INTRODUCTION

People today tend to disregard the importance of healthy lifestyle, proper diet and exercise. It is
very important to prepare a clean, safe and delectable food in our table. And it is alarming that children of
today prefer to eat process foods and loves to drink cola on which are bad for their health. We must take
an action to these problem for our children who are risk to this disease.
Acute gastroenteritis or diarrhea is one of the top illnesses reimbursed by PhilHealth. Diarrhea
with moderate and severe dehydration requires inpatient care because of the need for rapid intravenous
rehydration and close observation due to risk of developing complications.
Diarrhoeal disease is the second leading cause of death in children under five years old. It is both
preventable and treatable. Each year diarrhoea kills around 525 000 children under five. A significant
proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and
hygiene. Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year. Diarrhoea
is a leading cause of malnutrition in children under five years old. (www.who.int)

In low-income countries, children under three years old experience on average three episodes of
diarrhea every year. Each episode deprives the child of the nutrition necessary for growth. As a result,
diarrhea is a major cause of malnutrition, and malnourished children are more likely to fall ill from
diarrhea.
We choose this case because we want to spread awareness of this disease and to share our
knowledge for everyone, but people now are striving to prevent and control the condition. We want to
provide proper teachings to everyone especially those at risk and children that are susceptible to this
disease. Furthermore, we want to enhance our knowledge regarding this condition thus, we can protect
ourselves from acquiring the said disease in the far future.

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 Review of Related Literature

Gastroenteritis is a term used to refer to infections of the gastrointestinal tract caused by bacteria,
viral, or parasitic pathogens. Majority of these infections are food –borne illnesses whose common
manifestations are diarrhea and vomiting which may also be associated with systemic features such as
abdominal pain and fever (Behrman, 2008).
Once inside the intestinal mucosa, Enteropathogenesis either leads to an inflammatory or non-
inflammatory response. Non-inflammatory diarrhea is elicited through enterotoxin production by some
bacteria, destruction of villus (surface) cells by viruses, adherence by parasites, and adherence and / or
translocation by bacteria while inflammatory diarrhea is usually caused by bacteria that directly invade
the intestine or produce cytotoxins with consequent fluid, protein, and cells (erythrocytes, leucocytes) that
enter the intestinal lumen (Behrman, 2008).
Acute gastroenteritis or diarrhea is a decrease in stool consistency loose or liquid) and/or increase
in frequency of evacuation 3 or more times in 24 hours with or without vomiting or fever, usually lasting
for 7 days but not more than 14 days.
Acute diarrheal illness causes significant morbidity among young children and other older adults,
especially in less-industrialized nations of the world. Rapid propulsion of intestinal contents through the
small bowel results in diarrhea and may lead to serious fluid volume deficit. Common causes are
infections, malabsorption syndromes, medications, allergies and systemic diseases. Distention is caused
by excessive gas in the intestines. It may be due to the inability to digest adequately a specific nutrient,
such as lactose or it may result from defect in intestinal motility. Flatus (passing of bowel gas) may be
another clinical manifestation. In intestinal disorders, nausea results from distention of the duodenum.
Vomiting occurs from changes in the integrity of the intestinal wall or from changes in the motility of the
bowel caused by obstruction. Vomitus that contains fecal matter usually indicates a distal obstruction in
the small intestine. (Black Hawks 2004)

(Ref. http://www.doh.gov.ph/notifiable_diseases)

Dehydration is a common body fluid disturbance encountered in the nursing care of infants and children;
it occurs whenever the total output of fluid exceeds in total intake, regardless of the underlying cause.
When the lost fluid and electrolytes are not replaced adequately, a deficit of water and electrolytes
develops resulting in to dehydration.

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Two Types of Diarrhea (Ref. Wong’s Nursing Care of Infants and Children 2010)
1. Acute – a sudden increase inflammatory of stools is often caused by an infectious in the GI tract
cause spread by fecal or oral route.
a. Mild – 5-6% degree of DHN
Increase thirst, slightly dry buccal membrane.
b. Moderate – 7-9% degree of dehydration
Loss skin turgor, dry buccal mucous membranes, sunken eyeball/ fontanel.
c. Severe - more than 9% of dehydration
Rapid thread pulse, cyanosis, rapid breathy, lethargy/coma.
2. Chronic – increase stool frequency, increase water content with duration more than 14 days
caused by malabsorption syndrome, inflammation bowel disease, immune deficiency, food
allergy, lactose intolerance.

Clinical Manifestations of Acute diarrhea

 Fever
 Vomitus
 Watery stools
 Abdominal cramps
 Nausea
 Body malaise
 Bloody diarrhea
 Anorexia

Types of Dehydration

1. Isotonic – loss of water and salt.

2. Hypotonic – loss of salt more than water.
3. Hypertonic – loss of water more than salt.

Clinical Manifestations of Dehydration (Ref. Wong’s Nursing Care of Infants and Children 2010)

Manifestations Isotonic Hypotonic Hypertonic

Skin
Color Gray Gray Gray
Temperature Cold Cold Cold or Hot
Turgor Poor Very poor Fair
Feed Dry Clammy Thickened, doughy
Mucous Membrane Dry Slightly point Parched
Tearing and Salivation Absent Absent Absent
Eyeball Sunken Sunken Sunken
Fontanel Sunken Sunken Sunken
Body temperature Subnormal or elevated Subnormal or elevated Subnormal or elevated
Pulse Rapid Very rapid Moderately rapid
Respiration Rapid Rapid Rapid
Behavior Irritable to lethargic Lethargic or comatose, Marked lethargy with
convulsions extreme hyperirritability
on stimulation

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Complications

Diarrhea is usually temporary and causes no serious problem. However, it does pose on increased threat
to the very old, the very young and those in poor in health. These individuals are more likely to become
dehydrated and experience electrolyte imbalances and metabolic acidosis. Chronic diarrhea interferes
with absorption of nutrients and can lead to malnutrition and anemia.

Key measures to treat diarrhea include the following:

 Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and
sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the
water and electrolytes lost in the feces.
 Zinc supplements: zinc supplements reduce the duration of a diarrhea episode by 25% and are
associated with a 30% reduction in stool volume.
 Rehydration: with intravenous fluids in case of severe dehydration or shock.
 Nutrient-rich foods: the vicious circle of malnutrition and diarrhea can be broken by continuing to
give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious
diet – including exclusive breastfeeding for the first six months of life – to children when they are
well.
Consulting a health professional, for management of persistent diarrhea or when there is blood in stool or
if there are signs of dehydration.

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 PATIENT HEALTH HISTORY

BIOGRAPHIC DATA

Name : Patient R
Address : Purok-1, Brgy. Cagtina-Ealim, Mono, Surigao
Age : 2years 1month 23 days
Sex : Female
Civil Status : Child
Date of Birth : August 22, 2015
Birth of Place : Malimono, Surigao
Religion : Roman Catholic
Nationality : Filipino
Health Care Financing & Usual Source of Medical Care: PhilHealth

ADMISSION DATA

Hospital: : Caraga regional Hospital

Case Number:
Hospital Number:
Room Number:
Room Type:
Date Admitted:
Mode of Admission:
Admitting Vital Signs:
Weight:
Chief Complaint:
Final Diagnosis:
Admitting Physician:
Attending Physician:
: 00000177159
: 313878-2017
: PED-EX-56
: Ward
: October 15, 2017
: Per Stretcher
: HR 146, RR 37, Temp 38.30 C
: 10kg
: LBM and Vomiting
: AGE with Moderate Dehydration
: Dr. Edna M. Asodisen, MD
: Dr. Edna M. Asodisen, MD

BRIEF HISTORY OF PRESENT ILLNESS:

Four days prior to admission, the patient has a hyperthermia and diarrhea

GENERAL SURVEY:
The patient is awake upon admission and has a hyperthermia;
Upon admission Vital Signs:
Heart Rate : 146 bpm
Respiratory Rate : 37cpm
Temperature : 38oC

History Present Illness

Prior to admission, the patient has a hyperthermia and a severe watery stool, the family decided to rush
her at Caraga Regional Hospital.

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Past Health History

The patient has a hyperthermia and a severe watery stool. She had been immunized including
BCG, DPT, Oral Polio Vaccine, and Hepatitis B vaccine. The patient had chicken pox at the age of one.
The patient had no history of accident or any injury.

Medication:
The patient has a maintenance of vitamins such as tiki-tiki and celine

Family Health History

The patient’s grandmother on the mother’s side is anemic and her grandfather has an asthma.
Both grandparents on the father’s side have a hypertension.

Personal Health History

Personal Habits

Before her hospitalization,

She used to play Barbie doll with her cousins and she love to play in her mother’s cellphone.

During her hospitalization,

She won’t play with her Barbie doll anymore and always clings to her mother.
Diet
Before hospitalization
The client ate four times a day such as breakfast, lunch, merienda and dinner. According to the
significant others, she always ate rice, noodles, egg, and hotdogs. She drank 4 glasses of water in a day
the source of their water is from spring. She had no eating discomforts.

During Hospitalization
The patient has no appetite to eat and do not like to eat hospital foods.

Sleep rest and pattern

Before Hospitalization
The patient sleeps about 10 hours a day. From 8pm to 6am.She had no problem to sleep. Her
sleep was always continuous especially when she is tired. She always took her siesta.

During Hospitalization
The patient has a difficulty in sleeping and always irritable.

Elimination Pattern
Before Hospitalization
The patient defecates every day and her stool was soft but formed and its color is brown and had
a foul odor. She urinates five times a day and is yellowish in color. She had no discomfort to defecate and
to urinate.
During Hospitalization
The client defecates three-to-four times a day. Her stool is watery, and its color is green. She has
a discomfort to defecate.

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Activities of Daily Living
Before Hospitalization
The client had no difficulties in performing ADL’s and other instrumental activities of daily
living. She could eat, eliminate, stand, and walk.
During Hospitalization
The patient hadn’t sufficient energy for completing her desired required activities.

Recreation and Hobbies

Before Hospitalization
The client’s hobby is watching TV and playing with her cousins or neighbors.
During Hospitalization
Patient just lies or sits on the bed.

Social data
The patient lives in an extended family house. She is closer to her mother and loves to play with
her cousins.
During hospitalization the family of the patient especially her parents are supportive and more caring to
her.

Environmental Data
The patient resides in Purok-1, Brgy. Cagtina-Ealim, Malimono, Surigao. Their house is made of
wood and accessible transportation. The source of their water is from a spring.

Health Beliefs
Patient significant others believes in “Hilot” and quak doctors’, they seek help whenever their
baby has a cough or fever.

Psychological Data
Cognitive-Perception Pattern
Before her hospitalization
The patient is fine in terms of her cognitive abilities. She has no problems with her senses. She
can do scribbles, squatting, and can open door knobs.
During her hospitalization
She is very irritated and whenever she wants something she asks by pointing her finger to the
object.

Coping Stress- Tolerance Pattern

The patient’ mother will give her candy when she is in distress. And when patient is scolded by
her parents, her grandmother will come to the rescue.
During her hospitalization, she demonstrates anxiety with people wearing white whom comes near her
and clings to her mother, if there are unfamiliar people to her insight.

Values-Belief Pattern
She is a Roman Catholic. They attend mass regularly. According to her mother, before they
consult the doctors or the hospital, they first consult the quack doctors

Socio-economic status
The patient’s father is a construction worker and the breadwinner of the family but sometimes her
grandparents help them in time of need.

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Patterns of Health Care
Health care resources currently used is PhilHealth, dependent to her mother.

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 Physical Assessment

General Survey
Received lying on bed, awake, conscious, responsive, coherent. Wearing a light clothing top and a diaper
with uncombed hair. She appears irritable. She has IVF of 500 ml PLR infusing well at the right
metacarpal vein at 500- 42gtts/min.

Vital sign upon assessment:

 Temperature: 38.8
 Respiratory Rate: 37 cpm
 Pulse Rate: 146 bpm

Integumentary
 Skin
 Inspection: Client has pale complexion. It is clear that she has no jaundice, birth mark on her left
arm.
 Palpation:It is noticeable that client has a dry and poor skin turgor

 Nails
 Inspection:No lesions Noted
 Palpation: Nail beds are pink with slow capillary refill.

 Hair
 Inspection
 Hair is not evenly distributed on the scalp
 No lice, dandruff, and lesions.
 Not properly combed hair.

 Palpation
 No nodules palpated. Noted
 Head, Eyes, Ears, Nose, Throat (HEENT)
 Skull and face
 Inspection
 No edema
 No scars. Noted
 Palpation
 Rounded and normocephalic skull contour. Noted
 Smooth and uniform in consistency of skull.
 No tenderness. Noted
 No lesions.
 No masses. Noted
 Eyes and Vision
 Inspection
 Sunken eye balls. Noted

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 Conjunctiva is clear.
 Sclera are white
 No lesions Noted
 Pupils are equally round and reactive to light and accommodation test (which means the ability of
the eyes to focus on objects that are close and faraway)
 Ears and Hearing
 Inspection
 Ears are symmetrical and in line with the outer canthus of the eyes
 Ears are brown in color, smooth and can hear normally
 External canals are clear with no redness, swelling, lesions foreign body, and no discharge. Noted
 Palpation
 Ear return to position when recoiled
 Nose and Sinuses
 Inspection
 Nose is symmetrical to the midline of the face
 No lesions or swelling. Noted
 Air moves freely as the patient breathes through the nares.

 Oropharynx (Mouth and Throat)

 Inspection
 Mucosa and gingivae is pink
 No masses or lesions in the oropharynx. Noted
 Dry buccal membrane. Noted
 Dry tongue and pink.
 Tongue protrudes in midline with no tremor. Noted.
 Gums are pinkish with no bleeding.
 Client had only 8 lower teeth and 7 upper teeth.
 No plaques on her teeth. Noted
 Neck
 Inspection
 Head centered on neck
 Same color with facial skin
 Palpation
 No tenderness.
 No masses. Noted.
 No lesions.
 Nodules are palpable on her left leg. Noted.

 Thorax and Lungs

 Posterior
 Inspection
 Chest is symmetric
 Auscultation
 Equal chest expansion and registers a clear breath sound
 Anterior
 Inspection
 She has no difficulty of breathing with RR- 37 cpm
 Auscultation

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 Absence of adventitious sound upon auscultation noted

 Cardiovascular system and Peripheral vascular system

 Palpation
 Palpable peripheral pulses. Noted
 Auscultation
 Normal heart sound.
 Has a regular rhythm with 146 beats per minute.
 S1 heart sound heard as well as S2. Noted.
 Abdomen
 Inspection
 Skin is brown and uniform in color. Noted
 No striae.
 No scars. Noted
 No lesions.
 Abdominal distention. Noted.
 Auscultation
 Borborygmic sound presents
 Percussion
 NO tenderness. Noted
 Palpation
 No masses. Noted
 Musculoskeletal System
 Upper extremities
 Inspection
 No difficulty in moving. Noted.
 No swelling.
 No masses. Noted
 No deformity.
 Palpation
 No tenderness to palpation of joints. Noted
 Lower extremities
 Inspection: No difficulty in moving, swelling, masses and deformity. Noted
 Palpation: No tenderness to palpation of joints. Noted

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Neurologic System
Mental status: aphasia (specify type)
oriented to: time place good memory (as evidenced by)
attention span: can remember the last food level of consciousness
GCS score
Motor function
Reproductive System
Female Genital and inguinal area.
 During inspection client inguinal part has rashes. Noted

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 REVIEW OF SYSTEM

GENERAL DATA
Patient has a sunken eyeball, dry buccal membrane, and distended abdomen. She was lying on her
bed, appears to be irritated and lethargic. Her temperature is 38.40C.

 INTEGUMENTARY SYSTEM:
During the assessment the client had mild rashes on her inguinal part and her skin turgor is poor.
Her skin is pale and dry.

 HEAD, EYES, EARS, NOSE, THROAT (HEENT)

Patient had no history of head injury, eye problem and ear infection. She had no history of nasal
allergies, she had no history of neck lumps, and thyroid problem. There is an absence of tearing and
salivation. She had no history of epistaxis and bleeding gums, sore, lumps, toothaches. She had no
difficulty of swallowing as claimed.

THORAX AND LUNGS

Patient has a productive cough. There is no presence of signs and symptoms of the disease such
as bronchitis, pneumonia, and asthma.

CARDIOVASCULAR SYSTEM
Patient’s heart rate was 140 bpm. There was no history of cardiopulmonary disease.

GASTROINTESTINAL SYSTEM
Patient still likes to drink breastmilk and her favorite food is hotdog and egg. Sometimes the
client had an abdominal cramping and they use an oil liniment to relieve pain.

GENITOURINARY SYSTEM
Client had no history of urinary frequency, incontinence, and pain or burning upon urination. She
had no history of urinary tract infection. She had no vaginal discharge, swelling, masses, or lesions. And
her mother changes her diaper when she urinates 2-4 times a day.

MUSCULOSKELETAL SYSTEM
The patient manifested good posture and moved voluntarily; she had symmetrical musculature on
both sides of the body.

ENDOCRINE SYSTEM
Patient had no history of goiter, or thyroid problem.

NEUROLOGIC SYSTEM
Patient had no history of difficulty on unconsciousness, seizures and tremors. She is alert,
attentive, and oriented.

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Human Anatomy and Physiology

Digestive System (Essentials of Human Anatomy and Physiology 2008)

The Digestive System takes in food (ingests it), breaks it down physically and chemically into the nutrient
molecules (digests it), and absorbs the nutrients into the bloodstream. Metabolism produces cellular
energy (ATP) and accounts for all constructive and degradative cellular activities. Then it rids the body of
the indigestible remains (defecates).

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The organs of the digestive system can be separated into two main groups:

1. The Alimentary Canal- performs the whole menu of the digestive functions (ingests, digests,
absorbs, and defecates).
2. The Accessory Organs- (teeth, tongue, and several large digestive glands). Assist the process of
digestive breakdown in various ways.

The alimentary canal, also called the gastrointestinal tract is a continuous, coiled, hollow muscular tube
that winds through the ventral body cavity and is open at both ends. Its organs are the mouth, esophagus,
stomach, small intestine, and large intestine. The large intestine leads to the terminal opening or anus.

 Mouth – food enters the digestive tract through the mouth and oral cavity, a mucous-membraned
lined cavity.
 Esophagus – or gullet runs from the pharynx through the diaphragm to the stomach. About 25cm
(10inches long), it essentially a passageway that conducts food (by peristalsis) to the stomach.
 Stomach – the C-shaped stomach is on the left side of the abdominal cavity, nearly hidden by the
liver and diaphragm. The stomach acts as a temporary “storage tank” for food as well as a site for
food breakdown.
 Small intestine – is the body’s major digestive organ. Within its twisted passageways, usable food
is finally prepared for its journey into the cells of the body. The small intestine is a muscular tube
extending from the pyloric sphincter to the large intestine. It is the longest section to the
alimentary tube, with an average length of 2.5 to 7m (8-20 ft.) in a living person.
 Large intestine – is much larger in diameter than the small intestine but shorter in length. About
1.5 m (5ft.) long, it extends from the ileocecal valve to the anus. Its major functions are to dry out
the indigestible food residue by absorbing water and to eliminate these residues from the body as
feces.

Accessory Digestive Organs

 Teeth – the role of the teeth play in food processing needs little introduction. We masticate, or
chew, by opening and closing our jaws and moving them from side to side while continuously
using our tongue to move the food between our teeth. In the process the tear and grind the food,
breaking it down into smaller fragments.
 Tongue – occupies the floor of the mouth. The tongue has several bony attachments two of these
are to the hyoid bone and to the styloid process of the skull.
 Salivary Glands – empty their secretions into the mouth.
 Submandibular Glands and the sublingual glands – empty their secretions into the floor of the
mouth through tiny ducts.
 Liver – is the largest gland in the body. Its digestive function is to produce bile.
 Pancreas – is a soft, pink, triangular, gland that extend across the abdomen from the spleen to
duodenum. Only the pancreas produces enzymes that breakdown all categories of digestible
foods. The pancreas also has an endocrine function, it produces the hormones insulin and
glucagon.
 Gallbladder – is a small, thin-walled green sac that snuggles in a shallow fossa in the inferior
surface of the liver.

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The Essential Activities of the GI Tract:

1. Ingestion – Food must be placed into the mouth before it can be acted on. This is an active and
voluntary process.
2. Propulsion – if foods are to be processed by more than one digestive organ, they must be
propelled from one organ to the next. (e.g. swallowing).
3. Food breakdown: mechanical digestion – mixing of food in the mouth by the tongue, churning of
food in the stomach, and segmentation in the small intestine. Mechanical digestion prepares food
for further degradation by enzymes by physically fragmenting the foods into smaller particles.
4. Food breakdown: chemical digestion – The sequence of steps in which a large food molecule is
broken down to their building blocks by enzymes.
5. Absorption – Transport of the digested end products from the lumen of the GI tract to the blood
or lymph. For absorption to occur, the digested foods must first enter the mucosal cells by active
or passive transport processes. The small intestine is the major absorption site.
Defecation – is the elimination of indigestible residues from the GI tract via the anus in the form
of feces.

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PATHOPHYSIOLOGY

Precipitating Factors
Predisposing Factor  Contaminated
 Age Food & Water
 Gender  Poor Hygiene
 Immunocompromised  Lack of Sanitation
 Knowledge Deficit

ACUTE GASTROENTERITIS

Bacterial

Ingested of Contaminated food and water

Pathogens invades GI tract

Stimulation & Destruction of

Abdominal ---------- mucosal lining of the bowel wall
Pain

Stimulation of mucosal lining of intestine

Increase of Peristaltic Movement

------ Presence of
borborygmic
sound
Inhibition of Sodium Reabsorption

Increased Protein in the lumen

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 Diarrhea
Watery Stools ----------- ----------------------- Abdominal Distention

Acute

Fluid & Electrolyte

Imbalance

Dehydration
-------------------------------------------- ------------------------------------------------

Behavior: Sunken Absence of Dry Skin

-Irritability eyeball & Tearing &
Isotonic turgor
-Lethargic fontanel Salivation

Hyperthermia

If untreated:
Serious fluid Volume Deficit

Hypovolemic Shock Hypotension

------

Death

Legend:

------- Clinical Manifestation

Manifested to Patient

If untreated

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Drug Study No.1
Generic Name: Cefixime

Brand Name: Suprax

Classification: Therapeutic: anti-infectives

Dosage: 2.5 ml BID

Indication:
Treatment of the following infections caused by susceptible organisms. Otitis Media

Contraindication:
Caution: Hypersensitivity to cephalosporins, Serious hypersensitivity to penicillin.
Use cautiously in renal impairment.

Mechanism of Action:
Bind to the bacterial cell wall membrane, causing cell death.
Therapeutic Effects: Bactericidal against susceptible bacteria.
Spectrum: Like that of second-generation cephalosporins, but activity against staphylococci is less,
whereas activity against gram negative pathogens is greater, even for organisms resistant to first – and
second- generation agents. Notable is increased action against: Enterobacter, Haemophilus influenzae,
Escherichia coli, klebsielaa pnuemoniae, Neisseria gonorrhea, Citrobacter, Morganella, Proteus,
providencia, serratia, Moraganella, Proteus, Providencia, Serratia, Moraxella catarrhalis, Borrelia
burgdorferi. Some agents have activity against Pseudomonas aeruginosa (Ceftazidime, cefoperozone).
Not active against methicillin- resistance staphylococci or enterococci. Some agents have activity against
anaerobes, including Bacteroides fragilis (cefoperazone, cefotaxime, ceftizoxime, ceftriaxone.

Adverse Drug Interaction:

High doses, headache, GI: diarrhea, nausea, vomiting, cholestasis, cramps

Nursing Implications:
 Assess for injection at beginning of and throughout therapy.
 Before initiating therapy, obtain a history to determine previous use of the reactions to
penicillin’s of cephalosporins.
 Obtain specimens for culture the sensitivity before initiating therapy.
 Observe patient for signs and symptoms of anaphylaxis.
 Pedi: assess newborn for jaundice and hyperbilirubinemia before making decision to use
Ceftriaxone.

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Generic Name: Metronidazole

Brand Name: Flagyl

Classification: Anti-infectives, anti-protozoal and anti-ulcer agents

Dosage: 4ml TID, for 7days

Indication:
Treatment of the following anaerobic infections: Intra-abdominal infections (may be used with a
cephalosporins), Gynecologic infections, Skin and skin structures infections, CNS infections, Septicemia

Contraindication:
 Hypersensitivity to parabens (topical only): First trimester of pregnancy.
 Use cautiously in history of blood dyspraxias
 History of seizures or neurologic problems. Severe hepatic impairment.
 Pregnancy, lactation patients, receiving corticosteroids or predisposed to edema.

Mechanism of Action:
 Disrupts DNA and protein synthesis in susceptible organisms.
 Therapeutic Effects: Bactericidal, trichomonacidal or amoebicidal action.
 Spectrum: Most notable for activity against anaerobic bacteria, including Bacteroides,
Clostridium difficile

Adverse Drug Interaction:

 CNS: dizziness, headache
 EENT: tearing,
 GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue glossitis, unpleasant task,
vomiting
 Derma: rashes, burning, mild dryness, skin irritation, transient redness
 Hemat: leukopenia
 Local: phlebitis at IV site
 Neuro; peripheral neuropathy.
 Misc.: superinfection, disulfiram-type reaction with alcohol.

Nursing Implications:
 Assess patients for injection at beginning of and throughout therapy.
 Obtain specimens for culture and sensitivity before initiating therapy.
 Monitor neurologic status during and after IV infusions.
 Monitor intake and output and daily weight especially for patients on sodium restriction.
 Instruct patient to take medication exactly as directed with evenly spaced times between doses,
even if feeling better. Do not skip doses or double up on missed doses. Take missed doses as soon
as remembered if not almost time for next dose.
 May cause dizziness or light headedness. Caution patient to avoid activities requiring alertness
until response to medication is known.
 Inform patient that medication may cause urine to turn dark.

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Generic Name: Zinc Sulfate

Brand Name: Zincate

Classification: Mineral and electrolyte replacements/supplements.

Dosage: 5ml OD

Indication:
Replacement and supplementation therapy in patients who are at risk for zinc deficiency

Contraindication:
Hypersensitivity or allergy to any components in the formulation.
Use cautiously in renal failure.

Mechanism of Action:
Serves as a cofactor for many enzymatic reactions. Required for normal growth, and tissue repair, wound
healing and sense of taste of smell
Therapeutic Effects: Replacement in deficiency states.

Adverse Drug Interaction:

Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, gastric irritation, gastritis. Prolonged use may
cause copper deficiency (e.g. sideroblastic anemia, neutropenia).

Nursing Implications:
 Monitor progression of zinc deficiency symptoms during therapy.
 Encourage patient to comply with diet recommendation. Ask the patients to notify any of the
health care team if the patient feels nausea, vomiting, abdominal pain or tarry stools occur.
 Patient self-medicating with vitamin supplements should be cautioned not to exceed RDA. The
effectiveness of mega doses for treatment o various medical conditions is unproved and may
cause side effects.
 Emphasize the importance follow up exams.

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Generic Name: Metoclopramide

Brand Name: Reglan

Classification: Anti-emetics

Dosage: 2mg IVTT every 8hr PRN

Indication:
Prevention of chemotherapy-induced emesis. Treatment of postsurgical and diabetic gastric stasis.
Facilitation of small bowel intubation in radiographic procedures. Management of esophageal reflux.
Treatment and prevention of post-operative nausea and vomiting when nasogastric suctioning is
undesirable.

Contraindication:
 Contraindicated with hypersensitivity to metoclopramide
 Possible GI obstruction or hemorrhage
 History of seizure disorder
 Pheochromocytoma; Parkinson’s Disease

Mechanism of Action:
Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI
tract and accelerates gastric emptying.
Therapeutic Effects: Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Each passage
of nasogastric tube into small bowel.

Adverse Drug Interaction:

CNS: Drowsiness extrapyramidal reactions, restlessness, Neuroleptic Malignant Syndrome, anxiety,
depression, irritability, tardive dyskinesia.
CV: arrhythmias (Super ventricular tachycardia, bradycardia), hypertension, hypotension.
GI: constipation, diarrhea, dry mouth, nausea.
Endo: gynecomastia
Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis.

Nursing Implications:
 Assess patient for nausea, vomiting and abdominal distention and bowel sounds before and after
administration.
 Assess the patient for extrapyramidal side effects (parkinsonian- difficulty speaking or
swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity, tremors;
and dystonic- muscle spasms, twisting motions, twitching, inability to moves eyes, weakness of
arms of legs) periodically throughout course of therapy.
 Assess patient for signs of depression periodically throughout therapy.
 Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, & extremities;
lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm like
movements of tongue). Usually occurs after a year or more continued therapy. Report
immediately; may be irreversible.
 Pedi: Unintentional overdose has been reported in infants and children with the use of
metoclopramide oral solution. Teach parents how to accurately read labels and administer
medication.

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Generic Name: Ampicillin

Brand Name: Albercillin

Classification:
Therapeutic: anti-infectives
Pharmacologic: aminopenicillins / bacterial lactamase inhibitions

Dosage: 250mg IVTT every 6hr ANST

Indication: Treatment of the following infections: Skin and skin structure infections; soft tissue, Otitis
media; Sinusitis, Respiratory infections, Genitourinary infections, Meningitis, Septicemia. Endocarditis
prophylaxis

Contraindication:
Hypersensitivity to penicillin or sulbactams.
Use Cautiously in: Severe renal insufficiency (dosage reduction if CCR< 10ml/min); infectious
mononucleosis, acute lymphocytic leukemia or cytomegalovirus infections (increased incidence of rash);
Patients allergic to cephalosporins; OB: Has been used during pregnancy; Lactation: Is distributed into
breast milk. Can cause rash, diarrhea, and sensitization in the infant.
Mechanism of Action:
Binds to bacterial cell wall, resulting in cell wall, resulting in cell death; spectrum is broader than that of
penicillin.
Nursing Implications:
 Assess patient for infection (VS, wound appearance, sputum, urine, stool and WBC) at beginning
and throughout therapy.
 Obtain a history before initiating therapy to determine previous use and reactions to penicillin’s
or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an
allergic response.
 Obtain specimens for culture and sensitivity before therapy. First dose may be given before
receiving results.
 Instruct patient to take medication around the clock and to finish the drug completely as directed,
even if feeling better. Advise patients that sharing of this medication can be dangerous.
Pedi: Instruct parents and caregivers not to save or use this medication for other infections.
 Advise patients to report the signs of superinfection (furry overgrowth on the tongue, vaginal
itching or discharge, loose or foul- smelling stools) and allergy.
 Advice patients taking oral contraceptives to use and alternate or additional nonhormonal method
of contraception while taking ampicillin and until next menstrual period.
 Caution patient to notify health care professional if fever and diarrhea occur, especially is stool
contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care
professional. May occur up to several weeks after discontinuation of medications.
 Instruct the patients to notify health care professionals if symptoms do not improve.

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Generic Name: Paracetamol

Brand Name: Tempra

Classification: Therapeutic: antipyretics, nonopioid analgesics

Dosage: 250mg every 4hr PRN for fever

Indication:
 Mild pain
 Fever

Contraindication:
Previous hypersensitivity products containing alcohol, aspartame, saccharin, sugar or tartrazine (FDC
yellow dye HS) should be avoided in patient who have hypersensitivity or intolerance to these
compounds.
Use Cautiously in: Hepatic disease/ renal disease (lower chronic doses recommended); Chronic alcohol
use/ abuse; Malnutrition.

Mechanism of Action:
Inhibits the synthesis of prostaglandins that may serve as mediation of pain and fever, primarily in an
CNS, has no significant inflammation properties of GI toxicity

Adverse Drug Interaction:

 GI: hepatic failure, hepatotoxicity (overdose)
 GU: renal failure (high doses/chronic use)
 Hemat: neutropenia, pancytopenia, leukopenia
 Derma: rash, urticaria

Nursing Implications:
 Assess overall health status and alcohol usage before administering acetaminophen. Pt. who are
malnourished or chronical abuse alcohol are at higher risk of dendroping hepatotoxicity with
chronic use of visual dose of this drug.
 Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with
OTC drugs. Prolonged use of acetaminophen increases the risk of adverse renal effects. For short-
term use, combined doses of acetaminophen and salicylates should not exceed the recommended
dose of either drug given alone.
 Pain: Assess type, location, and intensity prior to and 30-60 min following administration.
 Fever: Asses fever: note presence of associated signs (diaphoresis, tachycardia and malaise).

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Generic name: Bacillus Clausii
Brand Name: Erceflora
Classification: Antidiarrheal
Mechanism Action:

 Contributes to the recovery of the intestinal microbial flora altered during the course of microbial
disorders of diverse origin.
 Produces various vitamin, particularly group B vitamins thus antibiotics and chemotherapeutic
agents.
 Promotes normalization of intestinal flora.
Indication:

 Acute diarrhea with duration at 14days due to 14 days due to infection, drugs or poison.
 Chronic or persistent diarrhea with durations of >14 days.

Nursing implications:

 Shake drug well before administration

 Administer drug orally
 Monitor patients for any unusual infections from drug
 Administer drug within 30min. after expiring container.

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Generic Name: Hyoscine
Classification: Antiemetics
Indication: relief of smooth muscle spasm of the gastrointestinal and gastrourinary system.
Mechanism Action: Acts as competitive inhibitor at postganglionic muscranic receptor sites of
parasympathetic nervous system and on smooth muscles that respond to acetylcholine but lack
cholinergic innervation. May block cholinergic transmission from vestibular nuclei to higher CNS center
and from reticular formation to vomiting center.
Contraindications: Acute hemorrhage
Myasthenia gravs
Reflux esophagitis
Obstructive uropathy
Ulcerative Colitis or toxic megacolon
Nursing Implications:

 Be alert for adverse reactions and drug interactions.

 Assess for eye pain
 Assess for urinary
 Assess for constipation
 Monitor urine output

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Brand Name: Ceelin
Classification: Vitamin C

Dosage: This medication administered orally for the prevention of deficiency conditions the dose is 25-75
mg / day.

Indication:
prevention and treatment of hypo- and avitaminosis of vitamin C; providing increased need for vitamin C
during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe
illness; in winter with an increased risk of infectious diseases.
For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by
the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal
microflora.

Contraindication:
Increased sensitivity to ascorbic acid.

Mechanism of Action: Ascorbic acid (vitamin c) is essential for the formation of intracellular collagen, is
required to strengthen the structure of teeth, bones, and the capillary walls. It participates in redox
reactions, the metabolism of tyrosine, converting folic acid into folinic acid, metabolism of carbohydrates,
the synthesis of lipids and proteins, iron metabolism, processes of cellular respiration. Reduces the need
for vitamins B1, B2, A, E, folic acid, pantothenic acid, enhances the body's resistance to infections;
enhances iron absorption, contributing to its sequestration in reduced form. Has antioxidant properties.
With intravaginal application of ascorbic acid lowers the vaginal pH, inhibiting the growth of bacteria and
helps to restore and maintain normal pH and vaginal flora (Lactobacillus acidophilus, Lactobacillus
gasseri).

Adverse drug interaction:

CNS: headache, fatigue, insomnia.
Digestive system: stomach cramps, nausea and vomiting.
Allergic reaction: describes a few cases of skin reactions and manifestations of the respiratory system.
Urinary system: when used in high doses - hyperoxaluria and the formation of kidney stones of calcium
oxalate.
Local reactions: with intravaginal application - a burning or itching in the vagina, increased mucous
discharge, redness, swelling of the vulva. ListenRead phonetically.
Other: sensation of heat.

Nursing implication:
Used with caution in patients with hyperoxaluria, renal impairment, a history of instructions on
urolithiasis. Because ascorbic acid increases iron absorption, its use in high doses can be dangerous in
patients with hemochromatosis, thalassemia, polycythemia, leukemia, and sideroblastic anemia.
Patients with high content body iron should apply ascorbic acid in minimal doses.
Used with caution in patients with deficiency of glucose-6-phosphate dehydrogenase.
The use of ascorbic acid in high doses can cause exacerbation of sickle cell anemia.
Data on the diabetogenic action of ascorbic acid are contradictory. However, prolonged use of ascorbic
acid should periodically monitor your blood glucose levels.
It is believed that the use of ascorbic acid in patients with rapidly proliferating and widely disseminated
tumors may worsen during the process. It should therefore be used with caution in ascorbic acid in

29 | P a g e
patients with advanced cancer.
Absorption of ascorbic acid decreased while use of fresh fruit or vegetable juices, alkaline drinking.

Brand Name: Tiki- Tiki

Classification: Multivitsmins
Dosage:
Pediatric patients 1 to 8 years old 17,500 to 35,000 Units daily for 10 days.

Indication:
Tiki Tiki Star (Vitamin A) injection is effective for the treatment of Tiki Tiki Star (Vitamin A) deficiency.
The parenteral administration is indicated when the oral administration is not feasible as in anorexia,
nausea, vomiting, pre- and postoperative conditions, or it is not available as in the “Malabsorption
Syndrome” with accompanying steatorrhea. Pediatric Use: Tiki Tiki Star (Vitamin A) treatment for
deficiency states has been recognized as an especially effective and important therapy in the pediatric
population.

Contraindication:
Increased sensitivity to ascorbic acid.

Mechanism of Action
For systemic use of Tiki Tiki Star (Vitamin C) Kimia Farma: prevention and treatment of hypo- and
avitaminosis of vitamin C; providing increased need for Tiki Tiki Star (Vitamin C) during growth,
pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in
winter with an increased risk of infectious diseases. For intravaginal use: chronic or recurrent vaginitis
(bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the
vagina) in order to normalize disturbed vaginal microflora.

Adverse Drug Interaction

CNS: headache, fatigue, insomnia. Digestive system: stomach cramps, nausea and vomiting. Allergic
reaction: describes a few cases of skin reactions and manifestations of the respiratory system. Urinary
system: when used in high doses - hyperoxaluria and the formation of kidney stones of calcium oxalate.
Local reactions: with intravaginal application - a burning or itching in the vagina, increased mucous
discharge, redness, swelling of the vulva. Other: sensation of heat.

Nursing Implication
iki Tiki Star (Vitamin C) is used with caution in patients with hyperoxaluria, renal impairment, a history
of instructions on urolithiasis. Because ascorbic acid increases iron absorption, its use in high doses can
be dangerous in patients with hemochromatosis, thalassemia, polycythemia, leukemia, and sideroblastic
anemia. Patients with high content body iron should apply ascorbic acid in minimal doses. Tiki Tiki Star
(Vitamin C) is used with caution in patients with deficiency of glucose-6-phosphate dehydrogenase. The
use of ascorbic acid in high doses can cause exacerbation of sickle cell anemia. Data on the diabetogenic
action of ascorbic acid are contradictory. However, prolonged use of ascorbic acid should periodically
monitor your blood glucose levels. It is believed that the use of ascorbic acid in patients with rapidly
proliferating and widely disseminated tumors may worsen during the process. It should therefore be used
with caution in ascorbic acid in patients with advanced cancer. Absorption of ascorbic acid decreased
while use of fresh fruit or vegetable juices, alkaline drinking.

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 Nursing Care Plan #1

ASSESSMENT:
Subjective Cues: “ma’am an ako bata sige magkalibang, basa raba ija tae ma’am”
Objective Cues:
o Frequency- 4x stool a day (noted)
o Consistency- watery with particles (noted)
o Presence of borborygmic sound
o Stool is green in color

NURSING DIAGNOSIS
Diarrhea related to bacterial infection as evidenced by frequent watery stools.

PLANNING
Within 8 hours of rendering nursing interventions patient’s stool will be formed.

NURSING INTERVENTIONS

Implementation Rationale
Independent These assessment findings are commonly
connected with diarrhea. If gastroenteritis
1. Assess for abdominal pain, abdominal involves the large intestine, the colon is not able
cramping, hyperactive bowel sounds, to absorb water and the client’s stool is very
frequency, urgency, and loose stools. watery.
2. Ask the client about a recent history of: Eating contaminated foods or drinking
 Drinking contaminated water. contaminated water may predispose the client to
 Eating food inadequately cooked. intestinal infection.
 Ingestion of unpasteurized dairy products.
These food items can irritate the lining of
3. Encourage the client to restrict the intake the stomach, hence may worsen diarrhea.
of caffeine, milk and dairy products.

When a client experience diarrhea,

the stomach contents which is high
4. Encourage the client to eat foods rich in potassium get flushed out of the gastrointestinal
in potassium. tract into the stool and out of the body, resulting
in hypokalemia.

Hands that are contaminated may easily spread

5. Teach the client about the importance the bacteria to utensils and surfaces used in food
of hand washing after each bowel preparation hence hand washing after each bowel
movement and before preparing food for movement is the most efficient way to prevent the
others. transmission of infection to others.

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 The anal area should be gently clean properly
6. Educate the client about perianal care after a bowel movement to prevent skin irritation
after each bowel movement. and transmission of microorganism.

Collaborative:
rationale
7. Administer antidiarrheal medications
(Erceflora) as prescribed by the physician

Evaluation:
Goal partially met, patient’s stool is semi-formed.

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 NURSING CARE PLAN #2

ASSESSMENT:
Subjective: “nag-sige man kalibanga an ako bata, ma’am” as verbalized by the S.O.
Objective:
 Dry mucus membrane
 Sunken eyeball
 Body malaise
 Poor skin turgor
 Elevated body temp: 38.4oC

NURSING DIAGNOSIS:
Deficient Fluid Volume related to active fluid loss as evidenced by diarrhea.

PLANNING
Within 8 hrs. of rendering nursing intervention patient will exhibit increase of fluid intake.

NURSING INTERVENTIONS:
Implementation Rationale
Independent
1. Assess skin turgor and oral mucous Signs of dehydration are also detected through the
membranes for signs of dehydration. skin. Skin of elderly patient’s losses elasticity,
hence skin turgor should be assessed over the
sternum or on the inner thighs. Longitudinal
furrows may be noted along the tongue.
2. Monitor and document temperature. Febrile states decrease body fluids by perspiration
and increased respiration. This is known as
insensible water loss.
3. Monitor fluid status in relation to dietary Most fluid comes into the body through drinking,
intake. water in food, and water formed by oxidation of
foods. Verifying if the patient is on a fluid
restraint is necessary.
4. Urge the patient to drink prescribed Oral fluid replacement is indicated for mild fluid
amount of fluid. deficit and is a cost-effective method for
replacement treatment. Being creative in selecting
fluid sources (e.g., flavored gelatin, frozen juice
bars, sports drink) can facilitate fluid replacement.
Oral hydrating solutions (e.g., Rehydrate) can be
considered as needed.
5. Provide comfortable environment by Drop situations where patient can experience
covering patient with light sheets. overheating to prevent further fluid loss.
6. Teach family members how to monitor An accurate measure of fluid intake and output is
output in the home. Instruct them to an important indicator of patient’s fluid status.
monitor both intake and output.

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 7. Identify an emergency plan, including Some complications of deficient fluid volume
when to ask for help. cannot be reversed in the home and are life-
threatening. Patients progressing toward
hypovolemic shock will need emergency care.
8. Provide measures to prevent excessive Fluid losses from diarrhea should be
electrolyte loss (e.g., resting the GI tract, concomitantly treated with antidiarrheal
administering antipyretics as ordered by medications, as prescribed. Antipyretics can
the physician). decrease fever and fluid losses from diaphoresis.
Collaborative
9. Administer parenteral fluids as Fluids are necessary to maintain hydration status.
prescribed. Consider the need for an IV Determination of the type and amount of fluid to
fluid challenge with immediate infusion be replaced and infusion rates will vary depending
of fluids for patients with abnormal vital on clinical status.
signs.
10. Monitor laboratory results as indicated: Depending on the avenue of fluid loss, differing
Hb/Hct, electrolytes, total electrolyte/metabolic imbalances may be
protein/albumin, BUN/Cr. present/require correction.

EVALUATION:
Goal Met, patient exhibits increase of fluid intake.

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 NURSING CARE PLAN # 3
ASSESSMENT:
Subjective cue:
“Gihilantan sija maam tas Grabe nija kapaso.” as verbalized by the S.O
Objective cue:
o Body Temperature: 38.3 (noted)
o Skin Warm to Touch (noted)
o Irritability (noted)
o Loss of appetite (noted)
o Dry buccal membrane
o The skin turgor is poor
o Appears to be lethargic.

NURSING DIAGNOSIS:
Hyperthermia related to Dehydration

PLANNING
Within 8 hours of rendering nursing intervention, client Body temperature will decrease from 38.3 0C C to
370C.

NURSING INTERVENTIONS

INTERVENTION RATIONALE

Independent
1. Monitor client temperature. To know the abnormalities of the patient
temperature.

2. Monitor Environmental temperature, Room temperature /number of blankets should be

limit/ add bed linens as indicated. altered to maintain near-normal body temperature.

3. Provide cooling blanket as indicated. It helps to reduce fever

4. Provide Tepid Sponge baths. Avoid use of May help reduce fever. Note. Use of ice water
Ice water. may cause chill, elevating temperature.

Dependent

5. Administer antipyretics (paracetamol) as Used to reduce fever by its central action on the
needed by the physician hypothalamus; fever should be controlled in
clients who are neutropenic or asplenic. However,
fever may be beneficial in limiting growth of
organism and enhancing auto destruction of

35 | P a g e
 infected cells.

EVALUATION:
Goal not Met, Client Body temperature 37.9 oC.

NURSING CARE PLAN # 4

ASSESSMENT:
Subjective:
“Permi naghilak ako bata ma’am, og gunitan nija permi ija tiyan.” as verbalized by the client
Objective:
 Crying (noted)
 Body malaise (noted)
 Apparent of guarding behavior
 Notice of facial grimace
 Irritability (noted)
 Appears to be restless

NURSING DIAGNOSIS
Acute pain related to prolonged diarrhea as evidenced by apparent abdominal pain.

PLANNING
Within 8 hours of rendering nursing interventions, the patient will display relief of pain.

NURSING INTERVENTION:
Implementation Rationale
INDEPENDENT
1. Note nonverbal cues; e.g., restlessness, Body language/nonverbal cues may be both
reluctance to move, abdominal guarding, physiologic and psychologic and may be used in
withdrawal, and depression. Investigate conjunction with verbal cues to determine
discrepancies between verbal and extent/severity of the problem.
nonverbal cues.
2. Review factors that aggravate or alleviateMay pinpoint precipitating or aggravating
pain factors such as stressful events, food
intolerance) or identity developing
complications.
3. Provide comfort measures (e.g., back rub, Promotes relaxation, refocuses attention, and
reposition) and diversional activities. may enhance coping abilities.
4. Provide rest periods to promote relief, One’s experiences of pain may become
sleep, and relaxation. exaggerated because of exhaustion. Pain may
result in fatigue, which may result in
exaggerated pain. A peaceful and quiet
environment may facilitate rest.
5. Get rid of additional stressors or sources Patients may experience an exaggeration in pain
of discomfort whenever possible. or a decreased ability to tolerate painful stimuli
if environmental, intrapersonal, or intrapsychic
factors are further stressing them.
COLLABORATIVE:

36 | P a g e
 6. Implement prescribed dietary Complete bowel rest can reduce pain, cramping.
modifications; e.g., commence with
liquids and increase to solid as tolerated.

EVALUATION:
Goal met, patient displays relief of pain.

NURSING CARE PLAN #5

ASSESSMENT
Subjective
“kuan lagi ni maam ameoba ug uti” as verbalized by the S.O.
Objective:
 Lack of source of information, (noted)
 Prominent of inaccurate follow-through of instruction

NURSING DIAGNOSIS:
Knowledge deficit related to unfamiliarity with information resources as evidenced by verbalizes
misconceptions or inaccurate information.

PLANNING:
Within 8 hours of rendering nursing interventions significant others will verbalize understanding of
causes of gastroenteritis, mode of transmission, and management of symptoms.

NURSING INTERVENTIONS:
Implications
1. Assess clients/S.O. knowledge of
gastroenteritis, its mode of transmission,
and its treatment.
2. Assess the client’s/S.O. knowledge on safe
food preparation and storage.
3. Determine the client’s/S.O. usual methods
of managing diarrhea or vomiting.
4. Educate the mother about the causes of and
treatments for gastroenteritis.
5. Educate the mother about the importance of
hand washing after toileting and perianal
Rationale
Clients/ S.O. who experience diarrhea and
vomiting may not correlate the symptoms with an
acquired intestinal infection. The client may not
realize the risk for transmitting the infection to
others.
The client may not understand the relationship of
gastroenteritis to the consumption of inadequately
cooked food, food contaminated with bacteria
during preparation, and foods that are not
maintained at appropriate temperatures.
An effective teaching plan will include methods of
symptoms management that the client has found
helpful in the past.
Knowledge about the possible cause of this
episode of gastroenteritis will help the client
initiate to prevent future episodes. The client needs
to recognize that the use of antibiotics is
controversial in managing diarrhea. The client
needs to understand the importance of fluid
replacement.
Good hand washing will prevent the spread of
infectious agents.

37 | P a g e
 hygiene and before preparing food for
others.
6. Educate the mother about food preparation Ground meats are the most common source of
and storage methods to reduce foodborne pathogens. These meats should be
contamination by microorganisms. cooked to an internal temperature of 160°F and
should have no evidence of pink color. Raw meats
should be kept separate from other ready-to-eat
foods. All utensils and surfaces that have been in
contact with the raw meat need to be washed with
hot, soapy water. Raw fruits and vegetables must
be washed before eating if they will not be cooked.
Only pasteurized milk, fruit juices, and ciders
should be consumed. Bacteria contamination or
growth is more likely to occur in foods that are not
maintained at appropriate temperatures until eaten.

EVALUATION:
GOALL MET, The mother verbalizes understanding of causes of gastroenteritis, mode of transmission,
and management of symptoms as evidenced by she does all intervention I instructed.

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 NURSING CARE PLAN # 6

ASSESSEMENT:
SUBJECTIVE:
“Maam sugod to nag kasakit sija ya na sija gana mukaon“ as verbalized by S.O.
OBJECTIVE:
 Noticeable weight loss with adequate food intake
 Food intake less than recommended daily allowance (noted)
 Presence of borborygmic sound

NURSING DIAGNOSIS:
Imbalanced Nutrition: less than body requirements related to decrease intake and inability of body to
absorb fluids
PLANNING:
Within 8hrs rendering nursing interventions patient will show good appetite as evidenced by she eats the
food give to her.

NURSING INTERVENTIONS:
IMPLICATIONS RATIONALE
Independent
1. Plan diet with client, suggesting foods Including client in planning gives a sense of
from home if appropriate. Provide small, control of environment and may enhance intake.
frequent meals/snacks of nutritionally Fulfilling cravings for no institutional food may
dense foods and nonacidic foods and also improve intake. Note: In this population,
beverages, with choice of foods palatable foods with a higher fat content may be
to client. Encourage high- recommended as tolerated to enhance taste and
calorie/nutritious foods, some of which oral intake.
may be considered appetite stimulants.
Note time of day when appetite is best,
and try to serve larger meal at that time.
2. Serve foods that are easy to swallow; e.g., Pain in the mouth or fear of irritating oral lesions
eggs, porridge, cooked vegetables. may cause client to be reluctant to eat. These
measures may be helpful in increasing food
intake.
3. Schedule medications between meals (if Gastric fullness diminishes appetite and food
tolerated) and limit fluid intake with intake.
meals, unless fluid has a nutritional value.
4. Encourage as much physical activity as May improve appetite and general feelings o
possible. well-being
5. Provide rest period before meals. Avoid Minimize fatigue; increases energy available for
stressful procedures close to mealtime. work and eating.
6. Encourage patient to sit up for meals Facilitates swallowing and reduces risk for

39 | P a g e
 aspiration.
Collaborative
 Consult a dietician/nutritional team as  To implement interdisciplinary team
indicated: management.

EVALUATION:
Goal met patient shows good appetite as evidenced by she eats the food give to her.

NURSING CARE PLAN # 7

ASSESSMENT:
Subjective: “Ma’am nagluja man ako bata sugod nasakit sija” as veralized by the S.O.
Objective:
 Lack of energy
 Decreased performance
 Disinterest in surroundings
 Lethargic or sluggish
 Inability to recover and restore energy, even after sleep
 Result of Hemoglobin on CBC is 9.5 g/dL

Nursing Diagnosis
Fatigue related to anemia
Planning
Within 8 hours of rendering nursing intervention, patient shows improve sense of energy

Nursing Intervention
Implementation Rationale
Independent
Restrict environmental stimuli, especially during Vivid lighting, noise, visitors, numerous
planned times for rest and sleep. distractions, and litter in the patient’s physical
surroundings can limit relaxation, disturb rest or
sleep, and contribute to fatigue.
Aid the patient with developing a schedule for A plan that balances periods of activity with
daily activity and rest. Emphasize the importance periods of rest can aid the patient complete
of frequent rest periods. preferred activities without contributing to levels
of fatigue.
Promote sufficient nutritional intake. The patient will need properly balanced intake of
fats, carbohydrates, proteins, vitamins, and
minerals to provide energy resources.
Encourage verbalization of feelings about the Acknowledgement that living with fatigue is both
impact of fatigue. physically and emotionally challenging helps in
coping.
Set practical activity goals with patient. This offers a sense of control and feelings of
achievement.
Stay away from topics that annoy or disturb Increased irritability of the CNS can make the
patient. Converse ways to react to these feelings. patient become easily excited, agitated, and
prone to emotional outburst.
Educate the patient and family about task Organization and management of time can assist

40 | P a g e
organization methods and time organization the patient save energy and avoid fatigue.
methods.
Aid the patient develop habits to promote Promoting relaxation before sleep and providing
effective rest/sleep patterns. for several hours of uninterrupted sleep can
contribute to energy restoration.
EVALUATION:
Goal met, patient shows improve sense of energy

NURSING CARE PLAN # 8

ASSESSMENT:
Subjective: ”naa siyay puya’puya nga nanubo sa bilahan ma’am” as verblized by the s.o.
Objective:
 Destruction of skin layer (noted)
 Rashes. (noted)
 Redness in inguinal area (noted)
 Dry skin (noted)

NURSING DIAGNOSIS:
Impaired skin integrity related to temperature extremes as evidenced by frequent use of diaper.

PLANNING:
Within 8hrs of rendering nursing intervention patient’s/S.O. will demonstrates understanding of plan to
heal tissue and prevent injury.

NURSING INTERVENTION
Intervention Rationale
Independent
1. Monitor status of skin around wound. Individualize plan is necessary according to
Monitor patient’s skin care practices, patient’s skin condition, needs, and preferences.
noting type of soap or other cleansing
agents used, temperature of water, and
frequency of skin cleansing.
2. Monitor patient’s continence status and This is to prevent exposure to chemicals in urine
minimize exposure of skin impairment site and stool that can strip or erode the skin.
and other areas to moisture from
incontinence, perspiration, or wound
drainage.
3. Tell patient to avoid rubbing and Rubbing and scratching can cause further injury
scratching. Provide gloves or clip the nails and delay healing.
if necessary.
4. Encourage a diet that meets nutritional A high-protein, high-calorie diet may be needed
needs. to promote healing.
5. Teach skin and wound assessment and Early assessment and intervention help prevent
ways to monitor for signs and symptoms of the development of serious problems.
infection, complications, and healing.
6. Instruct patient, significant others, and Accurate information increases the patient’s
family in proper care of the wound ability to manage therapy independently and

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 including hand washing, wound cleansing, reduce risk for infection.
dressing changes, and application of topical
medications).
Collaborative:
7. Administer antibiotics as ordered. Wound infections may be managed well and
more efficiently with topical agents, although
intravenous antibiotics may be indicated.
EVALUATION:
Goal Met, patient’s/S.O. demonstrates understanding of plan to heal tissue and prevent injury.

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LEGEND:

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Definition of Terms:

 Electrolyte- are minerals in your body that have an electric charge.

 Hypovolemic Shock- refers to a medical or surgical condition in which rapid fluid loss results in
multiple organ failure
 Immunocompromised - having an impaired immune system.
 Isotonic- taking place with normal contraction
 Pathogens - infectious agent is a biological agent that causes disease or illness to its host. The
term is most often used for agents that disrupt the normal physiology of a multicellular animal or
plant.
 Peristalsis, involuntary movements of the longitudinal and circular muscles, primarily in the
digestive tract but occasionally in other hollow tubes of the body, that occur in progressive
wavelike contractions. Peristaltic waves occur in the esophagus, stomach, and intestines.

REFERENCES:

Book References

 Doenges, M, Moorhouse M, & Murr A 2006, Nursing Care Plans 7th edition, F.A. Davis Comp.,
Pennsylvania

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  Hockenberry M, & Wilson D 2011, Wong’s Nursing Care of Infants and Children 9th edition,
Mosby Inc. Missouri
 Ignatavicious D, & Workaman L 2005, Medical Surgical Nursing 5th edition, Elsevier, Missouri
 Linton, A 2016, Introduction to Medical-Surgical Nursing 6th edition, Elsevier, Missouri
 Marieb, E 2008, Essentials of Human Anatomy and Physiology 9th edition, Pearson, Philippines

Electronic References

https://www.philhealth.gov.ph/circulars/2016/circ2016-001.pdf
https://nurseslabs.com/gastroenteritis-nursing-care-plans/
http://www.who.int/mediacentre/factsheets/fs330/en/
http://www.doh.gov.ph/notifiable_diseases

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