Acute Gastro

8/9/2019 Acute Gastro

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ACUTE GASTROENTERITIS

A Case Study Presented to the Faculty

Of The College of Nursing

In Partial fulfillment of the Requirements

For the Degree of College of Nursing

(SCHOOL)

By;

(NAME OF STUDENT)

(Month, Year Submitted)


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INTRODUCTION:

Disorders of intestinal absorption and bowel eliminations can affect health,

comfort, and well-being. Bowel function can be affected by inflammations, infections,

and tumors, obstructions, or changes in structure.

Clients with intestinal disorder often face extensive diagnostic testing, surgery,

and permanent changes in physical appearance and lifestyle. Nursing care is directed

toward meeting the clients physiologic needs, providing emotional support, and

educating the client to adapt to changes in lifestyle.

RELATED LITERATURE:

DEFINITION

Gastroenteritis, or enteritis, is an inflammation of the stomach and small

intestine. Enteritis may be cause by bacteria, viruses, parasites, or toxins. Upper GIsymptoms such as anorexia, nausea, and vomiting are common. Diarrhea of varying

intensity have abdominal discomfort are nearly universal features of gastroenteritis.

The infectious organism usually enters the body in contaminated water or food.

For this reason, gastroenteritis often is called food poisoning. Viruses commonly

cause acute diarrheal illness. Diarrhea due to rotaviruses or the Norwalk virus occurs

year-round in both adults and children. These illnesses are generally mild and self-

limited, but can have severe consequences in the very young, the very old, or in people

with impaired immune functions.

MANIFESTATIONS

Gastrointestinal Effects

o Anorexia, nausea, and vomiting

o Abdominal pain and cramping

o Borborygmi

o Diarrhea

General Effects

o Malaise, weakness, and muscle aches

o Headache

o Dry skin and mucous membranes

o Poor skin turgor

o Orthostatic hypotension, tachycardia

o Fever

Anatomy & Physiology of Gastrointestinal System


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The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral

cavity, where food enters the mouth, continuing through the pharynx, oesophagus,

stomach and intestines to the rectum and anus, where food is expelled. There are

various accessory organs that assist the tract by secreting enzymes to help break down

food into its component nutrients. Thus the salivary glands, liver, pancreas and gall

bladder have important functions in the digestive system. Food is propelled along the

length of the GIT by peristaltic movements of the muscular walls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients,

which can be absorbed into the body to provide energy. First food must be ingested into

the mouth to be mechanically processed and moistened. Secondly, digestion occurs

mainly in the stomach and small intestine where proteins, fats and carbohydrates are

chemically broken down into their basic building blocks. Smaller molecules are then

absorbed across the epithelium of the small intestine and subsequently enter the

circulation. The large intestine plays a key role in reabsorbing excess water. Finally,

undigested material and secreted waste products are excreted from the body via

defecation (passing of faeces).

In the case of gastrointestinal disease or disorders, these functions of the

gastrointestinal tract are not achieved successfully. Patients may develop symptoms of

nausea,vomiting, diarrhoea, malabsorption, constipation or obstruction. Gastrointestinal

problems are very common and most people will have experienced some of the above

symptoms several times throughout their lives.

Details:

Basic structure

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called
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epithelium. The contents of the tube are considered external to the body and are in

continuity with the outside world at the mouth and the anus. Although each section of

the tract has specialised functions, the entire tract has a similar basic structure with

regional variations. The wall is divided into four layers as follows:

Mucosa: The innermost layer of the digestive tract has specialised epithelial cells

supported by an underlying connective tissue layer called the lamina propria. The

lamina propria contains blood vessels, nerves, lymphoid tissue and glands that support

the mucosa. Depending on its function, the epithelium may be simple (a single layer) or

stratified (multiple layers). Areas such as the mouth and oesophagus are covered by a

stratified squamous (flat) epithelium so they can survive the wear and tear of passing

food. Simple columnar (tall) or glandular epithelium lines the stomach and intestines to

aid secretion and absorption. The inner lining is constantly shed and replaced, making it

one of the most rapidly dividing areas of the body! Beneath the lamina propria is the

muscularis mucosa. This comprises layers of smooth muscle which can contract tochange the shape of the lumen.

Submucosa: The submucosa surrounds the muscularis mucosa and consists of fat,

fibrous connective tissue and larger vessels and nerves. At its outer margin there is a

specialized nerve plexus called the submucosal plexus or Meissner plexus. This

supplies the mucosa and submucosa.

Muscularis externa: This smooth muscle layer has inner circular and outer longitudinal

layers of muscle fibres separated by the myenteric plexus or Auerbach plexus. Neural

innervations control the contraction of these muscles and hence the mechanical

breakdown and peristalsis of the food within the lumen.

Serosa/ Mesentery: The outer layer of the GIT is formed by fat and another layer of

epithelial cells called mesothelium.

The Individual Components of the Gastrointestinal System

Oral cavity

The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified

squamous oral mucosa with keratin covering those areas subject to significant abrasion,

such as the tongue, hard palate and roof of the mouth. Mastication refers to the

mechanical breakdown of food by chewing and chopping actions of the teeth. The

tongue, a strong muscular organ, manipulates the food bolus to come in contact with

the teeth. It is also the sensing organ of the mouth for touch, temperature and taste

using its specialised sensors known as papillae.

Insalivation refers to the mixing of the oral cavity contents with salivary gland secretions.The mucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a

limited role in the digestion of carbohydrates. The enzyme serum amylase, a

component of saliva, starts the process of digestion of complex carbohydrates. The final

function of the oral cavity is absorption of small molecules such as glucose and water,

across the mucosa. From the mouth, food passes through the pharynx and oesophagus


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via the action of swallowing.

Salivary Glands

Three pairs of salivary glands communicate with the oral cavity. Each is a complex

gland with numerous acini lined by secretory epithelium. The acini secrete their contents

into specialised ducts. Each gland is divided into smaller segments called lobes.

Salivation occurs in response to the taste, smell or even appearance of food. This

occurs due to nerve signals that tell the salivary glands to secrete saliva to prepare and

moisten the mouth. Each pair of salivary glands secretes saliva with slightly different

compositions.

Parotids: The parotid glands are large, irregular shaped glands located under the skin

on the side of the face. They secrete 25% of saliva. They are situated below the

zygomatic arch (cheekbone) and cover part of the mandible (lower jaw bone). Anenlarged parotid gland can be easier felt when one clenches their teeth. The parotids

produce a watery secretion which is also rich in proteins. Immunoglobins are secreted

help to fight microorganisms and a-amylase proteins start to break down complex

carbohydrates.

Submandibular: The submandibular glands secrete 70% of the saliva in the mouth.

They are found in the floor of the mouth, in a groove along the inner surface of the

mandible. These glands produce a more viscid (thick) secretion, rich in mucin and with

a smaller amount of protein. Mucin is a glycoprotein that acts as a lubricant.

Sublingual: The sublinguals are the smallest salivary glands, covered by a thin layer of

tissue at the floor of the mouth. They produce approximately 5% of the saliva and their

secretions are very sticky due to the large concentration of mucin. The main functions

are to provide buffers and lubrication.

Oesophagus

The oesophagus is a muscular tube of approximately 25cm in length and 2cm in

diameter. It extends from the pharynx to the stomach after passing through an opening

in the diaphragm. The wall of the oesophagus is made up of inner circular and outer

longitudinal layers of muscle that are supplied by the oesophageal nerve plexus. This

nerve plexus surrounds the lower portion of the oesophagus. The oesophagus functions

primarily as a transport medium between compartments.

Stomach

The stomach is a J shaped expanded bag, located just left of the midline between the

oesophagus and small intestine. It is divided into four main regions and has two borders

called the greater and lesser curvatures. The first section is the cardia which surrounds

the cardial orifice where the oesophagus enters the stomach. The fundus is the

superior, dilated portion of the stomach that has contact with the left dome of the

diaphragm. The body is the largest section between the fundus and the curved portion

of the J. This is where most gastric glands are located and where most mixing of the

food occurs. Finally the pylorus is the curved base of the stomach. Gastric contents are

expelled into the proximal duodenum via the pyloric sphincter. The inner surface of the


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stomach is contracted into numerous longitudinal folds called rugae. These allow the

stomach to stretch and expand when food enters. The stomach can hold up to 1.5 litres

of material.

The functions of the stomach include:

1. The short-term storage of ingested food.

2. Mechanical breakdown of food by churning and mixing motions.

3. Chemical digestion of proteins by acids and enzymes.

4. Stomach acid kills bugs and germs.

5. Some absorption of substances such as alcohol.

Most of these functions are achieved by the secretion of stomach juices by gastric

glands in the body and fundus. Some cells are responsible for secreting acid and otherssecrete enzymes to break down proteins.

Small Intestine

The small intestine is composed of the duodenum, jejunum, and ileum. It averages

approximately 6m in length, extending from the pyloric sphincter of the stomach to the

ileo-caecal valve separating the ileum from the caecum. The small intestine is

compressed into numerous folds and occupies a large proportion of the abdominal

cavity. The duodenum is the proximal C-shaped section that curves around the head of

the pancreas. The duodenum serves a mixing function as it combines digestivesecretions from the pancreas and liver with the contents expelled from the stomach.

The start of the jejunum is marked by a sharp bend, the duodenojejunal flexure. It is in

the jejunum where the majority of digestion and absorption occurs. The final portion, the

ileum, is the longest segment and empties into the caecum at the ileocaecal junction.

The small intestine performs the majority of digestion and absorption of nutrients. Partly

digested food from the stomach is further broken down by enzymes from the pancreas

and bile salts from the liver and gallbladder. These secretions enter the duodenum at

the Ampulla of Vater. After further digestion, food constituents such as proteins, fats,

and carbohydrates are broken down to small building blocks and absorbed into the

body"?Ts blood stream.

The lining of the small intestine is made up of numerous permanent folds called plicae

circulares. Each plica has numerous villi (folds of mucosa) and each villus is covered by

epithelium with projecting microvilli (brush border). This increases the surface area for

absorption by a factor of several hundred. The mucosa of the small intestine contains

several specialised cells. Some are responsible for absorption, whilst others secrete

digestive enzymes and mucous to protect the intestinal lining from digestive actions.

Large Intestine

The large intestine is horse-shoe shaped and extends around the small intestine like a

frame. It consists of the appendix, caecum, ascending, transverse, descending and

sigmoid colon, and the rectum. It has a length of approximately 1.5m and a width of

7.5cm. The caecum is the expanded pouch that receives material form the ileum and


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starts to compress food products into faecal material. Food then travels along the colon.

The wall of the colon is made up of several pouches (haustra) that are held under

tension by three thick bands of muscle (taenia coli). The rectum is the final 15cm of the

large intestine. It expands to hold faecal matter before it passes through the anorectal

canal to the anus. Thick bands of muscle, known as sphincters, control the passage of

faeces.

The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal

surface is flat with several deep intestinal glands. Numerous goblet cells line the glands

that secrete mucous to lubricate faecal matter as it solidifies.

The functions of the large intestine can be summarised as:

1. The accumulation of unabsorbed material to form faeces.

2. Some digestion by bacteria. The bacteria are responsible for the formation ofintestinal gas.

3. Reabsorption of water, salts, sugar and vitamins.

Liver

The liver is a large, reddish-brown organ situated in the right upper quadrant of the

abdomen. It is surrounded by a strong capsule and divided into four lobes namely the

right, left, caudate and quadrate lobes. The liver has several important functions. It actsas a mechanical filter by filtering blood that travels from the intestinal system. It

detoxifies several metabolites including the breakdown of bilirubin and oestrogen. In

addition, the liver has synthetic functions, producing albumin and blood clotting factors.

However, its main roles in digestion are in the production of bile and metabolism of

nutrients. All nutrients absorbed by the intestines pass through the liver and are

processed before traveling to the rest of the body. The bile produced by cells of the

liver, enters the intestines at the duodenum. Here, bile salts break down lipids into

smaller particles so there is a greater surface area for digestive enzymes to act.

Gall Bladder

The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior

surface of the liver's right lobe. It consists of a fundus, body and neck. It empties via the

cystic duct into the biliary duct system. The main functions of the gall bladder are

storage and concentration of bile. Bile is a thick fluid that contains enzymes to help

dissolve fat in the intestines. Bile is produced by the liver but stored in the gallbladder

until it is needed. Bile is released from the gall bladder by contraction of its muscular

walls in response to hormone signals from the duodenum in the presence of food.

Pancreas

Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its

head communicates with the duodenum and its tail extends to the spleen. The organ is

approximately 15cm in length with a long, slender body connecting the head and tail

segments. The pancreas has both exocrine and endocrine functions. Endocrine refers


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to production of hormones which occurs in the Islets of Langerhans. The Islets produce

insulin, glucagon and other substances and these are the areas damaged in diabetes

mellitus.

The exocrine (secretrory) portion makes up 80-85% of the pancreas and is the area

relevant to the gastrointestinal tract. It is made up of numerous acini (small glands) that

secrete contents into ducts which eventually lead to the duodenum. The pancreas

secretes fluid rich in carbohydrates and inactive enzymes. Secretion is triggered by the

hormones released by the duodenum in the presence of food. Pancreatic enzymes

include carbohydrases, lipases, nucleases and proteolytic enzymes that can break

down different components of food. These are secreted in an inactive form to prevent

digestion of the pancreas itself. The enzymes become active once they reach the

duodenum.

GENERAL DATA

NAME: Child X

AGE: 7 years old

SEX: Female

CIVIL STATUS: Child

OCCUPATION: ------

ADDRESS: Brgy. Taglin Macalelon Quezon

DATE/TIME OF ADMISSION: February 8, 2007 (11:15pm)

FINAL DIAGNOSIS: AGE

PHYSICAL ASSESSMENT

General Appearance:

conscious and coherent

alert and oriented to time, place and personlethargic and weak in appearance

needs assistance to move and ambulate

pale in appearance

Head

normocephalic

no mass and lesion

with evenly distributed black hair

dandruff noted

Eyes

with pale conjunctivapupils both reactive to light accommodation

with good visual acuity

Ears -

with normal auditory functioning

symmetrical in shape


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no deformities

with flaky cerumen

Nose -

centrally located

no nasal discharge

no nasal flaring

Mouth/Throat -

with dry crack pale lips

with dental carries

with dry oral cavity

with poor oral hygiene

with centrally located uvula and tongue

Chest/Lungs -

not in respiratory distress

with normal and equal chest expansionAbdomen -

(+) guarding on abdomen

With bowel sounds of 3/min

(+) tenderness on hypogastric area

(-) rebound

Genito-Urinary -

voiding freely with bright yellowish urine

no painful or tingling sensation

Extremities -

with good capillary refill

with poor skin turgor

with long dirty nails

with palpable pulses but weak at intervals

HISTORY OF PRESENT ILLNESS

Child X brought to the hospital without exact reason for having the chief

complaint: diarrhea, abdominal pain and vomiting.

PAST MEDICAL HISTORY

Previous Hospitalization-N/A

Immunization- Shereceived just a single dose of BCG.

Past Diseases- chickenpox, cough, colds and fever

FAMILY HEALTH HISTORY

Parents of Child X ( common cough, colds and fever)

I


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5 Siblings(chickenpox, common cough, colds, and fever) and

Child X(common cough, colds, fever, chickenpox, AGE)

No severe cases noted from the health of his family from the past just common,

cough, colds, and fever.

SOCIAL HISTORY

Activities of Daily Living

Child X was spending her days on the school playing with her friends, sometimes on the

backyard. She eats food and drink water even though shes not sure about its

safeties

Geographical Data

Their house is located approximately one kilometer away from the highway road and

town proper especially the church and Brgy. Health Center. Their source of

electricity is MERALCO. They just burn their garbage at their backyard.

PATHOPHYSIOLOGY

CONTAMINATED FOOD

DIGESTED FOOD

BACTERIAL OR VIRAL INFECTION

INFLAMMATION, TISSUE DAMAGE

EXOTOXIN / ENDOTOXIN DAMAGE TISSUE MORE DIRECTLY

DAMAGE INFLAMMATION INVADE INTESTINAL MUCOUSA OF

THE SMALL BOWEL OR COLON

IMPAIR INTESTINAL ABSORPTION MICROSCOPIC ULCERATION


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AND CAN CAUSE SECRETION OF

SIGNIFICANT AMOUNTS OF BLEEDING

ELECTROLYTES AND WATER INTO

THE BOWEL FLUID CAUDATE

DIARRHEA WATER AND ELECTROLYTE

SECRETION

FLUID LOSS

Feb 8, 2007 (Day 1)

- admitted, with the chief complaint of abdominal pain, diarrhea and vomiting

- monitoring of vital signs,

February 9 (Day 2)

-pale and weak in appearance

- with dry lips and oral cavity

- with flabby soft abdomen, (-)tenderness on epigastric and hypocastric area,

(-)rebound

- instructed on liquid diet

- CBC done

- temperature increased

February 10(Day 3)

-Pale and weak in appearance

-febrile 38.4oC

- with mild on and off abdominal pain

- seen and examined by Pediatricts, given meds

- urinalysis done

February 11(Day 4)

- weak and pale in appearance

- with dry lips and skin

February 12 (Day 7)

-conscious and coherent


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- with stable vital signs

-slight pale in appearance

- S/E by attending Physician with discharge order, and home meds prescription

- went home with fair condition

URINALYSIS RESULT

Macroscopic:

Color: bright yellow

Transparency: slightly turbid

Specific gravity: 1. 030

Chemical Test:

Sugar (-)

Albumin +1

Microscopic:

RBC: 4-5

WBC: 8-10

Epith. Cells: +1

Urates: +1

COMPLETE

BLOOD COUNT

RESULTS REFERENCE

VALUE

INTERPRETATION SIGNIFICANCE

Hemoglobin 12.16 g/dl Male: 14-18 g/dl decreased Decreased in various anemias,

severe or prolonged

hemorrhage, and with excessive

fluid intake

Hematocrit 36 vol % Male: 40-50 vol% decreased Decreased in severe anemias

or acute massive blood loss


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WBC Count

DIFFERENTIAL

COUNT

Neutrophils

Lymphocytes

TOTAL

12,400/cumm

84%

16%

100%

5,000-10,000/cumm

40-60%

35-40%

increased

increased

decreased

Increased in acute infectious

disease predominantly in the

neutrophilic fraction,possible for

stress or sepsis

CUES/DATA NSG.

DIAGNOSIS

GOAL/OBJECTIVE INTERVENTION RATIONALE EVALUATION

S:nanghihina

ako kaya dinalang ako

gumagalaw

masyado, at

lalo

sumasakit

itong tyan

koas

verbalized by

the pt.

O:

-weak and

pale in

appearance

-with body

malaise

-with facial

grimace

when moving

Activity

intolerancerelated to

fatigue,

lethargy, and

malaise

At the end of the

shift, patient reportsdecrease in fatigue

and reports

increased ability to

participate in

activities

1. Asses level of

activity toleranceand degree of

fatigue, lethargy,

and malaise when

performing

routine ADLS

2. Assist with

activities and

hygiene when

fatigued.

3. Encourage rest

when fatigued or

when abdominal

pain or discomfort

occurs.

4. Assist with

selection and

pacing of desired

activities and

exercises

5. Provide diet

high in

carbohydrates

with protein intake

consistent with

liver function.

6. Administer

supplemental

vitamins (A, B

complex, C, and

K)

1. Provides

baseline forfurther

assessment

and criteria for

assessment of

effectiveness

of

interventions

2. Promotes

exercise andhygiene within

pt level of

tolerance

3. Conserves

energy and

protects the

liver

4. Stimulates

pt interest in

selected

activities

5. Provides

calories for

energy and

protein for

healing

6. provides

additional

nutrients

Goal completely

met

At the end of

the shift pt:

>Exhibits

increased in

activities events

>Participates in

activities and

gradually

increases

exercises within

physical limits

>Reports

increased

strength and

well being

>Reportsabsence of

abdominal pain

and discomfort

>Plans activities

to allow ample

periods of rest

>Takes

vitamins as

prescribed


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CUES/DATA NSG.

DIAGNOSIS

GOAL/OBJECTIVE INTERVENTION RATIONALE EVALUATION

S:Sobrang

sakit nitong

tyan

ko(pointing

at epigastric

area),

pasumpong

sumpong

minsan nga

napapaiyak

ako sa

sobrang

sakit eh, as

verbalized

by the

patient

O:

-with the rate

of 7 in the 0-

10 pain

scale

-with facial

grimace

upon

palpation

-with

guarding

behavior on

abdomen

-irritable at

frequent

intervals

Chronic pain

and

discomfort

related to

enlarged

intestine

Goal: Increased level

of comfort

Objective:

At the end of the

nursing intervention,

pt. Pain will bedecreased with the

rate of 3 in the 0-10

pain scale

1. Perform a

comprehensive

assessment of the

pain

2.Provide quiet

environment, calm

activities.Maintain bedrest when patient

experiences

abdominal discomfort

3.Observe record and

report presence and

character of pain and

discomfort

4. Reduce sodiumand fluid intake if

prescribed

5. Assist client in the

use of relaxation

techniques and

encourage

ambulation as

individually indicated

6. Administer

medication as

prescribed.

(ranitidine/analgesic)

1.to assess

characteristics,

location, onset,

frequency,

quality and

severity of pain.

2.Reducesmetabolic

demands and

protects the liver

3.Provides

baseline to

detect further

deterioration of

status and to

evaluateinterventions

4.Minimizes

further formation

of ascites

5. To provide

relief of

causative

factors

6.Reduces

irritability of the

gastrointestinal

tract and

decreases

abdominal pain

and discomfort

Goal

Completely met

At the end of

the nsg.

Intervention pt:

>Reports painand discomfort

if present

>Maintains bed

rest and

decreases

activity in

presence of

pain

>Takes

medication as

prescribed

>Reports

decreased pain

and abdominal

discomfort (pain

is rated as 3 in

0-10 p1in scale)

>reduces

sodium and

fluid intake to

prescribed

levels if

indicated to

treat ascites


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CUES/DATA NSG.

DIAGNOSIS

GOAL/OBJECTIVE INTERVENTIO

N

RATIONALE EVALUATION

S:No

Subjective

complaint

O:

-Temp:38.4

>normal on

other days

-with flushing

face

-skin warm to

touch

-with poor

skin turgor

-sweating

Risk for

imbalanced

body

temperature:hyperthermia

related to

inflammatory

process of

cirrhosis

Goal: Maintenance

of normal body

temperature, free

from infection

OBJECTIVE:

At the end of nsg.

Intervention, pt.

Temp. will be in

normal range (37oC)

1. Record

temperature

regularly

2. Encourage

fluid intake

3. Apply cool

sponges or

icebag for

elevated temp.

4. Administer

antibiotics as

prescribed

5.Avoid

exposure to

infections

6.Keep patient

at rest while

temp is

elevated

7. Asses for

abdominal pain,

tenderness

1.Provides

baseline to

detect fever and

to evaluateinterventions

2.corrects fluid

loss from

perspiration and

fever and

increases pt

level of comfort

3.Promotes

reduction of

fever and

increases pt

comfort

4.Ensures

appropriate

serum

concentration of

antibiotics to

treat infection

5.minimize risk

of further

infection and

further increases

in body temp

and metabolic

rate

6.reducesmetabolic rate

7.may occur with

bacterial

peritonitis

Goal completely

met:

At the end of

the nsg.

Intervention pt:

-Exhibits normal

temp and

reports absence

of chills or

sweating

(temp:37oC)

-Demonstrates

adequate intake

of fluids

-Exhibits no

evidence of

local or

systemic

infection


16/19

DRUG

NAME

CLASSIFICATI

ON

INDICATION/

CONTRAINDICAT

ION

INTERACTI

ON/ ACTION

ADVERSE

REACTION

NURSING

CONSIDERATI

ON

Ampicillin

Cephalosporin,second

generation

(Anti-infective)

INDI: PO (axetil),Suspenion

(children, 3

months-12years).

1. pharynginitis or

tonsillitis due to

pyogenes.

2. Acute bacteraial

otitis media due to

S. pneumoniae, H.

influenzae, M.

catarrhalis, or S.

pyogens.

3. Acute bacterial

maxillary sinusitis

due to S.

pneumoniae or H.

influenzae.

4. Uncomplicated

UTIs

5. Perioperative

prevention

6. Early Lyme

disease

7.Secondary

bacterial infection

of acute bronchitis

CONT:

1.Contraindicated

in patients

hypersensitive to

drugs or other

cephalosporin's.

2. Use cautiouslyin patients

hypersensitive to

penicillin because

of possibility of

cross-sensitivity

Aminoglycosides:

may cause

synergistic

activity

against some

organisms;

may increase

nephrotoxicit

y. Monitor

patient'srenal function

closely

ACTION:

Second-

generation

cephalospori

n that inhibits

cell-wall

synthesis,promoting

osmotic

instability;

usually

bactericidal

CV: Phlebitis,thrombophlebitis,

GI:

Pseudomembrano

us colitis, nausea,

anorexia,

vomiting,

diarrhea,

HEMATOLOGIC:

transient

neutropenia,

eosinophilia,

hemolytic anemia,

thrombophocytop

enia,

OTHER:

hypersensitivity

reactions, serum

sickness,

anaphylaxis

1.Assess forinfections befor

and after

administration

2. For IM use

inject deep into

a large muscle

mass.


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with other beta-

lactam antibiotics

3. Use cautiously

to breast-feeding

women and inpatients with

history of colitis or

renal insufficiency


18/19

DRUG

NAME

CLASSIFICA

TION

INDICATION/

CONTRAINDICA

TION

INTERACTI

ON/

ACTION

ADVERSE

REACTION

NURSING

CONSIDERA

TION

Atrovent

(ipratropi

um

bromine)

DOSAGE

:

Atrovent

neb q6o

Bronchodilators/

anticholinergic

s

INDI: 1.Bronchospasm in

chronic bronchitis

and emphysema.

2. Rhinorrhea

caused by

allergic and

nonallergic

perennial rhinitis

3. Rhinorrhea

caused by the

common cold.

4. Rhinorrhea

caused by

seasonal allergic

rhinitis.

CONT: 1. In

patientshypersensitive to

drug, atrophine,

or its derivatives

and in those

hypersensitive to

soy lecitin or

related food

products, such

as soybeans and

peanuts.

2. Use cautiously

to patients with

angle closure

glaucoma,

prostatic

hyperplasia, or

bladder-nekc

obstruction.

3. Safety and

efficacy of

nebulization or

inhaler in

children younger

Antiholinergics: May

increase

anticholinerg

ic effects.

Avoid using

together.

ACTION:

Inhibits

Cholinergic

receptors in

bronchial

smooth

muscle,resul

ting in

decreased

concentratio

ns of cyclic

guanosinemonophosp

hate.

Produce

local

bronchodilati

on

CNS: dizziness,pain, headache,

nervousness.

CV: palpitations,

hypertension,

chest pain.

EENT: blurred

vision, rhinitis,

sinusitis,

epistaxis.

GI: nmausea, GI

distress, dry

mouth.

MUSCULOSKEL

ETAL:

Back pain.

RESPIRATORY:

upper respiratory

tract infection,

bronchitis ,

cough, dyspnea,

bronchospasm,

increased

sputum.

SKI: rash

OTHER: flulike

symptoms,

hypersensitivity

reaction.

1. If patient isusing a face

mask for

nebulizer, take

care to

prevent

leakage

around the

mask because

eye pain or

temporaryblurring of

vision may

occur

2. Safety and

efficiency of

use beyond 4

days in

patients with a

common coldhaven't been

established.

4. Patient with

a severe

peanut allergy

could have an

anaphylactic

reaction after

using Atroventinhalation

aerosol

metered-dose

inhaler (MDI).

Get a

thorough

allergy history

from patient

before giving

any drug.


19/19

than age 12

haven't been

established.

Acute Gastro

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