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A Case Presentation

Acute Gastroenteritis

Presented by:

Cabrera, Claire Anne Marie

Cabunilas, Edlyn Gay

Cajegas,Mae Ann

Callora, Ruby Jane

Celiz, Leah Caressa L.

Capuyan, Lea P.

Presented to:

Alistair Campos R.N.

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ACKNOWLEDGEMENT:

This case presentation will not be possible without the graces and guidance of

our Almighty Father.

We would also like to thank the staff of Southern Philippines Medical Center

especially the Pedia Ward for the knowledge and information they have shared to us.

To the family of our client who willingly shared to us all the needed information.

To our clinical instructors, whose clinical experience inspires us in this

profession.

To our families, whose love and unending support continues to encourage us.

To our friends and group mates, who are our companions in this chosen field.

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INTRODUCTION:

Gastroenteritis (also known as gastric flu or stomach flu, although unrelated

to influenza) is inflammation of the gastrointestinal tract, involving both the stomach andthe small intestine and resulting in acute diarrhea. It can be transferred by contact with

contaminated food and water. The inflammation is caused most often by

an infection from certain viruses or less often by bacteria, their toxins, parasites, or

an adverse reaction to something in the diet or medication. Worldwide, inadequate

treatment of gastroenteritis kills 5 to 8 million people per year, and is a leading cause of

death among infants and children under 5.

At least 50% of cases of gastroenteritis due to food borne illness are caused

by norovirus. Another 20% of cases, and the majority of severe cases in children, aredue to rotavirus. Other significant viral agents include adenovirus and astrovirus.

Different species of bacteria can cause gastroenteritis,

including Salmonella, Shigella, Staphylococcus, Campylobacter

jejuni , Clostridium, Escherichia coli ,Yersinia, Vibrio cholerae, and others. Some sources

of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and

bakery products. Each organism causes slightly different symptoms but all result in

diarrhea. Colitis, inflammation of the large intestine, may also be present.

Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers

to become infected during times of rain as a result of contaminated runoff water.[

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OBJECTIVES

General Objective:

To obtain an understanding of what acute gastroenteritis is.

Specific Objectives:

1. To know the causes of having acute gastro enteritis

2. To know the anatomy and physiology of the body organ involve in acute gastro

enteritis

3. To understand the pathophysiology of acute gastro enteritis.

4. To relate our patients chief complain on his condition.

5. To improve ourselves in making Nursing care plan.

6. To relate medication and other medical procedure.

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IDENTIFICATION OF THE CASE

Patient¶s code name: Harry Potter

Case #: 2010038954

Ward/Room #: Pedia Ward

Age: 9 months

Nationality: Filipino

Reason for admission: Diarrhoea, Vomiting

Admitting Diagnosis: Acute Gastro Enteritis

Attending Physician: Dr. Fremelle G. Rojo

Date Study began: August 26, 2010

Date Study ended:

Source of information/informant: Patient¶s Chart

Patient¶s Mother

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Family Background:

Erlinda- DM

Cesario

Nino

Brialyn

Alberto

Salome

Marcelo

Crisanto

Marilyn

Regina-Arthritis

Alberto- HPN

Charilyn

Shalina

Reynaldo

Harry Potter

Acute Gastroenteritis

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Socioeconomic Background:

Father: Driver

Monthly Income: more or less 5000

Mother: Housewife

Personal Background:

Baby Harry Potter was born November 4 2009. He was the youngest child of 5

children in the family of G4 P4 mother who was 31 years old. Patient was born via nonspontaneous vaginal delivery at home without assistance of any midwife.

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Medical and Health History/Background:

History of Present illness:

5 days PTA patient has diarrhea which was watery, patient has 2-3

episodes of diarrhea each day. Patient also vomits several times, vomitscontained water and foods as reported.

A. General survey

Baby Harry Poter was lying flat on bed, lethargic with sunken eyeballs, dry

pale lips, and distended abdomen.

B. Vital signs

Date/time PR RR Temp.

08/26/10 at 4:00 pm 130 bpm 37 cpm 37.9°c

08/26/10 at 8:00 pm 118 bmp 30 cpm 37.7°c

C. NUTRITIONAL STATUS

Upon admission, Admitting weight was 7.5kg. Duringour shift patient was

on breast feeding.

D. NEUROLOGIC STATUS

Patient was lethargic as observed by NOD.

E. INTEGUMENTARY SYSTEM

Fine and evenly distributed, thin and dry hair was noted.His nails were in

convex shape, smooth in texture.His skin was pale, dry, with fine and fare

complexion

F. HEENT

The size of head was in proportion with the body. The eyeswithsunken

fontanels.. Ear had no discharges noted. The throatwas functioning well and in

normal condition.

G. PULMONARY SYSTEM

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Respiratory rate was 30cpm and within normal range.

H. CARDIOVASCULAR SYSTEM

Patient¶s CR was 180 bpm which is normal. No murmur

heard upon auscultation. There was no history of cardiopulmonary disease.

I. GASTROINTESTINAL SYSTEM

The abdomen was distended. The patient vomited 5 times a

dayand defecated more than 2-3 times a day with watery stool.

J. MUSCULOSKELETAL SYSTEM

The patient manifested good posture and moved voluntarily.

Weakness was noted.

K. GENITO- URINARY SYSTEM

Patient voided on a full diaper at least 3 times per shift.

DEVELOPMENTAL TASK

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Developmental stages:

Developmental theories:

It provides a framework for examining, describing and appreciating human

development.

I -Sigmund Freud (psychoanalytic model of personality development states)

-the first person to provide a formal structured theory of personality

development.

-describes human development from the perspectives of personality,

thinking and behaviour. It explains development in terms of inner drives

and motives that are primarily unconscious and influence every aspect of

an individual thinking and behaviour.

Stage 1: Oral (birth -18 mons)

-initially sucking and oral satisfaction are not only vital to life, but also

extremely pleasurable in their own rights.

-the infant begins to realized that the mother/parent something separate

from self.

II -Erik Erikson (Psychosocial Development)

-individuals need to accomplish a particular task before successfully

mastering the stage and progressing to the next one.

Trust vs. Mistrust (birth to 1 yr)

-the infant¶s successful resolution of the stage requires a consistent

caregiver who is available to meet his needs.

-the infant is able to trust him or herself in others and in the world.

III - Jean Piaget (cognitive Development)

Period 1: sensorimotor (birth-2yrs)

- The infant develops the schema or action pattern for dealing with the

environment. It includes hitting, looking, grasping, or kicking.

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DEFINITION OF TERMS:

Acute Gastroenteritis (AGE)

is a catchall term for infection or irritation of the digestive tract, particularly the

stomach and intestine. It is frequently referred to as the stomach or intestinal flu,

although the

influenza virus is not associated with this illness. Major symptoms include nausea and

vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also

accompanied

by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults

usually

recover without problem, but children, the elderly, and anyone with an underlying

disease are

more vulnerable to complications such as dehydration.

Diarrhea

is defined as a change from normal bowel habits evidence by increased

frequency, amount, and water content of stools. It can be classified as acute or chronic

and is attributed to a multitude of causes. Acutediarrhea is self limiting to its caused, but

chronic diarrhea is considered when symptoms last longer than 3-4 weeks

Dehydration

It occurs in the body loses more water than it takes in. Is particularly common in

older people, becausetheir thirst centre does not function well therefore, an older

persons may not recognize that she or he is becoming dehydrated, at first dehydration

stimulates thirst centre of the brain, causing the person to drink more fluids, if water

intake cannot keep up with water loss, dehydration becomes severe, if dehydration

continuous, tissues of the body begin to dry out, and cells begin to shrivel and

malfunction.

Vomiting

Is a forceful contraction of the stomach that propels its content up to the

oesophagus and out through the mouth. Vomiting usually occurs with nausea and can

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be cause by any of the conditions that cause nausea. Vomiting serves to empty the

stomach of its contents and often makes a person with nausea feel considerably better,

at least temporary.

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ANATOMY AND PHYSIOLOGY:

Anatomy of the digestive system

If a human adult¶s digestive tract were stretched out, it would be 6 to 9 m (20to

30 ft) long. In humans, digestion begins in the mouth, where both

mechanicaland chemical digestion occur. The mouth quickly converts food into a soft,

moist mass. The muscular tongue pushes the food against the teeth, which cut,

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chop, andgrind the food. Glands in the cheek linings secrete mucus, which lubricates

the food,making it easier to chew and swallow. Three pairs of glands empty saliva into

themouth through ducts to moisten the food. Saliva contains the enzyme

ptyalin, whichbegins to hydrolyze (break down) starch²a carbohydrate manufactured

by greenplants.Once food has been reduced to a soft mass, it is ready to

be swallowed. The

tongue pushes this mass²called a bolus²to the back of the mouth and into

thepharynx. This cavity between the mouth and windpipe serves as a passageway

bothfor food on its way down the alimentary canal and for air passing into

the windpipe.The epiglottis, a flap of cartilage, covers the trachea (windpipe) when a

personswallows. This action of the epiglottis prevents choking by directing food from

thewindpipe and toward the stomach

Mouth

The mouth plays a role in digestion, speech, and breathing. Digestion begins when food

enters the mouth. Teeth break down food and the muscular tonguepushes food

back toward the pharynx, or throat. Three salivary glands²thesublingual gland,

the submandibular gland, and the parotid gland²secrete enzymesthat partially digest

food into a soft, moist, round lump. Muscles in the pharynxswallow the food, pushing it

into the esophagus, a muscular tube that passes foodinto the stomach. The epiglottis

prevents food from entering the trachea, orwindpipe, during swallowing.

Esophagus

The presence of food in the pharynx stimulates swallowing, which squeezesthe food

into the esophagus. The esophagus, a muscular tube about 25 cm (10 in)long, passes

behind the trachea and heart and penetrates the diaphragm (muscular wall between

the chest and abdomen) before reaching the stomach. Food advancesthrough

the alimentary canal by means of rhythmic muscle contractions(tightenings) known as

peristalsis. The process begins when circular muscles in theesophagus wall

contract and relax (widen) one after the other, squeezing fooddownward toward

the stomach. Food travels the length of the esophagus in two tothree seconds.

A circular muscle called the esophageal sphincter separates

the esophagusand the stomach. As food is swallowed, this muscle relaxes, forming an

openingthrough which the food can pass into the stomach. Then the muscle

contracts,closing the opening to prevent food from moving back into the esophagus.

Theesophageal sphincter is the first of several such muscles along the alimentary

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canal.These muscles act as valves to regulate the passage of food and keep it

frommoving backward

Stomach

The stomach, located in the upper abdomen just below the diaphragm, is asaclikestructure with strong, muscular walls. The stomach can expand significantlyto store all

the food from a meal for both mechanical and chemical processing.

Thestomach contracts about three times per minute, churning the food and mixing itwith

gastric juice. This fluid, secreted by thousands of gastric glands in

the lining ofthe stomach, consists of water, hydrochloric acid, an enzyme called

pepsin, andmucin (the main component of mucus). Hydrochloric acid creates the acidic

environment that pepsin needs to begin breaking down proteins. It also

killsmicroorganisms that may have been ingested in the food. Mucin coats

the stomach,protecting it from the effects of the acid and pepsin. About four hours or

less after ameal, food processed by the stomach, called chyme, begins passing a littleat atime through the pyloric sphincter into the duodenum, the first portion of

the small intestine

Liver

The liver is the largest internal organ in the human body, located at the top

ofthe abdomen on the right side of the body. A dark red organ with a spongy

texture,the liver is divided into right and left lobes by the falciform ligament.

The liverperforms more than 500 functions, including the production of a

digestive liquidcalled bile that plays a role in the breakdown of fats in food. Bile fromthe liverpasses through the hepatic duct into the gallbladder, where it is

stored. Duringdigestion bile passes from the gallbladder through bile ducts to the small

intestine,where it breaks down fatty food so that it can be absorbed into the body.

Nutrient-rich blood passes from the small intestine to the liver, where nutrients are

furtherprocessed and stored. Deoxygenated blood leaves the liver via the hepatic vein

toreturn to the heart.

Small Intestine

Most digestion, as well as absorption of digested food, occurs in the smallintestine. This

narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most ofthe lower

abdomen, extending about 6 m (20 ft) in length. Over a period of three tosix hours,

peristalsis moves chyme through the duodenum into the next portion ofthe small

intestine, the jejunum, and finally into the ileum, the last section of thesmall intestine.

During this time, the liver secretes bile into the small intestinethrough the bile duct. Bile

breaks large fat globules into small droplets, whichenzymes in the small intestine can

act upon. Pancreatic juice, secreted by thepancreas, enters the small intestine through

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the pancreatic duct. Pancreatic juicecontains enzymes that break down sugars

and starches into simple sugars, fats intofatty acids and glycerol, and proteins into

amino acids. Glands in the intestinal wallssecrete additional enzymes that break down

starches and complex sugars intonutrients that the intestine absorbs. Structures called

Brunner¶s glands secretemucus to protect the intestinal walls from the acid effects of

digestive juices.

The small intestine¶s capacity for absorption is increased by millions offingerlike

projections called villi, which line the inner walls of the small intestine.Each villus is

about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a singlelayer of cells. Even

tinier fingerlike projections called microvilli cover the cellsurfaces. This combination of

villi and microvilli increases the surface area of thesmall intestine¶s lining by about 150

times, multiplying its capacity for absorption.Beneath the villi¶s single layer of cells

arecapillaries (tiny vessels) of thebloodstream and the lymphatic system. These

capillaries allow nutrients producedby digestion to travel to the cells of the body. Simple

sugars and amino acids passthrough the capillaries to enter the bloodstream. Fatty

acids and glycerol passthrough to the lymphatic system.

Large Intestine

A watery residue of indigestiblefoodand digestive juicesremainsunabsorbed. This

residue leaves the ileum of the small intestine and moves byperistalsis into

the large intestine, where it spends 12 to 24 hours. The largeintestine forms an inverted

U over the coils of the small intestine. It starts on thelower right-hand side of

the body and ends on the lower left-hand side. The largeintestine is 1.5 to 1.8 m (5 to 6

ft) long and about 6 cm (2.5 in) in diameter.

The large intestine serves several important functions. It absorbs water²about 6 liters

(1.6 gallons) daily²as well as dissolved salts from the residue passedon by the small

intestine. In addition, bacteria in the large intestine promote thebreakdown of

undigested materials and make several vitamins, notably vitamin

K,which the body needs for blood clotting. The large intestine moves its

remainingcontents toward the rectum, which makes up the final 15 to 20 cm (6 to 8

in) of thealimentary canal. The rectum stores the feces²waste material that consists

largelyof undigested food, digestive juices, bacteria, and mucus²until

elimination. Then,muscle contractions in the walls of the rectum push the feces towardthe anus.When sphincters between the rectum and anus relax, the feces pass out of

the body.

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Pancreas

Is an organ that contains two basic types of tissue: the acini, which produce digestive

enzyme, and the islets, which produce hormones. The pancreas secretes digestives

enzymes into the duodenum and hormones in the blood stream. The digestive enzymes

such as amylase, lipase, and trypsin are release from the cells off the acini and flowdown various channels into the pancreatic duct. The Pancreatic duct joints the common

bile ducts at the sphincter of oddi, where both flow in the duodenum he enzymes are

secreted in an inactive form. They are activated only when they reach the digestive

tract. Amylase digests carbohydrates; lipase digest fats and trypsin digest proteins. The

pancreas also secretes large amount of sodium bicarbonate, which protects the

duodenum by neutralizing the acid that comes from the stomach.

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Predisposing Factors Precipitating Factors

>Environment >

Age(9mos)

>Hygiene>Gender(male)

>Stress

pathogens c

Ingestion of E.coli

Invasion of Gastic

Mucosa.

Toxins producing

watery largevolume diarrhea.

S/Sx:

y Watery stooly Fever

Irritation of the

gastric lining.

Fluid and electrolyte imbalance too much Na and H2O

are expelled from the body.

Increase fluid loss

Dehydration

S/Sx:

y Vomiting

S/Sx:

y Decreased skin turgor

y Sunken Eyes

Penetration of

gastric mucosa.

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If treated:

Diagnostic test:

Fecalysis

-to identify the causative agent.

CBC

-to determine iron deficiency anemia,

and insufficient amount of haemoglobin. To

evalutes the numbers of WBC.

Platelets

-use to measure bloods protective

mechanism.

Medical Management:

-give medications zinc,

metoclopramide, and paracetamol.

-advice low fiber diet and increase

fluids, this contributes to adding bulk to stool

which decrease risk of dehydration.

-oral rehydration therapy.

-IV therapy of D5LR .3% at 31cc/hr.

-VSq4

Nursing management:

-monitor VS

-advice bed rest

-monitor fluid intake output.

-administer medications as ordered.

-maintain careful hygiene.

-replace fluid loss by OFI

-TSB if patient is febrile.

If not treated:

diarrhea

Dehydration

Weight loss

Loss of appetite to feed

Generalized body

weakness/lethargy

Immobility

Bedridden

Infection due to 3rd

degree of

Ulceration

Pallor, hypoxia

Coma

Death

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MEDICAL MANAGEMENT:

LABORATORY

CBC Fecalysis Platelet

y Chemistry y Result y Unit y Range

y Cl y 108.9 y mmol/L y 101.0-111.0

y Na y 131.90 y mmol/L y 136.00-155.00

y K y 2.16 y mmol/L y 3.5-5.5

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DRUG STUDIES

Zinc (Zinc sulphate)

Zinca- Pak

Action:

Participate in synthesis and stabilization of proteins and nucleic acids in

subcellular and membrane transport system.

Indications and dosages:

Prevention of individual trace elements deficiencies in patients receiving longterm total parenteral nutrition.

Zinc

Full term infants and children younger than age 5: 100 mcg/kg/day.

Adverse Reaction:

Hypersensitivity to reactions to iodides

Interactions:

Non significant

Contraindications:

Contraindicated in patients hypersensitive to iodine.

Nursing consideration:

Check serum levels of trace elements in patients who have received TPN for two

months or longer. Give supplement, if ordered.

Report low levels of this elements.

Normal serum level 88-112mcg/dl zinc

Solution of trace elements are compounded by pharmacies for addition to TPN

solutions, according to various formulas

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Explain the need for zinc administration to patient and family.

Inform family members the trace elements are normally received from dietary

intake.

Acetaminophen (APAP, paracetamol)

Tempra

Action:

Unknown. Thought to produce analgesia by blocking generation of pain

impulses, Probably by inhibiting prostaglandins synthesis in the CNS or the synthesis or

a action of other substances that synthesized pain receptors to mechanical or chemical

stimulation. It¶s thought to relieved fever by central action in the hypothalamic heat

regulating centre.

Indication and dosages

PO

Children ages 4-11 months: 80mg PR Q4 4-6 hours PRN.

Adverse reactions:

Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia.

Hepatic: Liver damage, jaundice

Metabolic: hypoglycaemia

Skin: Rush, urticaria

Cotraindications:

Patients Hypersensitivity to drugs.

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Nursing Consideration:

Use liquid form for children or patients who have difficulty in swallowing.

Acetaminophen may produced false positive decreased in glucose level in home

monitoring system; drug may cause a false positive test result for urinary 5hydroxyindoleacetic acid.

Tell parents to consult prescriber before giving drug and not to used for marked

fever higher than 39.5° persisting longer than 3 days or recurren fever uless directed by

prescriber.

Warn parents High dosage unsupervised may caused hepatic damage.

Generic Name: Metoclopramide

Maxolon

Anti-emetic, GI stimulant

Dosage: 1 amp q 8 hours

Route: IV

Indication:

y Disturbances of GI motility.

y Relief of symptoms of acute and recurrent diabetic gastroparesis.

y Nausea and vomiting

y Metabolic diseases

y Short term for adults w/ symptomatic gastroensophageal reflux who fail to respond to

convention null therapy.

y Prophylaxis of post operative nausea & vomiting when nasogastric suction is undesirable.

Contraindications:

y Allergy to Metoclopramide

y GI hemorrhage

y Mechanical obstruction or perforation

y Epilepsy

y Use cautiously w/ previously detected breast cancer, lactation, pregnancy, fluid overload and

renal impairment

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Action:

Stimulates motility of upper GI tract w/o stimulating gastric, balliary or pancreatic secretions; appears to

synthesize tissues to action of acetylcholine; relaxes pyloric sphincter w/c when combined w/ effects on

motility, accerlerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility;

increases lower esophageal sphincter pressure; has sedative properties induces release of prolactin.

Side effects:

CNS:

Restlessness, Drowsiness, Fatigue, Insomnia, Dizziness, Anxiety

CV:

Transient Hypertension

GI:

Nausea & Diarrhea

Nursing Considerations:

y Monitor BP carefully during IV administration

y Monitor diabetic pts, arrange for alterations in insulin dose or timing if diabetic control is

compromise by alterations in food absorption.

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NURSING THEORY/IES APPLICABLE TOTHE CASE PRESENTED

Florence Nightingales¶s Environmental Theory

Defined Nursing: ³ The act of utilizing the environment of the patient to assist him in his recovery.´

Focuses on changing and manipulating the environment in order to put

the patient in the best possible conditions for nature to act.

Identified 5 environmental factors: fresh air, pure water, efficient

drainage, cleanliness/sanitation and light/direct sunlight.

Considered a clean, well-ventilated, quiet environment essential for recovery.

Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing

environment, the body could repair itself.

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DISCHARGE PLAN

Clients with Acute Gastroenteritis, watchers are instructed to take

the following plan for

discharge:

M- Medications should be taken regularly as prescribed , on exact dosage, time, &

frequency,

making sure that the purpose of medications is fully disclosed by the health care

provider.

E- Exercise should be promoted in a way by stretching hand and feet every

morning andexercise burping every after bottle feeding.

T- Treatment after discharge is expected for patients and watcher with Acute

Gastroenteritisto fully participate in continuous treatment

H-Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of

personal hygiene should be encouraged such as, daily bathing and changing of diapers

when soiled.

O- OPD such as regular follow-up check-ups should be greatly encouraged to clients

wather

with Acute Gastroenteritis as ordered by physician to ensure

the continuing management

and treatment.

D- Diet should be promoted, since, during admission, the patient was on NPO. Proper

selection of milk that are suitable for babies will help enhance

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JOURNAL UPDATE:

Rotavirus Vaccine Greatly Reduces Hospitalizations for Acute Gastroenteritis in

Children. Study FindsScienceDaily (May 14, 2010) ² Vaccinating infants against rotavirus, a leading causeof severe diarrhea and dehydration among babies and young children, was associatedwith a dramatic decline in U.S. hospitalization rates for acute gastroenteritis. Thefindings appear in a study, now available online, published in the June 1 issue of T heJournal of Infectious Diseases.

Worldwide, rotavirus infection is estimated to cause more than 500,000 deaths eachyear. Before a vaccine was introduced, the virus led to an estimated 55,000 to 70,000hospitalizations in the U.S. annually. A vaccine, RotaTeq, was licensed for use in the

U.S. and recommended for routine use in infants in 2006.In this study, Aaron T. Curns, MPH, and colleagues at the Centers for Disease Controland Prevention (CDC) and the Agency for Healthcare Research and Quality examinedhospitalization rates for acute gastroenteritis during the typical rotavirus season amongU.S. children under 5 years of age. They compared these rates over two periods: from2000 to 2006, before the rotavirus vaccine was introduced; and after, from 2007 to2008.Using hospital discharge data from 18 states accounting for almost 50 percent of theU.S. population, researchers compared the median hospitalization rate for gastroenteritis from all causes during the two time periods. Researchers considered themonths January through June to be the rotavirus season.

Hospitalization rates for gastroenteritis were 16 percent lower in 2007 and 45 percentlower in 2008 compared with rates before the vaccine was introduced. During 2008,infants aged 0-2 months had a 28 percent reduction, while those 6-23 months of agehad a 50 percent reduction. Rates among children aged 3-5 months and 24-59 monthsdeclined between 42 percent and 45 percent. The researchers estimated thatapproximately 55,000 acute gastroenteritis hospitalizations were prevented during the2008 rotavirus season because of vaccination. Hospitalization rates during this seasonwere substantially diminished with rates one-half to two-thirds lower at peak activitycompared to previous seasons.The researchers noted that the observed declines in hospitalizations exceeded their estimates and also occurred among age groups that were too young or too old toreceive the vaccine, suggesting that these children may have been protected by the"herd immunity" caused by their peers being vaccinated.In an accompanying editorial, Geoffrey A. Weinberg, MD, and Peter G. Szilagyi, MD,MPH, of the University of Rochester School of Medicine & Dentistry in New York,highlighted the importance of such vaccine effectiveness studies, which provide a real-world view that can improve the planning of public health initiatives. An advantage of thestudy design is its analysis of how well vaccination works within a population, theywrote.

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"These encouraging findings are important for emphasizing the benefits and increasingthe acceptance of rotavirus vaccination in the United States and will also help other countries assess the value of rotavirus vaccines for their children," the researchers said.In light of the study's results, "it remains essential to continue monitoring acutegastroenteritis hospitalization rates during subsequent rotavirus seasons to fully

understand and document the impact of vaccination as the program matures in thiscountry

Bibliography

Infectious Diseases Society of America (2010, May 14). Rotavirus vaccine greatly

reduces

IMPLICATION

Nur

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This can b ̈ use as a guide f © r practice by © ther nurses. They can g et

relev ant ideas in g iving pr © per care and inter ventions to their patients w ith

related illness or those w ho ha ve the sa e problem.

Nur

ucation

This study may ser ve as a helpful learning tool f or student nurses. They

may utilize this complied study as their ref erence f or research; this can also g ive

them g ood examples of nursing manag ements, and nursing diagnoses, w hich

w ill be a very useful guide w hen the w ill be mak ing their o wn Nursing care

Plans.

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Nur ing

arch

Students may use this compilation as their guide f or research. This w ill

hand them g ood vie w s and factual ideas w hich w ill be very essential f or their

added learning on kno wledg e f or AGE.

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EVALUATION

The case presentation is done but our client is still facing the big question of

w hat w ould be the outcome of her situation. W e started this study w hen everything

was just starting , the laboratory results was still pending and unf ortunately w e do not

ha ve the luxury of time to be w ith here, study her condition more and be there

w itnessing her hopeful recovery .

The case is still hang ing ; it is undone and can only be done w hen she·ll

be out of the hospital, free from such disease. Basing our case study that soon

to be presented, the client is manif esting signs and sy mptoms of a person

ha ving AGE basing the socio economic of the parents, it cannot sustain further

diagnostic exams and medications as stated by the mother they w ere not able to

allocate f inances to f or the hospitalization of their son.

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REFERENCES

NANDA by Marilyn E. Doenges, Alice Murr (2008) Nurses Pocket Guide Diagnoses, Prioritized

Interventions and Rationales. 11th

edition: Philadelphia, Pennsylvania: FA Davis Company

Medical Surgical by Bruner and Suddarths.

Merck Manual of medical Information by Mark H Beers, MD Anatomy and Physiology by Marieb

Pathophysiology by Silly.

Drug Handbook by Lippincott Williams and Wilkins (23 edition)

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