THEORITICAL CONCEPT AND NURSING CARE CONCEPT OF GASTROENTERITIS

Arranged by:
Adi Setiyono Diah Ayu Marcilia Gresia Ayu Santika Prantika Mahatma N. Setiawan Agung N. Suluh Tri Utomo Taufiq Budi N. Vindy Ayu H. Wachid Ary S. (P 27220008 041) (P 27220008 050) (P 27220008 018) (P 27220008 064) (P 27220008 068) (P 27220008 069) (P 27220008 035) (P 27220008 037) (P 27220008 074)

NURSING SCHOOL HEALTH POLYTECHNIC OF SURAKARTA 2010

THEORITCAL CONCEPT OF GASTROENTERITIS

A. Definition Gastroenteritis or acute diarrhea is the infection on the gastrointetinal caused by bacteria, virus, and parasite. (Donna L. Wong, 1996) .Gastronteritis is the inflammation of the gastric and colon caused by pathogen virus, sometimes infection come from contaminated food with staphylococcus or salmonella. (Lynda Juall Carpenito, 1998) Diarrhea is the defecation with the feces more than normal (100-200 ml/ hour of stool) with the feces character liquid or semi liquid with increasing on the frequency (Mansjoer, Arif., et all. 1999). According to WHO (1980), diarrhea is liquid defecation more than 3 times a day. B. Etiology According to Arif Mansjoer, 2000 the etiology of Gastroenteritis 1. Infection It cause the big number of diarrhea on child include infection of virus (rotavirus, adenovirus, Norwalk), paracite bacteria (zhigella, salmonella, e coli, vibrio), worms (ascaris, erichuris, strongiloideus), and Fungal (Kandida) 2. Malabsorbtion (carbohydrat, fat or protein) 3. Food (spoiled food, poisoning, allergy on food) 4. Imunodefisiensi SIGA (Secretory Immuno Globulin A) caused multiple of the bacteria (flata usus) and fungal canalida. The other factor is psychological factor, spicy food, acid food, mall absorption, and baby with weight underweight after labor

C.

Complication 1. Acidosis 2. Syock. 3. Puffing abdoment ( hypokalemia ). 4. Convulsion ( hyponatremia, hypokalsium, hypolikemia ).

D.

Pathophysiology The primary cause of diarrhea is increasing osmotic (disturbance) that cause food/ toxic/ toxic from microbes cannot absorb by the intestine well so the fluid and electrolyte move to intestine stream. Much contain the intestine will response to move it. The diarrhea occurs.

D.

Signs and Symptoms Sign: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Diarrhea (The fluid defecation more than 3 times with or without any blood or secret on the feces) Nausea/ vomiting Decrease the appetite Distended abdoment Weakness caused from anorexia and dehidration Fever (invasion of the bacteria on the body cause inflamation, due to increasing the body temperature) Laceration or redness on the perianal area The skin turgor delayed Membran mucose on mouth is dry The anterior fontanel is concave in <1 year old The weight is decrease Descrease the diuresis (oligouria until anuria) The blood pressure decrease The pulse increase The concious level decrease

Symptoms 1. The child cry, anxiety E. Diagnostic Examination 1. Feces examination a) b) c) 2. 3. 4. 5. F. Macroscopic and microscopic PH and glucose level on the feces Bacterial examination

BGA for examination PH acid base balance on the blood, amount of leukocyte, and hematocrite Ureum and creatinin examination to know physiology of the kidney. Electrolyte examination include Na, K, Calcium, and Phospat. Check for the leucocyte level

Treatment Basic treatment 1. Adequate information for client 2. Diet. 3. Symptomatic. 4. Antibiotic / Anti parasite. 5. Treat the diarrhea (water, electrolyte )

G. Pathway
Invasion Bacteria/ microorganisms to intestinal Exotoxin stimulate central thermoregulation Hyperthermia Cell mucosa intestine damage disturb intestine absorbsion Hypersecretion fluid and electrolyte Feces contain of fluid Increase intestine contain Gastric infalamation Nausea, vomit Decrease appetite Nutrition less than body requirement Stress, afraid, anxiety Stimulate nervus parasimpatic intestine increase motilitas intestine Hyperperistaltik Colon absorbsion decrease Feces contain much fluid

diarrhea Dehidration Syock hypovolemik death hospitalization Hospitalisasi anxiety loss fluid and electrolyte Deficit fluid volume and electrolyte Increase freq. defecate Feces contain of laktat acid Perianal iritation skin integrity disturbance

NURSING CARE CONCEPT OF GASTROENTRITIS

A. Assessment 1. Identity Client identity, parent/ guaranted identity, age, economic level, education level. 2. Chief complain Diarrhea 3. Present Health History Green yellow feces mix with secretor blood. Fluid consistency, frequency more than 5 times a day 3-5 day (acute diarrhea), >7 day ( long diarrhea), >14 days (chronik diarrhea). 4. Past Health History Previous diarrhea, antibiotic and corticosteroid using on long period, food allergic, Upper Respiratory Infection, UTI, OMA, morbili. 5. Nutrition History Personal hygiene, hand washing, environment hygiene, serving condition, frequency of eat, habitual eat pattern. 6. Family Health History History of diarrhea 7. Healthy environment history Sanitation 8. Denver Development Test History a. Growth o Weight increase 1 3 years old on range 1,5-2,5 kg (average 2 kg), Length 6-10 cm (average 8 cm) per year. o Head circumference increase 12cm on 1st year and 2 cm on the next year. o The teeth growth 8 : gigi susu; geraham pertama dan gigi taring all of them are 14 16. o Teethe eruption : geraham perama menyusul gigi taring b. Development

o Development stages Psychosexual according to Sigmund Freud. o Psychososcial development by Erik Erikson. 9. Physical Examination a. Measure the anthropometry. Below the normal range. b. General condition, decrease level consciousness, GCS c. Head : Fontanel anterior concave(is not concave if 1year <) d. Eyes : concave, dry e. Gastrointestinal system: dry mouth mucosa, distension abdomen, peristaltic increase > 35 x/mnt, decrease the appetite, nausea, vomit, drinking much and look thristy. Respiratory system : dyspnea, tachipnea > 40 x/mnt because metabolic acidosis (respiratory muscle contraction) f. Cardiovascular system: fast pulse > 120 x/mnt and weak, decrease the blood pressure on the moderate dehydration. g. Integument system : pale skin, decrease the skin turgor,> 2 s, increase the body temperature > 375 0 C, cold extremity (syock sign), capillary refill > 2 s, redness on the perianal area. h. Urination system : oliguria until anuria (200-400 ml/ 24 hour ), decrease the urination i. Hospitalization impact: stress because of separated, loss of game playing, invasive response, desperate, pain. B. Nursing Diagnose 1. Fluid and electrolyte imbalance related to the lost of body fluid (diarrhea) 2. Nutrition disturbance less than body requirement related to over output (diarrhea) and less intake. 3. Risk increasing body temperature related to infection process 4. Risk skin integrity disturbance related to increasing frequency of diarrhea 5. Anxiety related to the hospitalization, disease progress. 6. The other diagnose: a. High risk growth development disturbance related to decrease the body

weight. b. Comfort disturbance related to the diarrhea, vomiting, limiting diet and complication. C. Intervention Nursing Diagnose 1 1. Fluid and electrolyte imbalance related to the lost of body fluid (diarrhea) Goal: After receive the nursing intervention 3x24 hour the fluid, electrolyte can be maximum maintain with outcomes criteria: a. The vital sign on the normal range (P: 60-120 x/mnt, T: 36-37,5oC, RR: <40 x/mnt) b. Elastic turgor, wet membrane mucose, thre isnt concave eyes c. The feces texture is soft, the defecate frequency is 1/day Intervention: a. Monitor sign and symptomp of deficit fluid and electrolyte. R/ Decrease the fluid volume cirrculation caused the dry mucose and thick concentrate caused dry mucose membrane and thick concentration on urine. Early detection as replacing the fluid and improving deficit of fluid. b. Monitor intake and output R/ Dehydration increase the glomerulus filtration and make inadequate remove metabolism remain. c. Measure the weight regularly R/ Detection of the fluid loss. Loss of 1 kg means loss of one liter of fluid. d. Suggest the family to give much drinking -1 liter of water. R/ Change the loss fluid and electrolyte through oral way. e. Collaborate : 1) Laboratorium serum electrolyte (Na, K,Ca, BUN) R/ Fluid and electrolyte balance correction, BUN for examine physiology of the kidney.

2) Parenteral fluid ( IV line ) R/ Change the adequate hydration of fluid and ectrolyte soon. 3) Drugs: (antisekretion, antispasmolitic, antibiotic) R/ anti secretion to decrease fluid secretion and balance electrolyte, anti spasm for normal absorption process, antibiotic as limiting bacterial endotoxin. 2. Nutrition disturbance less than body requirement related to over output (diarrhea) and less intake. Goal: After receive the nursing intervention 7x24 hour the nutrition need filled with outcomes criteria: a. The appetite increase b. The weight increase or normal as the age Intervention : a. Discuss and explain about diet that should be limiting such as high fiber. fat, hot or cold). R/ high fiber, lipid, hot or cold stimulate irritation on gastric and the colon. b. Maintain the hygiene environment, avoid the smell or garbage, serve the food on the warm condition. R/ situasi yang nyaman, rileks akan merangsang nafsu makan. c. Maintain the sufficient rest and limit the excessive activities. R/ Decrease the excessive energy using. d. Monitor intake and out put on 24 hour R/ Knowing output amount to plan the food amount next. e. Collaborate with the other professional Nutritionist: Diet High calorie and protein, low fiber, milk, drugs or vitamin R/ Contain of the important nutrition to grow up. 3. Risk increasing body temperature related to infection process Goal: After receive the nursing intervention 1x24 hour there isnt increasing

high body temperature with outcomes criteria: a. The body temperature on the normal range ( 36-37,5oC) b. There isnt infection sign (Rubor, dolor, kalor, tumor, fungsiolaesa) Intervention : a. Monitor body temperature every 2 hour R/ Early detection about abnormal function on the body (infection) b. Apply warm compress R/ Stimulate central thermoregulation to decrease the body warm poduction. c. Collaboration prescribing the antipyretic R/ Stimulate the central thermoregulation on the brain to decrease the produce warming. 4. Risk skin integrity disturbance related to increasing frequency of diarrhea Goal: After receive the nursing intervention 1x24 hour there is not disturbance on the skin integrity with outcomes criteria: a. The re isnt irritation : redness, laceration, higiene is keeped. b. The family able to demonstrate perianal care well. Intervention: 1) Discuss about the important thing to keep the bed higiene. R/ Maintain the higiaene prevent the microbs growth. 2) Demonstrate and include the family to do the perianal care (if wet and change the under pants and incontinence sheet. R/ Prevent the skin irritation by the hunidity and acidity level of feces. 3) Manage sleep position or sit position 2-3 hour. R/ Maintain vascularization, diminish long pressure duration that promote to ischemia and irritation. 5. Anxiety related to the hospitalization, disease progress. Goal: After receive the nursing intervention 3x24 hour client able to adaptation with outcomes criteria:

a. The client receive the nursing intervention during hospitalization. Intervention: 1) Include the family during receive treatment R/ The beginning approach through family first promote the child familiar and friendly with the nurse. 2) 3) 4) Avoid the wrong perception about the nurse or medical team on the hospital. R/ Decrease the child anxiaty and afraid toward nurse and the hospital. Give the appreciate to client during hospitalization and after receive treatment. R/ Promote the child confidence, promote the brave and their ability. Do the more often communication with child verbal or non verbal. R/ Introduce the child toward the nurse, so the client will feel comfort and save. 5) Give the toys to stimulate child sensoric R/ Give playing therapy can promote the psychological healing and promote the child friendly toward the nurse.

DAFTAR PUSTAKA Bates. B, 1995. Pemeriksaan Fisik & Riwayat Kesehatan. Ed 2. EGC. Jakarta Carpenitto.LJ. 2000. Diagnosa Keperawatan Aplikasi Pada Praktek Klinis. Ed 6. EGC. Jakarta. Lab/ UPF IKA, 1994. Pedoman Diagnosa dan Terapi . RSUD Dr. Soetomo. Surabaya. Markum.AH. 1999. Ilmu Kesehatan Anak. Balai Penerbit FKUI. Jakarta. Ngastiyah. 1997. Perawatan Anak sakit. EGC. Jakarta Soetjiningsih, 1995. Tumbuh Kembang Anak. EGC. Jakarta Suryanah,2000. Keperawatan Anak. EGC. Jakarta Doengoes,2000. Asuhan Keperawatan Maternal/ Bayi. EGC. Jakarta

THEORITICAL CONCEPT AND NURSING CARE CONCEPT OF GASTROENTERITIS

Arranged by: Suluh Tri Utomo (P 27220008 069)

NURSING SCHOOL HEALTH POLYTECHNIC OF SURAKARTA 2010

THEORITICAL CONCEPT AND NURSING CARE CONCEPT OF GASTROENTERITIS

Arranged by: Erma Lina Yuniarti (P 27220008 014)

NURSING SCHOOL HEALTH POLYTECHNIC OF SURAKARTA 2010