Acute Gastroenteritis

Gastroenteritis or infectious diarrhea is a medical condition from inflammation of

the gastrointestinal tract that involves both the stomach and the small intestine. It
causes some combination of diarrhea, vomiting, and abdominal pain and cramping.
Dehydration may occur as a result. Gastroenteritis has been referred to as gastro,
stomach bug, and stomach virus. Although unrelated to influenza, it has also been
called stomach flu and gastric flu.
Cause
Viruses (particularly rotavirus) and the bacteria Escherichia coli and Campylobacter
species are the primary causes of gastroenteritis. There are, however, many other
infectious agents that can cause this syndrome. Non-infectious causes are seen on
occasion, but they are less likely than a viral or bacterial cause. Risk of infection is
higher in children due to their lack of immunity and relatively poor hygiene.
Signs and symptoms
Gastroenteritis typically involves both diarrhea and vomiting, or less commonly,
presents with only one or the other. Abdominal cramping may also be present. Signs
and symptoms usually begin 1272 hours after contracting the infectious agent. If
due to a viral agent, the condition usually resolves within one week. Some viral
causes may also be associated with fever, fatigue, headache, and muscle pain. If
the stool is bloody, the cause is less likely to be viral and more likely to be bacterial.
Some bacterial infections may be associated with severe abdominal pain and may
persist for several weeks.
Pathophysiology
Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or
large bowel. The changes in the small bowel are typically non-inflammatory, while
the ones in the large bowel are inflammatory. The number of pathogens required to
cause an infection varies from as few as one (for Cryptosporidium) to as many as
108 (for Vibrio cholerae).
Nursing Diagnosis
Fluid volume deficit related to abnormal bowel movement as evidenced by passage
of loose watery stool for more than 3 times
Acute pain related to inflammation of the gastrointestinal tract as evidenced by face
grimace
Activity intolerance related to decreased oxygen delivery to tissues of the body as
evidenced by altered LOC
Medications

Antacids such as Pepto-Bismol and Milk of Magnesia can be used to neutralize

stomach acid.

H2 antagonists such as famotidine (Pepcid) and cimetidine (Tagamet) reduce

the production of stomach acid.

Proton pump inhibitors such as omeprazole (Prilosec) and esomeprazole

(Nexium) inhibit the production of stomach acid.

Antibiotics are only necessary if you have a bacterial infection, such as from
H. pylori.

Management

Encourage increase intake of fluid

avoiding or limiting alcohol consumption

avoiding spicy, fried, and acidic foods

eating frequent, small meals

reducing stress

Dengue Fever
Dengue fever is a disease caused by a family of viruses that are transmitted by
mosquitoes. Dengue is transmitted by several species of mosquito within the genus
Aedes, principally A. aegypti. The virus has five different types; infection with one
type usually gives lifelong immunity to that type, but only short-term immunity to
the others. Subsequent infection with a different type increases the risk of severe
complications. As there is no commercially available vaccine, prevention is sought
by reducing the habitat and the number of mosquitoes and limiting exposure to
bites.
Pathophysiology
When a mosquito carrying dengue virus bites a person, the virus enters the skin
together with the mosquito's saliva. It binds to and enters white blood cells, and
reproduces inside the cells while they move throughout the body. The white blood
cells respond by producing a number of signaling proteins, such as cytokines and
interferons, which are responsible for many of the symptoms, such as the fever, the
flu-like symptoms and the severe pains. In severe infection, the virus production
inside the body is greatly increased, and many more organs (such as the liver and
the bone marrow) can be affected. Fluid from the bloodstream leaks through the
wall of small blood vessels into body cavities due to capillary permeability. As a
result, less blood circulates in the blood vessels, and the blood pressure becomes so
low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of

the bone marrow due to infection of the stromal cells leads to reduced numbers of
platelets, which are necessary for effective blood clotting; this increases the risk of
bleeding, the other major complication of dengue fever.
Symptoms of Dengue Fever
Symptoms, which usually begin four to six days after infection and last for up to 10
days, may include

Sudden, high fever

Severe headaches

Pain behind the eyes

Severe joint and muscle pain

Fatigue

Nausea

Vomiting

Skin rash, which appears two to five days after the onset of fever

Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Nursing Diagnosis

Deficient Fluid Volume related to increased capillary permeability, bleeding,

vomiting and fever.

Imbalanced Nutrition: Less than body requirements related to nausea,

vomiting, no appetite.

Increased body temperature related to the process of dengue virus infection.

Management

Monitor Vital Signs

Assess neurologic response, note LOC & orientation, reaction to stimuli,

papillary reactions & presence of seizures

Instruct client to have bed rest

Administer replacement fluids

Peptic ulcer disease (PUD)

Peptic ulcer disease (PUD), also known as a peptic ulcer or stomach ulcer, is a break
in the lining of the stomach, first part of the small intestine, or occasionally the
lower esophagus. An ulcer in the stomach is known as a gastric ulcer while that in
the first part of the intestines is known as a duodenal ulcer.
Signs and symptoms

abdominal pain, classically epigastric strongly correlated to mealtimes. In

case of duodenal ulcers the pain appears about three hours after taking a
meal;
bloating and abdominal fullness;
water brash (rush of saliva after an episode of regurgitation to dilute the acid
in esophagus - although this is more associated with gastro esophageal reflux
disease);
nausea, and copious vomiting;
loss of appetite and weight loss;
hematemesis (vomiting of blood); this can occur due to bleeding directly from
a gastric ulcer, or from damage to the esophagus from severe/continuing
vomiting.
melena (tarry, foul-smelling feces due to presence of oxidized iron from
hemoglobin);
rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to
acute peritonitis, extreme, stabbing pain, and requires immediate surgery.

Risks/ Causes

infected with the H. pylori bacterium

family history of ulcers
Have another illness such as liver, kidney, or lung disease
Drink alcohol regularly
Are age 50 or older
Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such
as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen
(Motrin, Advil, some types of Midol, and others), and many others available

by prescription; even safety-coated aspirin and aspirin in powered form can

frequently cause ulcers.
Excess acid production from gastrinomas, tumors of the acid producing cells
of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)
Excessive drinking of alcohol
Smoking or chewing tobacco
Serious illness
Radiation treatment to the area

Complications
Gastrointestinal bleeding is the most common complication. Sudden large bleeding
can be life-threatening. It occurs when the ulcer erodes one of the blood vessels,
such as the gastroduodenal artery.
Perforation (a hole in the wall of the gastrointestinal tract) often leads to
catastrophic consequences if left untreated. Erosion of the gastro-intestinal wall by
the ulcer leads to spillage of stomach or intestinal content into the abdominal
cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis,
initially chemical and later bacterial peritonitis. The first sign is often sudden intense
abdominal pain; an example is Valentino's syndrome, named after the silent-film
actor who experienced this pain before his death. Posterior wall perforation leads to
bleeding due to involvement of gastroduodenal artery that lies posterior to the 1st
part of duodenum.
Penetration is a form of perforation in which the hole leads to and the ulcer
continues into adjacent organs such as the liver and pancreas.
Gastric outlet obstruction is the narrowing of pyloric canal by scarring and swelling
of gastric antrum and duodenum due to peptic ulcers. Patient often presents with
severe vomiting without bile.
Cancer is included in the differential diagnosis (elucidated by biopsy), Helicobacter
pylori as the etiological factor making it 3 to 6 times more likely to develop stomach
cancer from the ulcer.

Exams and Tests

An endoscopy may be done so that a doctor can look at the inside of the stomach
and upper small intestine to check for an ulcer and collect a tissue sample (biopsy)
that can be tested for H. pylori or cancer.
Other tests that may be done include:
Fecal occult blood test (FOBT). This test may be done to detect blood in the stool,
which may be caused by a peptic ulcer or another serious problem, such as colon
cancer. By itself, an FOBT cannot diagnose peptic ulcer disease, but it may show if
an ulcer is bleeding.

Complete blood count (CBC). This blood test may be done to look for anemia, which
may be caused by a bleeding ulcer.
Upper GI series. This X-ray exam of the esophagus and stomach may be used to
diagnose peptic ulcer disease, although this test is being used less frequently.
Nursing Diagnosis

Acute Pain related to the effect of gastric acid secretion on damaged tissue
Anxiety related to coping with an acute disease
Imbalanced Nutrition related to changes in diet

Nursing Intervention

Avoid aspirin, which is an anticoagulant, and foods and beverages that

contain acid enhancing caffeine (colas, tea, coffee, chocolate), along with
decaffeinated coffee.
Encourage patient to eat regularly spaced meals in a relaxed atmosphere;
obtain regular weights and encourage dietary modifications.
Encourage relaxation techniques.
Assess for faintness or dizziness and nausea, before or with bleeding; test
stool for occult or gross blood; monitor vital signs frequently (tachycardia,
hypotension, and tachypnea).