Acute Gastroenteritis: Nueva Ecija University of Science and
Acute Gastroenteritis: Nueva Ecija University of Science and
Acute Gastroenteritis: Nueva Ecija University of Science and
CASE PRESENTATION:
ACUTE GASTROENTERITIS
IN PEDRIATRIC PATIENT
Prepared by:
Jamaica Jane J. Azarcon
Andrea Lorraine G. Benedicto
Lyca B. Berin
BSN II-C
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CHAPTER I
General Objectives
As a level 2 NEUST-CON student nurse, the general objective of this case study is to be able to
gain more knowledge, improved our skills and acquiring a good attitude as necessary in dealing with
different patients, perform basic nursing skills with confidence and competence as well as providing an
Specific Objectives
At the end of the clinical duty the student-nurses will be able to:
1. Assess the client from head to toe, focusing on the parts affected by the Acute
Gastroenteritis;
2. Obtain, document, and present a comprehensive medical history;
3. Explain the anatomy and physiology of Digestive System;
4. Define the Acute Gastroenteritis, become familiar with the important
diagnostic/laboratory examinations that will be used in the confirmatory and management
of Acute Gastroenteritis;
5. Understand the pathophysiology of Acute Gastroenteritis
6. Recognize the different medications used, its action, side effect and its action in the
management of Acute Gastroenteritis;
7. Understand the suggested medical management, employed to resolve problems;
8. Formulate appropriate Nursing Care Plan utilizing the Nursing Process; and
9. Identify nursing priorities; provide prompt nursing intervention that would help alleviate
the condition of the client thus increasing their capacity to function.
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Introduction
Gastroenteritis is characterized by diarrhea or vomiting and is described as inflammation
of the mucus membranes of the gastrointestinal tract. It's a very common childhood illness.
Children in developing countries are at a higher risk of morbidity and mortality than children in
developed countries. Although the exact burden and cost of FWBDs are uncertain, they are
overall Disability Adjusted Life Years (DALY) worldwide, according to the World Health
Organization (WHO). According to the most recent Department of Health (DOH) survey, acute
watery diarrhea (AWD) is the seventh leading cause of morbidity, affecting 76.3 people per
100,000. With a prevalence of 0.5 per 1,000 live births, AWD is also the seventh leading cause
of child mortality. Diarrhea is a leading cause of death in children under the age of five in
developing countries, with an estimated 2 million deaths per year. Acute gastroenteritis (AGE) is
still a leading cause of death and morbidity in people of all ages. Human noroviruses and
sapoviruses, among other enteric caliciviruses, are now recognized as essential etiologic agents
of this disease. Almost all acute infectious diarrhea, however, was thought to be caused by
bacteria or parasites. Acute diarrhea is characterized by a sudden rise in recurrence and changes
in stool consistency. It's usually caused by an infectious agent in the GI tract, but it may also be
caused by upper respiratory or urinary tract infections. Antibiotic treatment or the use of
laxatives can increase the risk of acute diarrhea in children.If dehydration does not cause serious
problems, it is normally self-limited within 14 days and no new therapy is needed.From 2008 to
2015, the mortality rate for acute watery diarrhea and acute bloody diarrhea decreased, following
the pattern for diarrhea and gastroenteritis of suspected infectious origin. However, since the
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mortality rate for acute watery diarrhea cannot be calculated, separate reporting would be
CLIENT’S INFORMATION
I. Patient’s Profile
Name: Patient X
Age: 6 Years Old
Date of Birth: March 14, 2015
Sex: Male
Civil Status: Child
Nationality: Filipino
Religion: Roman Catholic
Address of parents: Mabini St. Cabanatuan City
Date of Admission: April 8, 2021
Attending Physician: Dr. X
II. Presenting Complaints
Diarrhea
Fever
Poor appetite
Vomiting
Restlessness
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VI. Immunization
Hepatitis (B)
BCG
Polio (IPV) (4th dose)
Measles, mumps, and rubella (MMR) (2nd dose)
Chickenpox (Varicella) (2nd dose)
Influenza (Flu) (every year)
Medication used:
Generic Name: Ampicillin
Brand Name: Omnipen
q8hr, PO
Adverse effects:
nausea
vomiting
diarrhea
rash
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Admitting History
On April 8, 2021 at around 10:00 AM, a 6-year-old male client named X is admitted in
the Pediatric ward of ELJH with his parents. According to his mother complain, the client
experienced diarrhea and vomited for 3 times. The client experienced restlessness and also fever
and the client’s temperature is at 38.4 C.
The client’s final diagnosis was Acute Gastroenteritis. The client is now receiving an IV fluid of
D5 0.3 NaCL 500ml bottle, connected to a microset, to run for 8 hours.
The client shows weakness of the body due to poor appetite and diarrhea. The mother
also observes that her child has an intermittent fever. But due to multiple defecations and
vomiting the mother decided to admit the client in the hospital to know the proper treatment of
the child’s condition.
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Physical Assessment
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Normal
The client’s neck’s muscles
Muscles are equal in size, are equal in size, no inflamed
no inflamed nodules, and nodule and neck veins not
Neck
smooth movement with dilated.
no discomfort.
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Normal
The client’s lower
extremities are normal, no
presence of bone
No presence of bone
deformities, tenderness
deformities, tenderness
and swelling. Normally
Lower and swelling. Normally
firm and movements are
Extremities firm and movements
coordinated.
should be coordinated.
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CHAPTER II
Definition of the Case
Acute gastroenteritis (AGE) is a diarrheal disease with a rapid onset and a variety of
symptoms and signs, including nausea, vomiting, fever, and abdominal pain. It occurs when
pathogenic microorganisms (such as Clostridium perfringens, Vibrio cholera, and E. Coli) or
their toxins are consumed in food or water. Nausea, vomiting, diarrhea, and abdominal pain are
some of the symptoms. A viral or bacterial infection, as well as a parasitic infection, is the most
common causes of gastroenteritis.
Norovirus and rotavirus are the most common causes of viral gastroenteritis. The most
common causes of bacterial gastroenteritis are Escherichia coli (E. Coli), Salmonella, and
Campylobacter. Giardia is the most common cause of parasitic gastroenteritis. Gastroenteritis
outbreaks, which occur when a large number of people are sick at the same time and in the same
location, are most often caused by viral gastroenteritis. Children and adults may be affected by
norovirus outbreaks, while babies and children are often affected by rotavirus.
Although often considered a benign disease, acute gastroenteritis remains a major cause
of morbidity and mortality in children around the world, accounting for 1.34 million deaths
annually in children younger than 5 years, or roughly 15% of all child deaths. As the disease
severity depends on the degree of fluid loss, accurately assessing dehydration status remains a
crucial step in preventing mortality. Luckily, most cases of dehydration in children can be
accurately diagnosed by a careful clinical examination and treated with simple, cost-effective
measures. Although dehydration technically refers to pure water loss and can be associated with
euvolemic or even hypervolemic states in certain pediatric disorders, the term is used throughout
this article in its more general sense to mean overall fluid or volume loss due to diarrhea.
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Cases of Acute Gastroenteritis Globally
Acute gastroenteritis is a very common disease in babies and children all over the world.
Acute diarrhea causes more than 1.5 million outpatient visits, 200,000 hospitalizations, and 300
deaths among children in the United States per year, according to the Centers for Disease Control
and Prevention (CDC). Diarrhea is a leading cause of death in children under the age of five in
developing countries, with an estimated 2 million deaths per year. Gastroenteritis affects two
million to three million children under the age of five in the United States per year, resulting in 2
million to 3 million office visits and 10% of all pediatric hospital admissions. Furthermore,
rotavirus is responsible for about one-third of all hospitalizations for diarrhea in children under
the age of five, with an estimated direct cost of $250 million.
The gastrointestinal (GI) tract, also known as the digestive tract, as well as the liver,
pancreas, and gallbladder, make up the digestive system. From the mouth to the anus, the GI
tract is made up of a series of hollow organs connected by a long, twisting tube. The mouth,
esophagus, liver, small intestine, and large intestine, which includes the rectum and anus, are the
hollow organs that make up the GI tract. Food enters the mouth and travels through the GI tract’s
hollow organs to the anus. The stable organs of the digestive system are the liver, pancreas, and
gallbladder. The digestive system aids in the digestion of food.
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Book-Based Pathophysiology
Toxicogenic agents
*E.coli Pathogenic agents
*Shigella strains *Rotaviruses
*Salmonella species
Release an exotoxin
Destroy cells in the
intestinal villa
Impairs intestinal
absorption
malabsorption of
electrolytes
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The pathological conditions depend on the causative agent. Toxicogenic agent such as some
E.coli, and Shigella strains, release an exotoxin that impairs intestinal absorption. Invasive pathogens
such as some Shigella and Salmonella species and E.coli, penetrate the mucosa of the small bowel,
causing cellular destruction, necrosis, ulceration, bleeding, and exudation of protein-rich fluid. Pathogens
such as rotaviruses attach to the mucosal wall and destroy cells in the intestinal villa, causing
malabsorption of electrolytes. Parasites and toxins also interfere with intestinal functioning. The general
result of all pathogenic agents increased gastrointestinal motility and increased secretion of fluids and
electrolytes.
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Client-Based Pathophysiology
Modifiable Factors
Diarrhea
Fever
Poor appetite
Vomiting
Restlessness
Dehydration
Acute Gastroenteritis
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Risk Factors
Older adults. Adult immune systems tend to become less efficient later in life. Older
adults in nursing homes, in particular, are vulnerable because their immune systems
weaken, and they live in close contact with others who may pass along germs.
Anyone with a weakened immune system. If your resistance to infection is low — for
instance, if your immune system is compromised by HIV/AIDS, chemotherapy or another
medical condition — you may be especially at risk.
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Clinical Manifestation
Book-based Client-based
Medical Management
Medical treatment for gastroenteritis include:
Oral rehydration solution (ORS) is the treatment of choice for children with mild-
to-moderate gastroenteritis in both developed and developing countries, according to
the American Academy of Pediatrics (AAP), the European Society of Pediatric
Gastroenterology and Nutrition (ESPGAN), and the World Health Organization
(WHO).
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NURSING MANAGEMENT
Promote skin integrity. Cleanse the buttocks and genital region regularly and apply
a calming protective preparation such as lanolin A or D ointment to minimize itching
and excoriation; change diapers as soon as practicable, and putting disposable pads
under the baby may promote simple and regular changing.
Maintain adequate nutrition. Weigh the child on the same scale every day; take
measurements in the early morning before the morning feeding; and keep a close eye
on his or her intake and production. When a child is NPO, good oral hygiene is
essential; when oral fluids are added, the child is given oral replacement solutions; if
the child tolerates these solutions, half-strength formula may be introduced.
Maintain body temperature. If there is a fever, monitor vital signs at least every 2
hours, follow effective fever-reduction protocols, and administer antipyretics and
antibiotics as prescribed.
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CHAPTER III
Laboratories
Fecalysis
02/17/21 Interpretation
Color Yellowish Normal
Consistency Loose watery Sign of Diarrhea
Parasites No OVA or Parasite seen Normal
Hematology
Blood Chemistry
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Laboratory Results and Interpretation
1. High hematocrit – This means that the body has more red blood cells than what’s
considered to be healthy. High hematocrit levels could indicate underlying medical
conditions like dehydration.
2. High white cell count – A high white blood cell count may indicate that the immune
system is working to destroy an infection.
4. High lymphocytes – High lymphocyte blood levels indicate that the body is dealing with
an infection or other inflammatory condition.
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CHAPTER IV
NURSING CARE PLAN
Outcome
Assessment Diagnosis Planning Intervention Evaluation
Identification
Subjective data: Risk of fluid After 8 hours Short term: Independent: After 8
volume deficit of nursing hours of
“Naka apat na beses na After 4 hours Establish rapport
related to intervention nursing
siyang sumuka sa bahay” as of nursing
vomiting as the client will -to gain trust and intervention
verbalized by the mother. intervention,
evidenced by maintain fluid participation from the the client is
the client will
dry lips and volume at client continuosly
exhibit moist
poor skin functional level and
Objective data: mucous Assess vital signs.
turgor. as evidenced gradually
membrane and
by stable vital regaining
Dry lips good skin -Fever that occurs with
signs, moist his/her
Restlessness turgor. gastroenteritis
mucous energy.
Sunken eyes increases fluid loss
membranes
Poor skin turgor through perspiration
and good skin
Vital signs: turgor. Long term: and increased Goal was
After 8 hours respiration.The change partially
Temp: 38.4°C of nursing in HR is a met
PR:120 bpm intervention compensatory
RR:26 cpm no signs of mechanism to maintain
BP:90/70mmHg dehydration
cardiac output.
will be noted.
Usually, the pulse is
weak and may be
irregular if electrolyte
imbalance also
occurs. Hypotension is
evident in hypovolemia.
Assess skin turgor
-Fluid loss occurs first in
extracellular spaces,
resulting in poor skin
turgor and dry mucous
membrane
Place the client in a
position of comfort-
upright or lateral
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recumbent as tolerated
and monitor the airway
status
-to prevent caspiration
Do not give the client any
food or drinks for several
hours of vomiting
-----
Instruct the client to sip
small amounts of water
or suck ice chips every 15
mins for 3-4 hours.Next,
sip clear liquids every 15
mins for 3-4 hours.
Examples include water,
clear broth, gelatin and
apple juice.
-----
Avoid foods spicy foods,
fats/oils, milk and citrus
juice.
-it can irritate your
stomach or may be
difficult to digest.
When client can tolerate
clear liquids for several
hours without vomiting
and if the client is hungy,
try to feed in small
amounts of bland diet
(example) for 24-48 hours
after the last period of
vomiting.
When the client can
tolerate bland food, client
can resume normal diet.
-------
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Dependent:
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Administer parenteral
fluids as prescribed.
- if vomiting persists, IV
infusion is used to
achieve rehydration.
Admister anti emetic as
ordered
Source: https://nurseslabs.com
Outcome
Assessment Diagnosis Planning Intervention Evaluation
Identification
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- Dry lips After 3 days of intervention, the
-Restlessness nursing client defecated
Evaluate the pattern of
-Sunken eye intervention, formed soft
defecation.
-Poor skin turgor the client will stool daily.
- Defecation pattern can
defecate
promote immediate treatment.
Vital Signs taken formed soft
as: stool daily. Goal was met.
T: 38.6 C Assess for abdominal pain,
PR: 120 bpm abdominal cramping,
RR: 28 cpm hyperactive bowel sounds.
BP: 90/70 mmHg - These assessment findings are
commonly connected with
diarrhea.
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used for treating the diarrhea
of gastroenteritis.
Source: https://nurseslabs.com/gastroenteritis-nursing-care-plans/
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Email: nursing@neust.edu.ph
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Republic of the Philippines
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Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION EVALUA
IDENTIFICATION
Subjective: Hyperthermia The client will Short term: Independent: After 1 hour o
related to maintain normal body Establish rapport nursing interv
“Pagkagising ng anak dehydration as temperature. *After 1 hour of To gain trust and the patient’s
ko ay mainit na siya” as evidenced by performing promote cooperation temperature
verbalized by the elevated body nursing with the client. decreased to
mother of the client. temperature. intervention, the
patient’s *Monitor Vital signs.
Objective: temperature will To provide more
decrease from accurate indication After 4 hours
hot, flushed skin nursing interv
38.6C to 37.5C. of core temperature.
warm to touch the patient’s v
*Provide tepid signs returned
increased sponge bath. normal range
respiratory rate. Long term: TSB helps in
lowering the body
Vital signs: After 4 hours of temperature.
performing The goal was
Temp: 38.9 C nursing *Encourage ample
intervention, the fluid intake by
PR: 120bpm
patient’s vital mouth.
RR; 26cpm signs will return to the patient is
normal range: a dehydrated ,
BP: 90/70mmHg temperature of therefore fluid loss
36.5C to 37.5C, a contributes to fever.
pulse rate of 60-
100bpm and a *Promote a well
ventilated room
respiratory rate of
Opening the window
12-20cpm.
can supply fresh air
for the patients that
can help them to
improve their health.
Dependent:
*Administer anti-
pyretic medication as
prescribed by the
physician.
Antipyretic
medication are used
to treat fever by
reducing body
temperature.
Source:https: //nurseslabs.com/gastroenteritis-nursing-care-plans/
Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CHAPTER V
DRUG STUDY
NAME OF THE MECHANISM DOSAGE INDICATIONS CONTRAINDICATIO ADVERSE NURS
DRUG OF ACTION NS EFFECT CONSIDE
Generic name: Acts as Prevention of Metoclopramide is con Drowsiness Before:
Metoclopramide antiemetic by 1-3 years- nausea/ traindicated in children Restlessnes -Observe t
blocking 1 mg vomiting aged less than 1 year. s rights of dr
Brand name: dopamine (1ml) PO due to an increased Rash administra
Reglan receptors and risk of extrapyramidal Seizures -Assess for
promotes GI 3-5 years- disorders Swelling to metoclo
motility by 2 mg (especially -Assess for
Classification: enhancing the (2ml) PO hands and contraindic
Antiemetic response to feet)
GI stimulant acetylcholine 5-9 years- Constipatio During:
of tissue in 2.5 mg n or - Monitor
upper GI tract (2.5ml) diarrhea carefully d
causing PO administra
enhanced - Monitor f
motility and extrapyram
accelerated reactions, a
gastric consult phy
emptying they occur
without -For IV inf
stimulating give over a
gastric, biliary, minutes.
or pancreatic
secretions and After:
increases lowe -Educate th
esophageal parents abo
sphincter tone possible si
-Disposed
materials p
Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
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Republic of the Philippines
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ISO 9001:2015 CERTIFIED
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Name of Mechanism of Adverse Nursing
Dosage Indication Contraindication
Drug Action Effects Consideration
Generic Children 2- Contributes to the Acute Ascertained No known Before:
Name: 11 years: recovery of the diarrhea hypersensitivity adverse -Observe the 12
1-2 vials of intestinal with towards the effects. rights of drug
Bacillus administration
2 billion/ 5 microbial flora duration of components of
Clausii
mL altered during the <14 days the product.
suspension course of due to -Check and verify
with doctor’s order
microbial infection,
Brand Name: and Kardex.
disorders of drugs or
Route:
Erceflora diverse origin. It poisons. During:
Oral produces various Chronic or -Administer drug
vitamins, persistent orally.
particularly group diarrhea
Classification:
Frequency: B vitamins thus with After:
Anti- contributing to duration of
diarrheal OD correction of >14 days. -Monitor patient for
vitamin disorders any unusual effects
caused by from drug.
antibiotics &
chemotherapeutic -Disposed of used
agents. Promotes materials properly
normalization of
intestinal flora.
Source: https://www.mims.com/philippines/drug/info/erceflora?type=full
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Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
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neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Source: https://www.mims.com/philippines/drug/info/calpol?type=full
CHAPTER VI
Evaluation and Findings
After conducting the study, the student-nurses were able to appreciate more the essence of
utilizing the nursing process by providing clinical care and management for the pediatric client. Acute
diarrhea is an abrupt increase in recurrence and changes in consistency of stools. Infants and children are
in danger or at risk for the development of dehydration and malnutrition which is two significant
outcomes of the diarrhea.
Acute Gastroenteritis is an inflammation of the gastrointestinal tract in both the stomach and
small and large intestine. The digestive system is concerned with digestion and absorption of food.
Therefore, the inner lining of the digestive tract serves as a protective barrier to those indigestible and
harmful materials while allowing for the specific absorption of nutrients across the wall of the digestive
tract. Once across the wall of the digestive tract, the nutrients enter the blood and are distributed to the
tissues of the body.
Early accurate detection is important to improve patient outcomes. This study provides the
student-nurses a huge knowledge and understanding with regards on taking good care of a pediatric client
in the real clinical setting and taught the student-nurses to provide client’s care more efficiently and
competently to achieve an effective and quality nursing care.
Recommendation
Children who are old enough should be taught to wash their hands and avoid improperly stored
food and contaminated water.
All of the food that is placed out for consumption should be consumed within an hour.
Parents should encourage their child to drink fluids even if just in small frequent amounts.
Parents should not allow their children to swim in public water if they have diarrhea.
Children who are vomiting should be given small amounts of fluid to prevent dehydration.
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Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
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ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Infants and children with weakened immune system should not touch reptiles, birds or
amphibians because these types of animals typically carry salmonella bacteria that can cause
severe infection and diarrhea.
Parents should teach their children to avoid swallowing of water when they swim.
References:
Introduction
https://doh.gov.ph/sites/default/files/publications/CPG%20AID_Full%20version.pdf
https://pedsinreview.aappublications.org/content/33/11/487
https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-gastroenteritis
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Email: nursing@neust.edu.ph
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neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Nursing management
https://nurseslabs.com/gastroenteritis/
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