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 two 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; blood pressure 94/70 mmHg; heart rate 110 beats per minute; 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 turgor, 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.

Nurse Mai: Can you tell me about your stools?

Jay: I’ve had 4 to 5 watery stools every day for three days and vomited multiple times. I can’t keep food or water down.