Case study - Gastroenteritis: Nursing

Nurse Mai works in an emergency care setting and is caring for Jay, a 45 year old patient who presents with a three-day history of nausea, vomiting, and frequent watery diarrhea.

Jay says that he has a fever, crampy abdominal pain, and that he gets weak and dizzy when standing up, which is getting worse.

He also says he's having difficulty tolerating food or drink. He hasn't needed to urinate all day, and when he does, the urine is dark.

Jay adds that his symptoms began 2 days after attending a holiday party where food was shared, and family members who were at the party are also experiencing similar symptoms.

Given Jay's history and symptoms, the healthcare provider suspects acute gastroenteritis, and orders labs to evaluate hydration status, electrolytes, and presence of enteric pathogens.

While awaiting the results of testing, nurse Mai begins planning and implementing care. First, nurse Mai reviews the pathology of acute gastroenteritis, and considers Jay's symptoms.

She recalls that acute gastroenteritis is inflammation of the stomach and intestines, caused by a viral, bacterial, or parasitic infection.

Some of the common pathogens associated with acute gastroenteritis include viruses like norovirus, adenovirus, and enterovirus.

Bacteria such as Staphylococcus aureus, Bacillus cereus, E. coli, and Salmonella, and parasites like Cryptosporidium and Giardia.

Nurse Mai understands that these pathogens are primarily transmitted via the fecal-oral route, which means the pathogen is transmitted through food, water, hands, or objects that are contaminated by the feces of people or animals.

Nurse Mai suspects that Jay consumed food at the holiday party that became contaminated either by poor hygiene, inadequate cooking, or improper storage.

Once the contaminated food is consumed, the infection causes inflammation of the mucous membranes lining the stomach and intestines, leading to increased secretion of fluid into the gut, and frequent watery diarrhea.

Rapid fluid loss from diarrhea can result in dehydration, electrolyte imbalances, hypovolemia, and in severe cases, shock, or even death.

Nurse Mai also recalls that children, older adults, and immunocompromised individuals are at an increased risk of complications from acute gastroenteritis.

Next, nurse Mai obtains Jay's vital signs, which are temperature 100.1 °F, or 37.8 °C, BP, 94/70 millimeters of mercury, heart rate 110 BPM, respirations 20 breaths per minute, and oxygen saturation 97% on room air.

Nurse Mai performs a focused assessment that reveals hyperactive bowel sounds and abdominal tenderness. She also notes signs of dehydration, including delayed capillary refill, decreased skin turgur, and dry mucous membranes.

Nurse Mai, how are you feeling, Jay? Jay, I'm tired.

I feel a little lightheaded and weak, and my stomach hurts. I'm very nauseous.

Can you tell me about your stools? I've had 4 to 5 watery stools every day for 3 days and vomited multiple times.

I can't keep food or water down. Using this information, nurse Maya identifies fluid volume depletion as the priority concern, because dehydration can lead to serious complications, rehydration is nurse May's top priority.

With this problem in mind, Nurse Mai establishes individualized, measurable goals that Jay will maintain a BP above 110/70 millimeters of mercury, and he will have adequate urine output, decreased frequency of watery stools, and less nausea to promote oral intake.

Nurse Mai reviews the healthcare provider's orders, and following the principles of safe medication administration, starts the prescribed IV fluids and electrolytes, administers anti-emetics to control nausea, and antipyretics as needed for pain and fever.

She understands that anti-diarrheals are not routinely administered, since they slow the motility of the gut, which interferes with the body's ability to eliminate the infection.

Lastly, nurse Mai encourages Jay to drink the provided oral fluids as tolerated. Given the infectious nature of gastroenteritis, nurse Mai performs strict hand hygiene with soap and water, and follows standard precautions, including wearing a gown and gloves when providing care.

Throughout her shift, Nurse Mai continues to monitor Jay's vital signs, intake and output, hydration status, abdominal pain, and nausea.

She remains alert for worsening symptoms and knows to report these to the healthcare provider promptly. Toward the end of the shift, nurse Mai evaluates the outcomes of her actions so far.

Jay's vital signs are temperature 98.9 °F, or 37.2 °C, BP is 112/76 millimeters of mercury, heart rate 80 BPM, respirations, 14 breaths per minute, and oxygen saturation 98% on room air.

His urine output has increased and is light yellow, and his stools, while still frequent, are less watery. Although Jay still has some nausea, it has improved, and he's tolerating oral fluids.

Before the end of her shift, nurse Mai reinforces educational materials and reviews key prevention strategies with Jay and his family.

She explains that acute gastroenteritis is an infection that's caused when a pathogen is transmitted via the fecal-oral route, which means that the pathogen from an infected person's stool is ingested by another person.

This usually happens when an infected person doesn't wash their hands well after using the bathroom. The pathogens that linger on their hands can spread to anything they then touch, such as food, surfaces like tabletops, or utensils used to prepare and serve food.

Other people can become infected if they touch those contaminated areas and then eat or touch their mouth without washing their hands first.

Nurse Mai then reinforces proper hand hygiene, including washing hands with soap and water for at least 20 seconds after using the bathroom, and before preparing food.

She also reviews safe food handling practices, such as avoiding raw or undercooked foods, including shellfish, eggs, and unpasteurized dairy products, and ensuring proper storage of perishable items.

Finally, nurse Mai emphasizes the importance of maintaining hydration and seeking medical care if symptoms worsen, persist beyond several days, or if severe dehydration, high fever, or ongoing vomiting occurs.

All right, it's a quick recap. Nurse Mai observed clinical manifestations related to Jay's suspected acute gastroenteritis, including nausea, vomiting, watery diarrhea, abdominal pain, low-grade fever, weakness, and dizziness.

She connected these findings with acute gastroenteritis. Identified priority problems, implemented supportive care, evaluated Jay's response to treatment, and reinforced patient and family education with an emphasis on proper hand hygiene and safe food handling to reduce future risk.