Description
Assignment PromptFor this assignment you will create an engaging, 20-minute recorded presentation of an acute health problems related to a particular body system.Your presentation should include an overview of the health problem identified, an in-depth review of the associated anatomy and physiology, an overview of treatment methodologies, differential diagnosis, and information related to the needs of the patient and/or family related to the problem. Your presentation should be prepared in PowerPoint, and recorded with voice over narration.ExpectationsLength: 10-12 slides in length (excluding title and reference slides, with a maximum recording length of 20 minutes)Citations: At least one high-level scholarly reference in APA per post from within the last 5 yearsPlease include script/presenter notes in each slides
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ACUTE
GASTROENTERITIS
Merlie Ramira, DNP, FNP-BC, CEN
Gastroenteritis
• causes irritation and inflammation of the stomach
and intestines (the gastrointestinal tract) “stomach
flu.”
Most common symptoms of gastroenteritis are
• diarrhea
• nausea
• crampy abdominal pain
• vomiting
Gastroenteritis
•Viral infections are the most common
cause of gastroenteritis but bacteria,
parasites, and food-borne illnesses (such
as shellfish) can also be the offending
agents
•”food poisoning,” when they actually may
have a food-borne illness.
CDC Data
•In 2007 – 17,000 people died from
gastroenteritis, and the most common
infections were Clostridium difficile and
norovirus.
Causes of Gastroenteritis
•Viruses – may last one to two days.
Norovirus – Fifty to seventy percent of cases of
gastroenteritis in adults.
This virus is highly contagious and spreads
rapidly, most common cause of gastroenteritis
in the United States.
Causes of Gastroenteritis
Transmission
• Consuming contaminated food and liquids.
• Touching objects contaminated with norovirus and
then placing the hands or fingers in the mouth.
• Direct contact with an infected individual (for
example, exposure to norovirus when caring for or
sharing foods, drinks, eating utensils with an affected
individual.
• Exposure to infected individuals and objects in
daycare centers and nursing homes.
• Norovirus is often in the news when cruise ship
passengers contract the virus causing gastroenteritis.
Viruses
• Rotavirus – was also the leading cause of severe
diarrhea in U.S. infants and young children before
rotavirus vaccine was introduced for 2006
• Adenovirus-most commonly causes respiratory
illness; gastroenteritis, bladder infections, and rash
illnesses.
• Parvoviruses – fifth disease
• Astrovirus infection – is the third most frequent cause
of gastroenteritis in infants
Bacteria
Bacteria -can continue for a longer period of time.
• Salmonella – is contracted by ingesting the bacteria in
contaminated food or water, and by handling poultry or
reptiles such as turtles that carry the germs.
• Campylobacter – occurs by the consumption of raw or
undercooked poultry meat and cross-contamination with
other foods.
• Infants may acquire the infection by contact with poultry
packages in shopping carts. Campylobacter is also
associated with unpasteurized milk or contaminated water.
The infection can be spread to humans by contact with
infected stool of an ill pet (for example, cats or dogs). It is
generally not passed from human to human.
Bacteria -Shigella
• Shigella bacteria generally spreads from an infected
person to another person.
• Present in diarrheal stools of infected individuals
while they are ill, and for up to one to two weeks
after contracting the infection.
• Contracted by eating contaminated food, drinking
contaminated water, or swimming or playing in
contaminated water (for example, wading pools,
shallow play fountains).
• Shigella can also spread among men who have sex
with men
Bacteria-Clostridium Difficile
Overgrow in the large intestine after a person has been on
antibiotics for an infection, normal flora is destroyed
• Clindamycin (for example, Cleocin)
• Fluoroquinolones (for example, levofloxaci [Levaquin],
ciprofloxacin [Cipro, Cirpo XR, Proquin XR])
• Penicillins
• Cephalosporins
The CDC lists C. Difficile as one of the most common causes
of death due to gastroenteritis and suggest that new strains
of the bacteria have become more aggressive and
dangerous
Parasites and Protozoans (Giardia,
Cryptosporidium)
• A person may become infected by drinking
contaminated water.
• Swimming pools are common places to come in
contact with these parasites.
• Giardia is the most frequent cause of waterborne
diarrhea, causing giardiasis. People become infected
after swallowing water that has been contaminated
by animal feces (poop).
• Drinking infected water from river or lakes but
giardia may also be found in swimming pools, wells
and cisterns.
Cryptosporidium (Crypto)
• A parasite that lives in the intestine of affected individuals or
animals. The infected individual or animal sheds the
Cryptosporidium parasite in the stool.
• Crypto may also be found in food, water, soil, or
contaminated surfaces (swallowing contaminated water,
beverages, uncooked food, unwashed fruits and vegetables,
touching contaminated surfaces such as bathroom fixtures,
toys, diaper pails, changing tables, changing diapers, caring
for an infected individual or handling an infected cow or calf).
• Those at risk for serious disease are individuals with
weakened immune systems.
Other Common Causes of Gastroenteritis
•Gastroenteritis that is not contagious to others
can be caused by chemical toxins, most often
found in seafood, food allergies, heavy metals,
antibiotics, and other medications.
Common Symptoms
• Low grade fever to 100 F (37.7 C)
• Nausea with or without vomiting
• Mild-to-moderate diarrhea
• Crampy painful abdominal bloating
• Blood in vomit or stool Vomiting more than 48 hours
• Fever higher than 101 F (40 C)
• Swollen abdomen or abdominal pain
• Dehydration – weakness, lightheadedness, decreased
urination, dry skin, dry mouth and lack of sweat and
tears are characteristic signs and symptoms.
When to Seek Medical Care
• Most often gastroenteritis is self-limiting, but it can
cause significant problems with dehydration.
• Vomiting blood or having bloody or black bowel
movements are not normal, and emergency care
should be sought. Some medications such as iron or
bismuth subsalicylate (Pepto-Bismol) can turn stool
black in color.
• Fever, increasing severity of abdominal pain, and
persistent symptoms should not be ignored and
seeking medical care should be
Patient History & Physical Exam
• Diet change, food preparation habits, and storage – exposure
to undercooked or improperly stored or prepared food (food
poisoning).
• Symptoms caused by bacteria or their toxins will become
apparent
• Staphylococcus aureus in 2 to 6 hours
• Clostridium 8 to 10 hours
• Salmonella in 12 to 72 hours
• Medications: If the patient has used antibiotics recently, they
may have antibiotic-associated irritation of the
gastrointestinal tract – clostridium difficile infection.
Differential Diagnosis
•Appendicitis
•Gallbladder disease
•Pancreatitis
•Crohn’s Disease
•Diverticulitis
•Ulcerative Colitis
Diagnostic Tests
•CBC
•CMP
•Stool sample
•Mucus
•Blood
•Leukocytes
•Stool culture
Gastroenteritis Treatment
•Replacing fluids when the affected individual is
nauseous and doesn’t want to drink (hydrate).
•Small frequent offerings of clear fluids,
sometimes only a mouthful at a time, may be
enough to replenish the body’s fluid stores
and prevent an admission to the hospital for
intravenous (IV) fluid administration.
•Jello and popsicles
Assess Degree of Dehydration
•Mild (3-5%)
•Normal or increased pulse
•Decreased urine output
•Thirsty
•Normal physical exam
Degree of Dehydration
•Moderate (7-10%)
•Tachycardia
•Little/no urine output
•Irritable/lethargic
•Sunken eyes/fontanelle
•Decreased tears
•Dry mucous membranes
•Skin- tenting, delayed cap refill, cool, pale
Degree of Dehydration
•Severe (10-15%)
•Rapid, weak pulse
•Decreased blood pressure
•No urine output
•Very sunken eyes/fontanelle
•No tears
•Parched mucous membranes
•Skin- tenting, delayed cap refill, cold, mottled
Dehydration in Children
• Oral rehydration therapy using balanced electrolyte
solutions such as Pedialyte or Gatorade.
• Plain water is not recommended because it can dilute
the electrolytes in the body and cause complications
such as seizures due to low sodium.
For infants and children, fluid status can be monitored
by:
• Whether they are urinating
• If they have saliva in their mouths
• Tears in their eyes
• Sweat in their armpits or groin
Dehydration in adults
•Clear fluids are appropriate for the first
24 hours to maintain adequate hydration.
•After 24 hours of fluid without vomiting,
begin a soft-bland solid diet such as the
BRAT diet (bananas, rice, apples, toast)
and then progress the diet to other foods
as tolerated.
Gastroenteritis Medical Treatment
•IV to replace fluids back into the body
(rehydration).
•In infants, depending upon the level of
dehydration, intravenous fluids may be
delayed in order to attempt oral rehydration
therapy. Frequent feedings, as small as a 1/6
ounce (5 cc) at a time, may be used to restore
hydration
Gastroenteritis Medications
• Antibiotics are usually not prescribed until a bacteria
or parasite has been identified as the cause of the
infection.
• Antibiotics may be given for certain bacteria,
specifically Campylobacter, Shigella, and Vibrio
cholerae
• Antibiotics are not used to treat virus infections
• Some infections, such as salmonella, are not treated
with antibiotics. Supportive care comprising of fluids
and rest, the body is able to fight and resolve the
infection without antibiotics.
Antimicrobial therapy
• Aeromonas-species of bacterium that is present in all
freshwater environments and in brackish water. Some
strains of A. hydrophila are capable of causing illness in
fish and amphibians as well as in humans who may
acquire infections through open wounds or by ingestion
of a sufficient number of the organisms in food or water.
• TMP/SMZ
• Dysentery-like illness, prolonged diarrhea
• Campylobacter
• Erythromycin, azithromycin
• Clostridium dificile
• Metronidazole, vancomycin
• E. coli
• TMP/SMZ
Antimicrobial therapy
• Salmonella
• Cefotaxime, ceftriaxone, ampicillin, TMP/SMZ
• Infants < 3 months
• Typhoid fever
• Bacteremia
• Dissemination with localized suppuration
• Shigella
• Ampicillin, ciprofloxacin, ofloxacin, ceftriaxone
• Vibrio cholerae
• Doxycycline, tetracycline
Gastroenteritis Medications
• Anti-emetics
• Antidiarrheal medications
• Alter intestinal motility
• Alter absorption
• Alter intestinal flora
• Alter fluid/electrolyte secretion
• Antidiarrheal medication generally not recommended
• Minimal benefit
• Potential for side effects
Gastroenteritis Follow-up
•The diet should be advanced slowly from bland
non-dairy soups and grain products to a solid
meal.
•Food handlers should not return to work until
their symptoms have resolved.
•Salmonella infections are a special case; those
who work in the medical profession or who are
food handlers need to have negative stool
cultures for Salmonella before being allowed
to return to work.
Gastroenteritis Prevention
•Always wash your hands.
•Eat properly prepared and stored food.
•Bleach soiled laundry.
•Vaccinations for Vibrio cholerae, and rotavirus
have been developed. Rotavirus vaccination is
recommended for infants in the U.S. Vaccines
for V. cholerae may be administered to
individuals traveling to at-risk areas.
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