According to Walsh & Crumble, (2012), the organism invades the enterocytes in the villus epithelium through foods and multiplies rapidly, altering the body’s immune system response to infection resulting in inflammatory reactions. The infection then results in transudation of fluids into the intestinal lumen and the bowel reacts to the infections with hypermotility producing severe diarrhea. Bacteria also cause gastroenteritis by several mechanisms through ingestion of contaminated foods. Examples are Escherichia coli, Clostridium deficit, and Staphylococcus aureus adhere to the intestinal mucosa and produce enterotoxins. These toxins impair interstitial absorption and cause bleeding and secretion of electrolytes and water. The resulting diarrhea contains blood parasites like giardia and cryoperelium invade the interstitial mucosa causing diarrhea. It is acquired through person-to-person transmission.
Beers (2011) stated that gastroenteritis can be basically divided into three main groups which are;
- Acute gastroenteritis
- Chronic gastroenteritis
- Toxic gastroenteritis
This may develop in acute illness especially when the patient has had a major traumatic injury like bums and severe infections. The ingestion of irritating food as hot pepper can cause acute gastroenteritis. Excessive intake of alcohol and hypersensitivity to food such as gluten and cow milk can lead to this condition. It may also be secondary to infections like malaria, pernicious anemia among others. Acute gastroenteritis is characterized by severe abdominal cramps, nausea, vomiting, fever, general malaise, and diarrhea.
This is caused by intestinal infections caused by recurring exposure to irritating substances such as surgical alterations such as short bowel syndrome which reduces the size of the colon leading to decrease anal status like anxiety or depression over a period of time can lead to chronic gastroenteritis. Chronic gastroenteritis is characterized by nausea, vomiting, anorexia, diarrhea, dyspepsia, nonspecific fever, hiccup, and dehydration.
It occurs as a result of ingestion of irritants or corrosive poisons and substances that counteract the protective function of the mucosal lining of the gastrointestinal tract. Ingestion of poison like mercury, ammonia, and carbon dioxide can lead to the condition. Drugs like aspirin and other non-steroidal anti-inflammatory drugs, cytotoxic agents, caffeine, corticosteroids, and indomethacin when taken in large doses can lead to toxic gastroenteritis. Endotoxins released from infecting bacteria such as Escherichia coli, staphylococcus aureus, or salmonella can lead to this condition. Toxic gastroenteritis is characterized by nausea, vomiting, anorexia, diarrhea, fever, malaise, and dyspepsia.
According to Boyce (2014) following are the signs and symptoms of gastroenteritis;
- Nausea and vomiting
- Loss of appetite
- Abnormal flatulence
- Abdominal pains
- Abdominal cramps
- Bloody stools (dysentery – suggesting infection by amoeba, Salmonella, Shigella, Campylobacter, or some pathogenic strains of Escherichia coli.
- Fainting and Weakness
LeMone & Burke (2014) indicated that in severe cases;
- Dehydration comes as a result of excessive vomiting and the frequent passing of watery stools.
LeMone, Burke, Bauldoff & Gubrud (2011) stated that;
Stool culture (by direct rectal swab) can be used to identify the causative organism.
Stool Microscopy for ova or parasite
Gram stain of vomitus may reveal Staphylococci in Staphylococcus food poisoning.
A blood culture may be performed to assess for bacteremia with suspected infection of the gastrointestinal tract.
Blood serum examination may reveal the presence of suspected toxins especially if botulism is present.
According to Walsh & Crumble (2012), Gastroenteritis when acute must be treated as a medical emergency for the following reasons,
- To avoid the complications of the disease.
Hospitalization may be needed as the patient requires support treatment consisting of bed rest, nutritional support, and increase fluid which needs monitoring. Histamine-receptor antagonists such as cimetidine may be prescribed as they block gastric secretion. Antacids may be used as buffers which can be administered hourly to the situation. Analgesics may also be given for abdominal pains.
Anti-emetics, for example, Phenergan is given to reduce vomiting. Intravenous fluids and electrolytes replacement, bismuth-containing compounds such as prochlopauzine, or benzamide can be given. The intravenous fluids which are normally given are normal saline, dextrose saline, and ringers lactate.
According to Beers (2011), the following are the management of gastroenteritis.
The nursing management are put under the following headings,
- Comfort and rest
In order to promote rest and comfort for client there is the need to perform the following
activities for the patient.
- Promote period of rest during symptomatic stages according to the level of fatigue.
- Maintain a well straighten bed, free of creases and cramps to promote comfort.
- Emotional support and divisional activities are necessary especially when recovery and convalesces are prolonged.
- Encourage gradual resumption of activities and mild exercise during convalescence period. They should however be planned not to interfere with rest period.
- Administer prescribed analgesics to relieve pain.
- Maintain adequate nutrition.
It is always difficult for the patient to take in sufficient food and fluids due to the nausea and vomiting. If patient cannot tolerate fluids orally, then intravenous fluids should be
instituted. If patient cannot eat, replace the lost fluids and electrolytes with light soup as
tolerated by the patient. There is a need to varied client’s food to make it enjoyable. Client
should be allowed to eat the food of her choice but is advisable to avoid milk and milk
products as it precipitate the reoccurrence of the condition. Restore normal body weight
by maintaining a well balance diet rich in calories, protein, and vitamins.
- Personal hygiene.
The nurse should always wash hands thoroughly before and after carrymg out any procedure on the patient to prevent the spread of infection. The nurse should always teach
client on ways to maintain personal hygiene. Advice client to eat food cooked from home
rather than buying from outside to minimize infections. Patient should be instructed to
wash hands immediately after visiting toilet and before and after handling food. Client
should always avoid the use of contaminated water food and also avoid eating raw fruits
and vegetables without washing them.
According to Walsh & Crumble (2012),
- Teach the patient about gastroenteritis, describing its symptoms and varied causes.
- Explain why stool specimen may be necessary for diagnosis and the purpose of the prescribed treatment.
- Instruct patient to wait until diarrhoea subsides before resuming the intake of fruit juice, tea among others.
- Tell patient to limit foods that are spicy or high in roughages or raw fruits or vegetables, explain that those foods can precipitate diarrhoea.
- Review the proper use of prescribed drugs and ensure that patient understands the desired effects and possible adverse effects.
- Teach preventive measures and proper measures to prevent recurrence and if the patient expects to travel, advise patient to pay close attention to what she eats and drinks especially in developing nations.
- Instruct patient and family to thoroughly cook foods especially pork and to refrigerate perishable foods like milk, to wash hands with warm water and soap before handling food especially after visiting the bathroom.
- Instruct patient and family to thoroughly clean utensils and eliminate flies and cockroaches from the home.
This is the act of ensuring that data is collected on the health needs of patients and verifying their validity in order to free them from errors, bias and misinterpretations.
Data collected from patient, family members, health records as well as literature reviewed were valid and accurate. Hence Mrs. H.F. diagnosis is true as she presented with signs and symptoms of Gastroenteritis and confirmed by the laboratory investigations.