is characterized by nausea, vomiting, diarrhea and cramps which if not promptly and
adequately treated might lead to hypovolemia, septicemia and shock.
The organs affected include the following:
Stomach
Small intestine

REVIEW OF ANATOMY AND PHYSIOLOGY OF THE STOMACH

The stomach is a j- shape dilated portion of the alimentary tract situated in the epigastric,
umbilical and left hypochondriac region of the abdominal cavity. It has a capacity of about
one liter or more. Its inner lining has thick gastric folds (rugae) of the mucosa and sub
mucosa layers that appear when the wall is distorted. The stomach receives food from the
esophagus, mixes it with gastric juice, initiates the digestion of protein, carried on limited
absorption and moves food into the small intestine (Lema-perez, Laura, et. al 2019).
Organs Associated with the stomach;
Anteriorly: the left lobe of the liver and the anterior abdominal wall
Posteriorly: abdominal aorta, pancreas, spleen, left kidney and adrenal gland.
Superiorly: diaphragm, esophagus, left lobe of the liver
Inferiorly: the transverse colon and small intestine.

STRUCTURE OF THE STOMACH

The stomach is continuous with the esophagus at the lower esophageal sphincter and it has
two curvatures. The lesser curvature is short, lies on the posterior surface of the stomach and
it the downward continuation of the posterior wall of the esophagus. Just before the pyloric
sphincter it curves upwards to complete the j shape. Where the esophagus joins the stomach

10
the anterior region angles acutely upwards, curves downwards forming the greater curvature
and then slightly upwards towards the pyloric sphincter.
PARTS OF THE STOMACH
The stomach can be divided into:
 Cardiac sphincter
 Fundus
 Body
 Pylorus

Cardiac sphincter: is a small area near the esophageal opening.

Fundus: it balloons superiorly to the cardiac sphincter. It is a temporary storage area and
sometimes fills with swallowed air. This produces gastric air bubble which may be used as a
landmark on a radiograph of the abdomen.
Body: this is the main part of the stomach which is between the fundus and the pylorus.
Pylorus: a funnel shaped portion that narrows and becomes the pyloric canal as it approaches
the small intestines.
At the end of pyloric canal, the circular layer of and its muscular wall thickens, forming a
powerful muscle, the pyloric sphincter.
The muscle is a valve that controls epigastric emptying (shier, butter and Lewis, 2010)

WALLS OF THE STOMACH

The walls of the stomach are made up of the following layers from inside to outside:
 Mucosa
 Sub mucosa
 Muscularies externa
 Serosa

MUCOSA
This is the first main layer that consists of the epithelium and the lamina propriae ( composed
of loose connective tissue) with a thin layer of muscle called Muscularies mucosae separating
it from the sub mucosa beneath(Eyken, peter Van, et.al. 2014).

11
SUBMUCOSA
This layer lies over the mucosa and consists of fibrous connective tissue separating the sub
mucosa from the next layer. The Meissen’ plexus is in this layer.(Brehmer , 2010)
MUSCULARIES EXTERNA
This layer lies over the sub mucosa, the muscularis externa in the stomach differs that of
other gastrointestinal organs in that it has three layers of smooth muscle instead of two. They
are:
1. Inner oblique layer which is responsible for churning the food.
2. Middle circular layer which is concentric to the longitudinal S axis of the stomach and it
controls the movement of chimed food into the duodenum.
3. Outer longitudinal layer where the Auer Bach’s plexus is found for innervation of both the
middle circular and outer longitudinal layer.

SEROSA
This layer lies over the muscularis extema consisting of layers of connective tissue
continuous with the peritoneum.

BLOOD SUPPLY
Arterial supply to the stomach is by the left gastric artery, a branch of coeliac artery, the right
gastric artery and the gastroepiploic artery. (Okada, 2019)

NERVES SUPPLY
This is by the sympathetic the parasympathetic nerves. (Anne Aguand Moore Keith, 2010).

VENOUS DRAINAGE
Gastric vein that drain into the portal vein.

FUNCTIONS OF THE STOMACH

The functions of the stomach includes:
1. It act as temporary storage for food
2. It secretes the gastric juice containing the enzymes called pepsin and rennin that
digest foods.
12
 3. It kills some of the bacteria ingested with the food by the help of hydrochloric acid in
the gastric juice.
4. Regulation of passage of gastric content into the duodenum.
5. Secretion of hormone- gastrin.
6. Limited absorption of water, alcohol and some lipid.( Waugh and Grant,2010)

GASTRIC JUICE
Stomach size varies with the volume of food it contains, which may be 1.5 liters or more in
an adult. After a meal food accumulates in the stomach in layers, the last part of the meal
remaining in the fundus for some time .Mixing with the gastric juice takes place gradually
and it may be some time before the food is sufficiently acidified to stop the action of salivary
amylase.
The gastric muscle generates a churning action that breaks down the bolus and mixes it with
gastric juice. Peristaltic waves in the stomach wall propel the contents towards the pylorus.
When the stomach is active the pyloric sphincter closes. Strong peristaltic
contraction of the pylorus force chime, gastric contents after they are sufficiently liquefied,
through the pyloric sphincter into the duodenum in small spurts. Parasympathetic stimulation
increases the motility of the stomach and secretion of gastric juice; sympathetic stimulation
has the opposite effect. (Brunner, L, S. 2010)
Gastric juice
About 2 liters of gastric juice are secreted daily by specialized secretory glands in the mucosa
it consists of:
 Water
 Mineral
 Mucus secreted by mucous neck cells in the glands and surface mucous cells on the
stomach surface
 Hydrochloric acid secreted by parietal cells
 Intrinsic factor
 Inactive enzyme precursors- pepsinogens secreted by chief cells in the glands.

13
FUNCTIONS OF GASTRIC JUICE

 Water further liquefies the food swallowed

 Hydrochloric acid:
 Acidifies the food and stops the action of salivary amylase
 Kills ingested microbes provides the acid environment needed for the action of
pepsins.
 Pepsinogens are activated to pepsins by hydrochloric acid and by pepsins already
present in the stomach. These enzymes begin the digestion of proteins, breaking
them into smaller molecules .Pepsins have evolved to act most effectively at a very
low PH, between 1.5 and 3.5.
 Intrinsic factor (a protein) is necessary for the absorption of vitamin B12 from the
ileum.
 Mucus prevents mechanism injury to the stomach wall by lubricating the contents. It
also prevents chemical injury by acting as a barrier between the stomach wall and the
highly corrosive gastric juice; hydrochloric acid is present in potentially damaging
concentrations and pepsins would digest the tissues. (Peate, ian, 2008)

SECRECTION OF GASTRIC JUICE

There is always quantity of juice present in the stomach, even when it contains no food. This
is known as fasting juice. Secretion reaches its maximum level about I hour after a meal, then
decline level after about 4 hours. There are three phases of secretion of gastric juice.
Cephalic phase: This flow of juice occurs before food reaches the stomach and is due to
reflex stimulation of the vagus (parasympathetic) nerves, initiated by the sight, smell, taste or
thought of food. Sympathetic stimulation, e.g. during emotional states, inhibits gastric
activity.
Gastric phase: When stimulated by the presence of food, the enteroendocrine cells in the
(pylorus) and duodenum secrete the hormone gastrin directly into the circulating blood.

14
Gastrin, circulating in the blood that supplies the stomach, stimulates the gastric glands to
produce more gastric juice.
In this way, secretion of digestive juice is continued after completion of a meal and the end of
the cephalic phase. Gastrin secretion is suppressed when the PH in the pylorus falls to about
1.5.
Intestinal phase: When the partially digested contents of the stomach reach the small
intestine, two hormones, secretin and cholecystokinin (CCK), are produced by endocrine
cells in the intestinal mucosa.
They slow down the secretion of gastric juice and reduce gastric motility. By slowing the
emptying rate of the stomach, the chime in the duodenum becomes more thoroughly mixed
with bile and pancreatic juice. This phase of gastric secretion is most marked following a
meal with a high fat content.
The rate at which the stomach empties depends largely on the type of food eaten. A
carbohydrate meal leaves the stomach in 2-3 hours, a protein meal remains for longer and a
fatty meal remains in the stomach for longest; (Malagelada et; al. 1979)

SMALL INTESTINE
The small intestine is continuous with the stomach at the pyloric sphincter. The small
intestine is about 2.5cm in diameter and a little over 5 meters long; it leads into the large
intestine at the ileocaecal valve. It lies in the abdominal cavity, surrounded by the large
intestine. In the small intestine the chemical digestion of food is completed and absorption of
most nutrients take place. S (Anne, 2010).

PART OF THE SMALL INTESTINE

It is divides into three and they are:
Duodenum: it is about 25cm long and curves around the head of the pancreas. Secretions
from the gall bladder and pancreas merge in a common structure- the hepatopancreatic
ampulla- and enter the duodenum at the duodenal papilla. The duodenal papilla is guarded by
a ring of smooth muscle, the hepatopancreatic sphincter (of oddi).
Jejunum: This is the middle section of the small intestine and it is about 2cm long and
continuous with the duodenum.
The ileum: this is terminal portion is about 3cm long and end at the ileocaecal valve, which
controls the flow of material from the ileum to the caecum, the first part of the large intestine,
and prevents backflow.
15
STRUCTURE
The walls of small intestine contains four layers of tissue but some modification in the
peritoneum and mucosa (mucous membrane lining) are described below.
Peritoneum: The mesentery, a double of peritoneum, attaches the jejunum and ileum to the
posterior abdominal wall. The attachment is quite short in comparison with the length of the
small intestine; it is therefore fan-shaped. The large blood vessels and nerves lie on the
posterior abdominal wall and the branches to the small intestine pass between the two layers
of the mesentery.
Mucosa: The surface area of the small intestine mucosa is greatly increased by permanent
circular folds, villi and microvilli.
The permanent circular folds, unlike the rugae of the stomach, are not smoothed out when the
small intestine is distended. The promote mixing of chyme as it passes along.
Blood supply: The superior mesenteric artery supplies the whole of the small intestine.
Venous drainage: This is by the superior mesenteric vein, which joins other veins to form
the portal vein.
Nerves supply: Innervation of the small intestine in both sympathetic and parasympathetic.

MICROSCOPIC STRUCTURE OF THE SMALL INTESTINE

The structure of the small intestine can be divided into three features which are:
Mucosa folds: the inner surface of the small intestine, not flat but thrown in circular folds
which not only increase surface area but in mixing the ingested by acting as baffles.
(Woodward, 2021)
Villi: the mucosa forms multitude of projections which protrudes into the lumen and covered
with epithelia cells.
Microvilli: the lumen plasma membrane of absorptive cells is with densely packed
microvilli.

CHEMICAL DIGESTION IN THE SMALL INTESTINE

When acid chyme passes into the small intestine it is mixed with pancreatic juice, bile and
intestine juice, and is in contact with the absorptive enterocytes of the villi. The digestion of
all nutrients is completed;
 Carbohydrates are broken down to monosaccharaides.

16
  Proteins are broken down to amino acids.
 Fats are broken down to fatty acids and glycerol.

FUNCTION OF SMALL INTESTINE

1. Helps in the absorption of water from the fluid materials coming from the ileum to it,
thereby concentrating the mass into a solid or semi-solid faecal matter.
2. Protection against infection by microbes that have survived the antimicrobial action of
the hydrochloric acid in the stomach.
3. Secretion of the hormones cholecystokinin (CCK) and secretion.
4. Helps to secret mucus which binds the faeces together in order to aid faecal
elimination.
5. Onward movement of its contents which is produced by peristalsis.
6. Completion of chemical digestion of carbohydrate protein and fats in the enterocytes
of the villi.
7. Secretion of intestinal juice.(Anne Waugh &Allison Grant 2015)

GASTROENTERITIS
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and the
intestine (gastrointestinal tract)

CAUSES OF GASRTOENTERITIS
Gastroenteritis has many causes. Virus and bacteria are the most common causes, they are
very contagious and can spread through contaminated food and water. In up to 50% of
diarrhea outbreaks, non- specific agent is found improper hand washing following a bowel
movement handling a diaper can spread the disease from person to person.
Gastroenteritis caused by virus may last for 1-2 days, on the other hand, bacteria causes work
or more.
(Parashar, U.D. et; al, 1998)
Bacteria causing gastroenteritis are;
 Eschetichia coli,
 Salmonella typhae,
 Shigella.

17
Viruses causing gastroenteritis are;
 Adenoviruses
 Rotaviruses
 Caliciviruses
 Astroviruses
 Noroviruses
Other common causes are chemical, toxins most commonly found in seafood, food allergies,
heavy metals, antibiotics and other medications also may be responsible for gastroenteritis
that are not infectious to others.( Smelte, Bare, Hinkle &Cheever, 2010)

TYPES OF GASTROENTERITIS
1. VIRAL GASTROENTERITIS
This is an infection caused by a variety of viruses that result into vomiting and diarrhea.
Many different viruses can cause gastroenteritis which includes rotaviruses, noroviruses, and
adenoviruses.
Signs and symptoms includes:
 Watery stool ( diarrhea)
 Vomiting
 Headache
 Fever
 Abdominal cramp.
2. BACTERIA GASTROENTERITIS
This is an infection caused by variety of bacteria that results into vomiting and diarrhea.
Many different bacteria can cause gastroenteritis including salmonella species, Escherichia
coli, staphylococcus, and shigella. The symptoms depend on the infection. (Pawlowski et. al,
2009)
Signs and symptoms includes:
 Vomiting and nausea
 Diarrhea
 Abdominal pain

18
  Loss of appetite
 Dehydration
 Electrolytes imbalance
 Bloody stools.

WHO CAN GETS GASTROENTERITIS

Anyone can come down with gastroenteritis. But you are more likely to get it if you are in a
place where lots of people share living or dining spaces, such as; (Moe, Christine L; et; al.
2021)
 Children in day care or at camp
 Nursing homes
 Military personnel
 Prisons
 Psychiatric
 Travelers to well developed countries
 Anyone with immune compromised state

INCIDENCE OF GASTROENTERITIS
Epidemic viral gastroenteritis occurs throughout the world and is very common. As it name
suggests, this disease often occurs in epidemic outbreaks among groups of people.
Campylobacter enteritis occurs worldwide, commonly in epidemic outbreaks. Its incidence is
highest during warm months. Diarrhea is caused by Escherichia coli and also occurs
worldwide commonly in epidemics. The highest incidence is in area of poor sanitation during
warm month. Shigellosis occurs worldwide in every age group but is most frequent in
children under the age of 10 years. Children and the elderly are more susceptible to shigella
because of their immature or depressed immune system. Outbreaks of shigellosis are
common in area with crowded living condition. (Joyce Black & Esther Matassarin- Jacobs,
2010).

19
PATHOPHYSIOLOGY OF GASTROENTERITIS
Whenever the causative organism gets entrance into the gastrointestinal tract, they would
irritate and inflame the intestinal mucosa. The inflammation causes the swelling and redness
of the mucosa. The toxins produced by these organisms irritate the nerve ending in the
mucosa leading to serve abdominal cramps with abdominal tenderness. The abdominal
cramps make the patient to become restless. The inflammation of the gastric mucosa by the
bacteria and their toxins causes the frequent vomiting while the inflammation of the intestinal
mucosa by the bacteria enterotoxins causes the release of excessive stools called diarrhea.
The essence of diarrhea and vomiting is to serve as body defense mechanism to get rid of the
bacteria and their toxins along this tract. (Profet, 1991).
Profuse diarrhea and vomiting leads to dehydration manifesting as sunken eyes, loss of skin
turgor, depressed fontanels (in children) and loss of weight. The laws of fluid and electrolytes
including glucose cause the general weakness. The laws of materials from the body will also
cause hypovolemia characterized by low blood pressure and fat but feeble pulse. These would
be fast, sighing and shallow respiration due to acidosis caused by hypernatremia resulting
from dehydration. The patient’s skin would be clammy due to constriction subnormal due to
hypovolemia in which less blood flows through the constricted peripheral blood vessel while
more blood flows to the vertical center.

PROGNOSIS OF GASTROENTERITIS
Although infectious gastroenteritis is usually acute, rapid onset with a short duration, certain
parasites such as Giardia can cause chronic diarrhea. For more severe or prolong cases, the
prognosis depends on the organism causing the gastroenteritis and the effectiveness of
treatment.
Recovery can be delayed by an extensive infection unusual reaction to medicines, or infection
from bacteria that produces more powerful toxin. Without replacement, extreme loss if body
fluid and electrolyte can lead to shock, coma or death. (Joyce Black &Esther Matassarin-
Jacobs, 2010).

PREVENTION OF GASTROENTRITIS

20
 1. Adequate personal and environmental hygiene: This will help in maintaining body
immunity in which if the bacteria are ingested, the body will be able to fight against it.
2. Through cooking of food substances before eating: this will reduce the rate of
chemicals that are used to preserve it can cause infection to the body.
3. Proper waste disposal: this will reduce some virus that cannot be seen with the
physical eye which can cause the disease or any bacteria that can feed on it.
4. Eat properly prepared and stored food: this helps the body to digest the food
properly and reduce the rate of any organism that can affect the body. (Essoussi, L.H.
& Zahaf, M. 2009).

CLINICAL MANIFESTATIONS OF GASTROENTERITIS

 Nausea and vomiting as a defense mechanism to get rid of the bacteria along the tract.
 Diarrhea occurs due to inflammation of the intestinal mucosa by the bacteria toxins
and enterotoxins which cause the release of excessive amount of fluid and
electrolytes.
 Abdominal cramping and distension occurs due to irritation of the nerve endings in
the mucosa lining by the toxins.
 Increased white blood cell (WBC) count due to loss of fluid and electrolyte in the
body.

DIAGNOSTIC INVESTIGATIONS
Tests may not be needed but if the symptoms persist for a long period of time, the health care
practitioner may consider the following:
 Blood culture to asses for bacteremia with suspected of the gastrointestinal tract.
 Stool specimen of Microscopy, Culture and Sensitivity (MCS) which reveals the
infective organism.
 Serum osmolality, serum electrolyte are all used to assess the client’s fluid volume
state, electrolytes and acid- base balance. (Webber, 2009).
GENERAL NURSING MANAGEMENT OF A PATIENT WITH
GASTROENTERITIS
The goal of management is to prevent death and complications that may arise from the
disease process.
ADMISSION

21
These include history taking using nursing process approach in other to come up with a plan
of care by the nurse. They include:
 Taking patient history
 Doing a general inspection of the patient from head to toe.
 Making patient comfortable on bed.

REST
Patient should have a good bed rest and visitors should be restricted from the patient.

OBSERVATION
 Physical examination to detect abnormalities
 Monitor patient vital signs
 Monitor the amount of time patient vomit and stools.

DRUGS
 Administer the prescribed intravenous fluids such as Normal saline, Ringers lactate.
 Administer prescribed oral drugs such as Ciprofloxacin, Metoclopramide.

DIET
Patient should be given nothing per oral for the first 24hours, but if patient is not vomiting, a
full fluid diet may be given.

PHYSICAL CARE
Two hourly mouth care should be done to moisten the mouth. Assisted bed or bathroom bath
should be given.
HEALTH EDUCATION
Health educate the patient on adequate personal and environmental hygiene. Health educate
the patient on proper waste disposal. The patient should be educated on the following:
 Importance of diet.
 Food hygiene.
 Compliance to drug regimen.
 Keeping to hospital appointments.

MEDICAL MANAGEMENT OF GASTROENTEROTISIS

22
This is aimed at reducing inflammation, providing rest for the diseased gastrointestinal tract
so that healing may take place, preventing or minimizing complications.
Supportive measures include fluid and electrolyte replacement through the use of intravenous
fluids like half strength Darrow solution, Normal saline and also control of temperature
through the use of antipyretic like paracetamol, anti-biotic like Ciprofloxacin, antiemetic like
Metoclopramide.

REVIEW OF DRUGS
This aspect of study deals with the review of possible drugs that can be used in the
management of patient with gastroenteritis.
ANTIBIOTICS
Also known as antibacterial are types of medication that destroys or down the growth of
bacterial. Antibiotics are used in treating infections caused by bacterial. Examples are:
CIPROFLOXACIN
Drug class: Broad spectrum antibiotics
Modes of action: It is bactericidal in action, they inhibit the bacterial enzymes DNA
(Deoxyribonucleic acid) gyrase which is required for DNA replication and transcription.
Indications: Gastroenteritis, cholera, campylobacter and salmonella enteritis typhoid,
gonorrhea, diarrhea.
Dose: Tablets (250-750mg), injections (200-400mg in 20mls and 40mls respectively).
Routes of administration: Oral and intravenous.

23
Side effects: Nausea and vomiting, dyspepsia, abdominal pain, flatulence, pancreatitis,
dysphagia, tremor, headache, dizziness.
Contraindications: History of tendon disorders related to quinolone use, history of epilepsy
or conditions that predispose to seizures.
Nurses Responsibilities
 Obtain specimen for culture and sensitivity before first dose therapy. May begin
pending the result.
 Administer oral medications preferably 2 hours after meals, may administer with food
to avoid gastrointestinal upset.
 Give plenty fluid to maintain proper hydration.
 Administer intravenous infusion slowly over 60minutes to reduce the risk of venous
irritation.
 Advice patient nit to drive or operate any machinery if dizziness occurs.
METRONIDAZOLE
Class of drugs: Antibacterial and antiprotozoal
Mode of action: it is a pro-drug. It binds to the bacteria and protozoa DNA and inhibiting
protein synthesis.
Indications: Anaerobic bacterial infection such as gingivitis, and other oral infections, pelvic
inflammatory disease, tetanus, septicemia, peritonitis, gastroenteritis and brain abscess.
Dose: 200-400mg
Routes of Administration: orally, intravenous.
Side effects: nausea and vomiting furred tongue, gastrointestinal disturbance.
Contraindications: Chronic alcohol dependence, hepatic impairment and hepatic
encephalopathy.
Nurses Responsibilities
 Administer after meal to minimize gastrointestinal distress and its metallic taste.
 Give intravenous infusion slowly, do not push.
 Use with caution in hepatic disease or alcoholism and in conjunction with known
hepatotoxic drugs.
 Emphasize on good personal hygiene after bowel motion via hand washing and care
of perineum.

24
ANTIEMETICS
These are drug that is effective against vomiting and nausea. They are typically used to treat
motion sickness and side effect of opioid analgesic, general anesthetics and chemotherapy
directed against cancer. For example:

METOCLOPRAMIDE
Class of drug: Antiemetic
Mode of action: Blocks the dopamine receptor in the central nervous system, increasing the
tone of the lower esophageal sphincter and promoting gastric empting.
Dosage: oral, 10-15mg up to 4 times daily
Side effects: difficulty in breathing, swelling of your face, lips, tongue. Or throat, restless,
insomnia.
Nurses Responsibilities
 Monitor BP carefully during IV administration
 Monitor for reactions, and consult physician if they occur
 Monitor diabetics patients, arrange for alteration in insulin dose or timing if diabetic
control is compromised by alterations in timing of food absorption.

PENTAZOZINE
Class of drugs: Opioid analgesic
Mode of action: They binds to opiate receptors in the CNS (central nervous system). Alters
perception of and response to painful stimuli.
Indication: moderate severe pain, sedation prior to surgery
Contraindication: patient who are physically dependent on opioid, hypersentivity
Side effects: dizziness, euphoria, hallucination, dry mouth, nausea, vomiting.
Route of administration: Intramuscular, intravenous.
Dose: 30mg
Dosage form; Ampoule
Nursing intervention
Assess blood pressure, pulse and Respiration before and periodically during administration

25
Assess prior analgesic history to avoid drug to drug interaction.

THEORETICAL APPLICATION: DOROTHY OREM’S THEORY OF SELF- CARE

DEFICIT (1970-1980)
Orem (1979) developed a definition of nursing that emphasizes client’s self needs. Orem’s
theory of self- care deficit is a combination of their theories. This includes the theory of self –
care, theory of self-care deficit and theory of nursing system.

SELF CARE
The self -care theory is divided into four, namely:
Self-care: this is the ability to perform the daily normal functions of living.
Self- care agency: this is an individual’s ability self- care activities and it can either be by the
self-care agent or a dependent care agent.
Self-care requisites: this is also called self- care needs and these are measures of action
taken to provide self-care and there are three categories, namely:
 Universal requisites
 Development requisites
 Health deviation requisites
Therapeutic self-care: these are actions done to maintain health and wellbeing.

SELF CARE DEFICIT

This is when self-care agency is not adequate to meet the known self-care demand. Orem’s
theory explains not only when nursing is needed but also how people can be assisted through
the following methods of helping:
 Acting of going for
 Guiding
 Teaching
 Supporting
 Providing an environment that promotes the individual’s ability to meet current and
future needs.

THEORY SYSTEMS
Orem identifies three nursing systems:

26
Wholly compensatory system: they are required by individuals who are unable to control
and monitor environment and process information.
Partly compensatory systems: these required by individuals who are partially able to
control monitor environment and process information.
Supportive education systems: these are those who need to learn how to perform self- care
and need assistance or help the ways of helping in self – care deficit are applied here.

APPLICATION OF THEORY
According to Orem’s theory, emphasis was laid on the methods of helping a patient with self
– care deficit, these methods are applied below:

ACTING OR DOING FOR: At the initial stage of admission, Mrs. O.P. wasn’t able to
perform the normal daily functions of living such as bed bath, oral toileting, cleaning of
environment and feeding. I assisted my client by performing all.

TEACHING: I taught Mrs. O.P. on the causes and predisposing factors of gastroenteritis. I
also taught him to take proper care of herself bearing in mind the fact that he was not strong
enough to perform these activities.

SUPPORTING: I supported her in carrying out the normal daily activities of living so as to
help her feel better about herself.
Providing an environment that promotes the individual’s ability to meet current and future
needs.

CHAPTER 3
GENERAL MANAGEMENT OF MRS. O.P.
This chapter deals with comprehensive information about the total nursing care of Mrs. O.P.

ADMISSION

27
Mrs. O. P. was wheeled into the ward 4 in company of the accident and emergency nurse and
student nurse and the relative on 2nd of April, 2024, around 3:10pm, on account of Acute
Gastroenteritis.
Patient was admitted to give supportive care, monitor and prevent complication, bed making
was done, and environment was tidied up, the toilet and bathroom was introduced to the
patient and her relative, the patient was made to rest and made comfortable on bed during the
admission process. Vitals signs checked and recorded as follows:
Temperature 37.20c, pulse 114b/m, respiration 20c/m, blood pressure 100/70mmhg spo2
95%.
Patient gave history that she has been hospitalized 10 years ago on account of malaria and
vomiting of about 3 episodes. Patient has never had any blood transfusion, nor had any
surgery done.
Patient was in her normal state of health until about 2 days ago when she started vomiting
and stooling watery after taking pap. She had 4 episodes of vomiting which was about
300mls, and stooling watery about 5 times before she was brought to the hospital.

On examination, an elderly woman, had generalized body pain, dehydrated with sunken
eyes, conscious and alert, pale, nil pedal edema, nil jaundiced, ears, nil discharges, Neck, no
enlarged lymph nodes, nose, no discharges, then she was placed on the following line of
management.
REST
Mrs. O.P. was made comfortable in bed, she also had her bath regularly so that she will feel
relaxed and encouraged to sleep well.
OBSERVATION
Mrs. O.P. was observed for signs of impending dehydration, vital signs was done and
observed daily for abnormalities, and vomitus was checked for the presence of blood or
mucus.
DIET
Mrs. O.P. was placed on nothing per oral for the first 24 hours. She was placed on a clear
fluid modified pap then she was encouraged to eat semi- liquid, also fruits rich in vitamins
e.g. apple
Was given.
DRUGS
Mrs. O.P. Was placed on the following drugs;
28
  IV Ciprofloxacin 4oomg 12hourly for 2 days
 IV Metronidazole 500mg 8 hourly for 2 days
 IV Hyoscine 20mg 8 hourly for 1 day
 IV paracetamol 600mg 8 hourly for 24 hours
 IV Metoclopramide 10mg 8 hourly for 24 hours
 IV Normal saline 500ml 24 hourly for 2 days
IV Fluid Ringer lactate 500ml 24 hourly for 1 day alternate with intravenous normal
saline 500ml 24hourly then add( 5ce of intravenous vitamin B complex into each
pant of intravenous fluid).
 IV Dextrose water 5%, 500mg 4hourly for 24hour

PHYSICAL CARE Mrs. O p. was assisted in bed bathing, oral care every morning
throughout her stay in the hospital. She was assisted with feeding and was placed in a
comfortable position in bed.
PSYCHOLOGICAL CARE
Mrs. O .P. and her relatives were reassured and they were health educated on the disease
condition, the cause, the signs and symptoms, the importance of early treatment and the
preventive measure in order to reduce their anxiety

SPECIFIC DAY TO DAY CARE OF MRS. O.P.

Day 1 (02nd of April, 2024)

29
Patient was met in bed early in the morning, she had assisted oral care and bed bath was
done
Bed linen was changed and environment tidied up.
Vitals signs was checked and read, T-37.2OC, P-114b/m, Bp-100/70mmhg, Spo2 96%
Due medication was administered and charted.
IV Fluid Dextrose water 5% 500ml 4 hourly was put up dripping 20 drops per minutes
IV Fluid, normal saline, 500mls alternate with IV fluid Ringers lactate (add 5ce of vitamins
B complex) was monitored as per chart.
IV medications( IV Ciprofloxacin 500mg 12 hourly for48hours,, IV metronidazole 500mg 8
hourly for48hours,, IV hyoscine 20mg 8 hourly for 24 hour,, Tab slow k 600mg t. d .s) for
2weeks, was administered and well tolerated.

Day 2 (03rd of April, 2024)

Patient was met sleeping on duty resumption, intravenous fluid 500ml normal saline dripping
2015 drops per minutes, she was still weak, vital signs checked and charted, temperature
37.20c, pulse 88b/m, respiration 20c/m, blood pressure 100/70mmhg, spo2 95%. Bed bathing
was done, assisted in oral care, bed linen was changed and environment was taken care.
Medical team was reviewed her and as thus; continue present line of management, normal
saline 500mls over 24 hours for 1 day, iv ciprofloxacin 500mg 12 hourly for 48hours, iv
metronidazole 500mg 8 hourly for 48 hours, tab slow k 600mg t.d.s for 2 weeks, . She was
taken over in a fair state, she had 3 episodes of loose stool and vomiting of about 200mls.

Day 3 (04th of April, 2024)

Patient was met sitting up in the bed on duty resumption, pleasantries exchanged and well
tolerated. Patient complained of pain and inability to fall asleep, after which she vomited,
vomitus was brownish, she was cleaned and given psychological support. Vital signs checked
and charted, with temperature read 36.50c, blood pressure 110/70mmhg, pulse 20b/m,
respiration 20c/m spo2 98%, IV paracetamol 600mg 8hourly for 48hours, was administered,
IV metoclopramide 10mg 8 hourly for24 hour was administered, intravenous normal saline
was put up dripping minimally into the vein at the rate of 30 drops per minutes, she had her
meal served of pap (150ml) and moinmoin and well tolerated.

30
Day 4 (05th of April, 2024)
Patient was met sitting in bed, she was doing fine on duty resumption, in company of the
relatives, she was be able to go to bathroom herself, oral hygiene was done, bed linen
changed, vital signs checked and charted, T-36.5 0c, p- 74b/m,spo2-98%, R-20cm, b/p-
110/60mmhg due medications was administered, R/L 500mls was put up, dripping minimally
into the vein at a rate of 30 drops per minute, she complained of abdominal pain. She later
passed some faeces which was normally compacted and also 2 episodes of vomitus. She was
reviewed and planned thus:

Continue IV fluid Ringer’s Lactate alternate to D/W 500ml 24 hourly for 1 day

Continue IV Ciprofloxacin 400mg 12 hourly for 48 hours

IV kcl 20mmol in alternate pant fluid of normal saline 500mls 24 hourly for 1 day

She also reassured by the doctor.

Day 5 (06th of April, 2024)

She was met sitting up in bed in the morning duty resumption, she had her bath and her oral
care unaided. Bed linen was changed and her environment was tidied up. Breakfast was
served which was a plate of jollify rice and well tolerated. Vital signs was checked and
charted, Temperature 36.50c, Blood pressure 120/80, pulse 76 beat per minutes, Respiration
22c/m, sp02 98%. She was seen during the ward round by medical team, and she was planned
thus:
Tab vitamin C 11 t. d .s 2/52
Syrup hem force 10mmls t. d. s 2/52
Continue IV fluid Ringer’s Lactate 500ml for 24hour.
Due medication was administered and charted.

Day 6 (07th of April, 2024)

Patient was met sleeping on duty morning resumption, she had a fair shift spent, she is more
better, no fresh complain, bathing and oral hygiene done, vital signs checked and charted T-

31
36.50c,P-68b/m,Bp-120/70mmhg, sp02 98%. Due medication was administered and charted.
Tab vitamin C 11 t.d.s for 2 weeks, syrup hem force 10ml t.d.s for 2 weeks
She was reviewed by the medical team and planned thus:
 CT present line of care
 Add Tab zinc 500mg 2/52
Due parenteral medication administered and charted (paracetamol 500mg, ciprofloxacin
500mg). Breakfast, Rice and beans was served and she was able to eat well.

Day 7 (08th of April, 2024)

Patient was met sitting on the bed on morning duty resumption, breakfast (pap and
moinmoin) was served and well tolerated, due medications Tab zinc 500mg for 2 weeks, Tab
vitamin C 11 t.d.s for 2 weeks, syrup hem force 10ml t.d.s for 2weeks were administered and
charted.
She was seen by doctor during ward round and she was discharged home. She was advised on
the importance of follow up care, the advantage of complying with drug regimen and to visit
the hospital if she notices any sign of disease. She was also educated on the intake of
vegetables, fruits, and also the usefulness of food hygiene. She was also advised on the
dangers of self- medication. She was given some drugs home: Tab zinc 50mg daily for
10days, Tab ciprofloxacin 500mg 12hly for 5days,Tab metronidazole 400mg 8 hly for 5 days,
Tab paracetamol 1g 8 hly for 5 days, her due drugs administered and vital signs was done and
charted to be T- 36.0, P-90b/m, and BP-130/60mmhg. Her case file was sent to the account
hospital department for bill settlement, she was able to pay her bill and she went home in a
cheerful and good condition.

32
 NURSING DIAGNOSIS

• Deficit fluid volume related to vomiting and diarrhea, evidence by loss of skin Tugor,
and sunken eyes.
• Acute pain related to abdominal discomfort evidence by patient verbalization pain.
• Disturbed sleep pattern related to frequent vomiting and pain evidence by patient
verbalization, fatigue.

33
 NURSING CARE PLAN FOR MRS.O.P. WITH DIAGNOSIS OF ACUTE
GASTROENTERITIS.

S/N NURSING NURSING NURSING SCIENTIFIC EVALUATION

DIAGNOSES OBJECTIVES INTERVENTION RATIONALE
1 Fluid volume Mrs. O.P. fluid i. Assess patient’s i. To serve as a Mrs. O.P.’s fluid
deficit related to balance would level of baseline data. was restored
vomiting and be restored to dehydration. after 5 hours of
diarrhea, normal within nursing
evidence by loss 6-8 hours of ii. Monitor ii. To evaluate intervention.
of skin tugor, nursing patient’s input fluid balance.
and sunken eyes intervention. and output.

iii. Give copious iii. To maintain

oral fluid like hydration.
ORS.

34
 iv. Administer iv. To restore loss
prescribed fluid and
intravenous electrolytes.
infusion such as
Ringer’s lactate.

2 Acute pain Mrs. O.P. will i. Assess the i. To serve as a Mrs. O.P. will
related to verbalize less level of pain, baseline data verbalize less
abdominal pain within location and pain after 20
discomfort 30minutes of intensity. minutes of
evidence by nursing nursing
patient interventions. ii. Place the ii. To promote intervention.
verbalizing pain. patient in a patient’s
comfortable comfort and
position. relief pain.

iii. Provide iii. To divert the

diversional patient’s
therapy. attention away
from the pain.

iv. Administer iv. To act on the

prescribed pain receptor in
analgesics like the
Drugamol 30ml hypothalamus
im.. thereby
reducing pain.
3 Disturbed sleep Mrs. O.P. will i. Nurse patient in i. To conserve Mrs. O.P. was
pattern related to be able to sleep complete bed energy and able to sleep for
frequent for about 5 rest and limit induces 4 hours during
vomiting and hours during the visitors. uninterrupted. the day and
pain, evidenced day and about 8 about 7 hours of
35
 by patient’s hours of uninterrupted
verbalization uninterrupted ii. Give cold or ii. Warm bath sleep at night.
fatigue. sleep at night. warm bath. stimulates
blood flow to
the brain, thus
ensuring sleep.

iii. Dim or put off iii. To reduce

light. stimulation and
enhance sleep.

iv. Give prescribed iv. To act on the

mild sedative nervous system
drug e.g. to produce
Diazepam 5- calmness which
10mg induces sleep.

ADVICE ON DISCHAGE
Mrs. O.P. was encouraged to eat well, take a lot of water as well as are medications as
prescribed by the physicians. Mrs. O. P’s and her relative were advised the treatment
regimens after discharge and to follow all the health talk on personal, food and environmental
hygiene given to them on discharge and to report to the hospital if any complications arises.
It was observed on 8th of April, 2024 that she was not passing stool and vomiting, nil
abdominal pain, nil fever and body weakness and was discharged home by the medical team
during ward round and was advised to come for checkup appointment.
The following advice was giving to her during discharge:
 Explanation on how to take her oral medications and she was encouraged to take them
adequately as prescribed.

36
  She was encouraged to perform personal hygiene, food hygiene, and environmental
hygiene
 She was advised on the need to take adequate diet, vitamins, fruits, vegetables, and
copious fluids.

FOLLOW UP CARE
Mrs. O.P. was called via the telephone on 9 th April, 2024 after discharge to ask about her
health status and she claimed that she is very much better and she was reminded of her
appointment scheduled for 15th of April, 2024.
On 15th of April, 2024, Mrs. O.P. came to the General Outpatient Department for her medical
checkup. General assessment showed that her condition was satisfactory and she was asked to
follow the educative guidelines which she was given.

37
 CHAPTER FOUR
SUMMARY
This is a care study of Mrs. O.P, a 75 years old woman who was brought by her relatives into
Seventh Day Adventist Hospital, Ile-Ife on 2 nd of April, 2024. She presented with the history
of abdominal pain, watery stooling, vomiting, accompanied with chills and a feeling of
general discomfort and uneasiness which started two days before hospitalization. She was
brought to the hospital for proper Nursing
(Bed bath, oral care, food service, bed making, drug administration, and medical
management).
(NS 5% 500mls 8hrly, IV ciprofloxacin400mg 12hrly, IV Fluid R/L 1 hourly, then, D/W
500mls 1 hourly,IV Metronidazole 500mg 8 hrly ,IV Hyosine 20mg 8 hourly, IV
38
Metoclopramide 10mg, for 24 hours, Tab slow k, t.d.s for 2 weeks, IV Paracetamol 600mg 8
hrly, Tab zinc 500mg f0r 2 weeks, Vitamin C 11t.d .s for 2 weeks, syrup hem force 10ml for
2 weeks.
During the time of hospitalization, she was given bed bath because she was so weak, oral
hygiene, observation of vital signs and as well interacted with. She was made to rest
physically and mentally and was made to eat well. Vital signs on admission was,
Temperature-370C, Pulse rate of 116b/m, Blood pressure of 70/50mmhg, spo2 96%
In summary, gastroenteritis is a disease that cuts across, sex, race, family and occupational
background, the disease is mostly caused by bacterial, virus, poor environmental hygiene and
personal hygiene with the following manifestations stooling, vomiting, abdominal pain and
generalize body weakness.
Although it rarely cause death itself, unless if not managed well or if complications develop.
During the course of hospitalization, nursing diagnosis was made and comprehensive nursing
care plan was followed strictly for Mrs. O.P, The Nursing diagnosis formulated for
Mrs. O.P, includes;
 Acute pain related to abdominal discomfort evidence by patient verbalization
 Deficit fluid volume related to vomiting and diarrhea, evidence by loss of skin tugor
and sunken eyes.
 Disturbed sleep pattern related to frequent vomiting and pain evidence by patient
verbalization fatigue.

There was no complication throughout the period of hospitalization. Mrs. O.P condition was
resolved as she no more complained of pain, she was be able to feed very well and she was
discharged home on 8th of April, 2024 in a satisfactory condition. And need to be present in
the General Outpatient Department on 15th of April, 2024 for her medical checkup.

39
 CONCLUSION
This care study has revealed that viral, bacterial, and parasite infections are the common
cause of gastroenteritis. It also revealed that infection is acquired through contaminated food
and water.
Epidemic Viral gastroenteritis occurs throughout the world and it is very common. It can be
controlled if human water supply is purified. Drinking water should be preserved very well,
food and fruits should be washed and cooked thoroughly. Personal and environmental
hygiene must always be maintained. All of these have to be followed to acquire good health
and to avoid the occurrence of gastroenteritis in our community. The study also revealed that
gastroenteritis will not kill if immediate medical attention is sought.

RECOMMENDATION
Based on the conclusion of this study, my recommendation goes thus;
The government: the government should provide essential waste management services,
modernized health care facilities. Health care givers including the nurses should provide
information to the measles during health talk at outpatient department visit, hospital
admission on food hygiene and balanced diet as a prevention measure of gastroenteritis, the
government should ensure that adequate disposal system should be made available for use by
the masses at all level.

40
Attention should be paid to personal hygiene with emphasis on washing of hands before food
and after visiting the toilet. As well as food hygiene, environmental hygiene, proper
household waste disposal system.
To the health care workers, seminars programs, and workshop should be made available to
the health care practitioners and to the public to enlighten the more on the predisposing
factor, causes, sign and symptoms, and the treatment of Gastroenteritis.

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A; pirrotte,P;& Zenhausern, F. . (2021). Canada.

Bennet, D., & Khorsandian, Y. P. ((2021)). Molecular and physical A focus on cancer
population. Clinical and Translational Medicine,11(6), e461.

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Bolukbas, F. F., & al., e. (Dig Dis Sci 49, 11,-12 (2004)). A dramatic response to ketotifen in
a case of eosinophilic gastroenteritis mimicking abdominal emegency.

Brehmer, Axel, Holder Rupprecht, and Winfried Neuhuber. ((2010) p, 149-161.). Two
submucosal nerve plexus in human intestines. Histochemistry and cell biology 133.2.

Brunner, L. (2010). Brunner & Suddarth's textbook of medical- surgical nursing(vol. 1).
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Essoussi, L. H,& Zahaf, M. (n.d.). Exploring the decision- making process of canadian
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Lemma- Perez, Laura, et al,. ((2019)). Phenomenological- Based model of human stomach
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Malagelada, j.-R. V. (( 1979) page 101-110.). "Digestive gastric, Different gastric,

pancreatic, and biliary responses to solid- liquid or homogeized meals" Digestive
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Malagelada, juan-R; Vay LW Go, and W .H. J. S ummerskill. ((1979) 24.2, page 101-110).
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Moe, C. L. (2001). " Outbreaks of acute gastroenteritis associated with Norwalk- like viruses
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Okada, Ken- ichi, et al. ((2014); ). Preservation of the left gastric artery on the basis of
anatomical features in patients undergoing distal pancreatectomy with celiac axis en-
bloc resection(DP- CAR). World journal of surgery 38.11, 2980-2985.

Parashar, U. D., & al., e. (( 1998) page 615-621.). " An outbreak of viral gastroenteritis
associated with consumption of sandwiches; Impilications for the control of
transmission by food handlers." Epidemiology& infection 121.3.

Pawlowski, Sean W; Circle Alcantara Warren, and Richard Guerrant. (( 2009) page 1874-
1886.). "Diagnosis and treatment of acute or persistence diarrhea" Gastroenterology
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Profet, M. (1991 page 23-62.). "The function of allergy: immunological defense against
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Trumpp, C. E. ((1983); 219-229.). Management of communicable diseases in day care centre

Pediat

Works Cited
Eyken, peter Van, et al. . (2014, page 1-16). Mucosa and submucosa Colitis, SPRINGER,
Cham.

A; pirrotte,P;& Zenhausern, F. . (2021). Canada.

Bennet, D., & Khorsandian, Y. P. ((2021)). Molecular and physical A focus on cancer
population. Clinical and Translational Medicine,11(6), e461.

Bolukbas, F. F., & al., e. (Dig Dis Sci 49, 11,-12 (2004)). A dramatic response to ketotifen in
a case of eosinophilic gastroenteritis mimicking abdominal emegency.

Brehmer, Axel, Holder Rupprecht, and Winfried Neuhuber. ((2010) p, 149-161.). Two
submucosal nerve plexus in human intestines. Histochemistry and cell biology 133.2.

Brunner, L. (2010). Brunner & Suddarth's textbook of medical- surgical nursing(vol. 1).
Lippincott Williams & Wilkins.

Essoussi, L. H,& Zahaf, M. (n.d.). Exploring the decision- making process of canadian
organic food consumers: Motivations and trust issues. Qualitative market research:
An international journal.

Lemma- Perez, Laura, et al,. ((2019)). Phenomenological- Based model of human stomach
and its role in glucose metabolism. journal of Theoretical Biology 460, 88-100.

Malagelada, j.-R. V. (( 1979) page 101-110.). "Digestive gastric, Different gastric,

pancreatic, and biliary responses to solid- liquid or homogeized meals" Digestive
diseases and sciences 24.2.

43
Malagelada, juan-R; Vay LW Go, and W .H. J. S ummerskill. ((1979) 24.2, page 101-110).
Different gastric, pancreatic. and biliary responses to solid- liquid or homogenized
meals. Digestive diseases and sciences.

Moe, C. L. (2001). " Outbreaks of acute gastroenteritis associated with Norwalk- like viruses
incampus settings. journal American college Health 50.2, 57-66.

Okada, Ken- ichi, et al. ((2014); ). Preservation of the left gastric artery on the basis of
anatomical features in patients undergoing distal pancreatectomy with celiac axis en-
bloc resection(DP- CAR). World journal of surgery 38.11, 2980-2985.

Parashar, U. D., & al., e. (( 1998) page 615-621.). " An outbreak of viral gastroenteritis
associated with consumption of sandwiches; Impilications for the control of
transmission by food handlers." Epidemiology& infection 121.3.

Pawlowski, Sean W; Circle Alcantara Warren, and Richard Guerrant. (( 2009) page 1874-
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