age case presentation(softcopy)
TRANSCRIPT
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Acute Gastroenteritis
Introduction
Inflammation of the gastrointestinal tract, involving both the stomach and the
intestine and resulting in acute diarrhea. The inflammation is caused most often by
infection with certain viruses, less often by bacteria or theirtoxins, parasites,
oradverse reaction to something in the diet or medication. At least 50% of cases of
gastroenteritis as foodborne illness are due to norovirus. Another 20% of cases, and
the majority of severe cases in children, are due to rotavirus. Other significantviral agents include adenovirus and astrovirus.
Some types of acute gastroenteritis will not resolve without antibiotic
treatment, especially when bacteria or exposure to parasites are the cause.
Physicians may want to diagnose the cause by analysing a stool sample, when
stomach symptoms remain problematic. Inadequate treatment of gastroenteritis kills
5 to 8 million people per year and is a leading cause of death among infants andchildren under 5.
The most common symptoms are diarrhea, vomiting and stomach pain,
because whatever causes the condition inflames the gastrointestinal tract.
Dehydration can actually cause greater nausea, and can begin to cause organ shut
down if not properly addressed. Acute gastroenteritis is quite common among
children, though it is certainly possible for adults to suffer from it as well.
While most cases of gastroenteritis last a few days, acute gastroenteritis can
l t f k d th A t t t iti h ld th b t k i l d
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Astrovirushttp://www.wisegeek.com/what-are-antibiotics.htmhttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Infanthttp://www.wisegeek.com/what-are-antibiotics.htmhttp://en.wikipedia.org/wiki/Astrovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Inflammation -
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last for weeks and months Acute gastroenteritis should thus be taken seriously and
Birthplace: Quezon City
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Date and Time of Admission: July 3, 2012 12:38AM
Medical History:
Past Medical History:
Client verbalized of having hepatitis A in the year 1989, this year being the
last time he had been hospitalized. He seldom had common illnesses like colds,
fever and cough.
History of Present Illness:
Patient AFL verbalized that 3 days before admission he experienced diarrhea
already, but he said that his condition was still tolerable and doesnt need for medical
help. He feels relieved of condition when he is able to eliminate. After 3 days of
diarrhea, patient AFL decided to consult for medical help to identify what is the
reason for his condition. He was admitted in the UPHSD Medical Center on July 3,
2012.
Nursing History (Gordons Functional Pattern of Assessment)
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formed and brownish in color. During ill, he experienced to eliminate 8 times a day,
watery and greenish stool. Patient experienced pain when he is not able to eliminateas soon as peristalsis is felt.
ACTIVITY-EXERCISE PATTERN
Patient AFL said that his only exercise is his daily activities in his work. He
does all of his daily activities independently.
SLEEP-REST PATTERN
Patient AFL usually sleeps 6-7 hours per night. He feel rested whenever he
wakes up. He watches television as his ritual to feel sleepy.
SELF-PERCEPTION AND SELF-CONCEPT PATTERN
Patient AFL, describes his self as a very calm person. He answers questions
readily. He views his self as a neutral type of person. He said that he controls the
situation as calm as possible that he doesnt want to stress his self too much. He
also said that in everything and decision he makes he is assertive of it.
ROLE-RELATIONSHIP PATTERN
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PHYSICAL ASSESSMENT
General Appearance
Area
Assessed
Actual Findings Normal Findings Analysis
Body Built Proportionate Proportionate Normal
Body Odor No odor no odor Normal
Posture and
Gait
Coordinated and
erect
Coordinate and
erect
Normal
Affect or mood Calm Cooperative Calm and cooperative
Speech Understandable Understandable Normal
Vital Signs
Area
Assessed
Actual Findings Normal Findings Analysis
Temperature 36 degreesCelsius
36.5-37.5degreeCelsius
Normal
Pulse Rate 79 bpm 60-100 bpm Normal
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areas areas
Skin turgor Skin snaps backimmediately
Skin snaps backimmediately
Good skin turgor
Mouth
Area
Assessed
Actual Findings Normal Findings Analysis
Lips Moistened Pinkish, moist, intact Normal
Teeth Yellowish in color
with some dentalcaries
Pearly white normal teeth Normal
Gums Pinkish Pinkish Normal
Tongue Midline, movable Midline, movable Normal
Abdomen
Area Assessed Actual Findings Normal Findings Analysis
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RBC 0-1/hpf
DVS CEUS 4-6/HPF
Epithelial Cells RareBacteria Few
Fecalysis:
Result
Color Greenish brownConsistency Mucoid
Pus Negative
Mucus Positive
Parasite None
BUN & Creatinine Test:
Normal Result
BUN 3.2 7.1 mmo/L 5.4
Creatinine 58 110 cmoL/L 85
Potassium 3.5 5.1 mmo/L 3.5
Sodium 137 145 mmo/L 141
Complete Blood Count:
Normal Results
RBC 4 0 6 0 10^12/L 6 87
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Signs and Symptoms:
Increased White Blood Cells Increased Platelet Count
Acute Diarrhea
Increased hemoglobin
Abdominal Cramps
Greenish stool
Sympthomatology:
Clinical Manifestation Absent/ Present Rationale
Increased White BloodCells
Present Acute infection occured,the white blood cellsproduce colony-stimulatingfactor (CSF), which further
stimulates the bonemarrow to increase theproduction of the whiteblood cell. This productioncan be doubled within afew hours.
Increased Platelet Count Present A high platelet count canbe caused by cancer,infections, anemia, andinflammatory diseasesincluding inflammatory
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Greenish stool Present Stool can also appeargreen for physical
reasons, and not just fromwhat you've been eating.Bile that is secreted in thefirst part of the smallintestine is actually green.As stool is digested andpassed through the large
intestine it is turned into adarker brown color.Because of the fastperistalsis the largeintestine is unable tochange the color of thestool.
ANATOMY AND PHYSIOLOGY
Gastro-Intestinal Tract
http://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htm -
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Esophagus:
Once food has been chewed and mixed with saliva in the mouth, it is
swallowed and passes down the oesophagus. The oesophagus has a stratified
squamous epithelial lining (SE) which protects the oesophagus from trauma; the
submucosa (SM) secretes mucus from mucous glands (MG) which aid the
passage of food down the oesophagus. The lumen of the oesophagus is
surrounded by layers of muscle (M)- voluntary in the top third, progressing toinvoluntary in the bottom third- and food is propelled into the stomach by waves of
peristalisis.
Stomach:
The stomach is a 'j'-shaped organ, with two openings- the oesophageal and
the duodenal- and four regions- the cardia, fundus, body and pylorus. Eachregion performs different functions; the fundus collects digestive gases, the body
secretes pepsinogen and hydrochloric acid, and the pylorus is responsible for
mucus, gastrin and pepsinogen secretion.
The stomach has five major functions:
Temporary food storage
Control the rate at which food enters the duodenum
Acid secretion and antibacterial action
Fluidization of stomach contents
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Small Intestine
The small intestine is the site where most of the chemical and mechanicaldigestion is carried out, and where virtually all of the absorption of useful materials is
carried out. The whole of the small intestine is lined with an absorptive mucosal type,
with certain modifications for each section. The intestine also has a smooth muscle
wall with two layers of muscle; rhythmical contractions force products of digestion
through the intestine (peristalisis). There are three main sections to the small
intestine.
The duodenum forms a 'C' shape around the head of the pancreas. Its main
function is to neutralise the acidic gastric contents (called 'chyme') and to initiate
further digestion; Brunner's glands in the submucosa secrete an alkaline mucus
which neutralises the chyme and protects the surface of the duodenum.
The jejunum
The ileum. The jejunum and the ileum are the greatly coiled parts of the small
intestine, and together are about 4-6 metres long; the junction between the two
sections is not well-defined. The mucosa of these sections is highly folded (the folds
are calledplicae), increasing the surface area available for absorption dramatically.
The pancreas consists mainly of exocrine glands that secrete enzymes to aid
in the digestion of food in the small intestine. The main enzymes produced arelipases, peptidases and amylases for fats, proteins and carbohydrates respectively.
These are released into the duodenum via the duodenal ampulla.
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What Are the Functions of the Gastrointestinal Tract?
esophagus acts like a conduit, a tube that moves ingested materialfrom the mouth to the stomach. Wavelike contractions (called peristalsis) move foodfrom the mouth down the neck, through the chest and into the stomach. Theesophagus has a tight sphincter muscle where it meets the stomach. This loweresophageal sphincter is a ring of thick muscle that acts as a door, and it preventsacid reflux or movement of acid from the stomach back up into the esophagus.
sist in the early stages of
digestion and prepare the food for further processing in the small intestine. First, itserves as a short-term storage area, allowing the animal to consume a large mealquickly and processing it over a longer period of time. Second, substantial chemicaland enzymatic digestion begins in the stomach, particularly of proteins. Third, thestomach's contractions mix and grind food with secretions, liquefying or blending thefood, a necessary step before the food is delivered to the small intestine.
blood occurs. When in the small intestine, food particles are exposed to enzymesand bile, which convert the food to even smaller particles capable of being absorbedinto the blood. In addition to absorbing food particles, the small intestines also theabsorb other materials such as water, electrolytes and other molecules. The smallintestines provide nutrients to the body and play an important role in water and acid-base balance.
very important functions. It recovers the last available water and electrolytes from thefood, forms and stores feces, and works with bacteria to produce enzymes capableof breaking down difficult-to-digest material
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Pathophysiology
Predisposing Factors:
Age
Precipitating Factors:
Ingestion of contaminated food
Ingestion of
contaminated food
Direct Invasion of
the bowel wall.
Stimulation and
destruction of mucosal
lining of the bowel wall
Stimulates
defacation
Digestive and
absorptive malfunction
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Nursing Diagnoses:
Actual Nursing Problem
1. Diarrhea related to inflammation of the GI tract.
2. Acute Pain related to injuring agents (physical-inflammation of the GI tract).
3. Contamination related to ingestion of contaminated food.
Potential Nursing Problem
1. Risk for Deficient Fluid Volume related to excessive loss through feces.
2. Risk for Imbalance Nutrition: less than body requirement related to altered
taste sensation as evidenced by aversion to eating.
Prioritization List:
ACTUAL PROBLEMS
PROBLEM RANK CUES JUSTIFICATION
Diarrhea related to
inflammation of the
GI tract.
1 BM 3x
Stool: watery andgreenish in color
This is our 1st
priority because it isthe chief complaintof the client that
ti
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POTENTIAL PROBLEMS
PROBLEM RANK CUES JUSTIFICATIONRisk for DeficientFluid Volumerelated toexcessive lossthrough feces.
1 Hyperactive bowelmovements, BM 3x
This became our 1stpriority because itcauses loss of fluidand electrolytesassociated withdiarrhea and/orvomiting. Fluids andelectrolytesimbalances canalso alter vital bodyfunctions.
Risk for Imbalance
Nutrition: less than
body requirement
related to altered
taste sensation as
evidenced by
aversion to eating.
2 Sudden weight lossof 2%.
This became our2nd priority becauseit can be managed
by proper diet. Andpatient can complyto the regimenindependently.
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NURSING CARE PLAN
ACTUAL
Assessment NursingDiagnosis Planning Intervention Rationale Evaluation
O:
(+) BM 3x
Stool : wateryand greenish incolor
Hyperactivebowel sound
(+) mucus in
stool (+) abdominal
pain
(-) blood instool
Diarrhea relatedto inflammation of
the GI tract.
After 6 hoursof nursingintervention,the patient willverbalizeunderstandingof causativefactors and
rationale fortreatmentregimen.
Obtain baselinevital signs andmonitor every 24hours.
Observe stools foramount, color,
consistency, odor,and frequency.
Determined recentexposure todifferent or foreignenvironments,change in drinkingwater or foodintake.
Teach interventions
to prevent futureepisodes ofdehydration/inadequate intake.
Encourage increaseoral intake of fluids.
Fluid andelectrolyteimbalancescan alter vitalbody functions.
Aids in thediagnosis andin monitoring
the childsstatus.
It may help toidentify thecausativeenvironmentalfactors.
To understand
the importanceof drinkingextra fluidduring bouts ofdiarrhea.
To replacefluid and lossand to preventdehydration.
Goal met.
Patientverbalizedunderstandingof causativefactors andrationale fortreatment
regimen.
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Promote adequaterest period.
Monitor intake and
output.
To reduceperistalsismovement.
Provide
information todetermine thestatus of fluidbalance fluidneedsreplacement.
Assessment Diagnosis Planning Intervention Rationale
S: Hindi ko kasi alamna panis na pala yungkinain ko.O:
Abdominal pain
(+) nausea andvomiting
Contamination relatedto ingestion of
contaminated food.
After 6 hours of nursinginterventions, thepatient will verbalizeunderstanding ofindividual factors thatcontributed to injury andplans for correctingsituation(s) wherepossible.
Implemented acoordinateddecontaminationplan (e.g., removalof clothing,showering with soapand water).
Recommendedperiodic inspectionof well water, tapwater and food.
To prevent furtherharm to client and toprotect healthcareproviders.
To identify possiblecontaminants.
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Assessment Diagnosis Planning Intervention Rationale Evaluation
S: Sumasakit kasiyung tiyan ko lalona kapagnararamdaman kong padumi na ko.O:
Mild Pain on theabdomen.
Pain scale: 6/10
Facial grimace
Pain related toinjuring agents(physicalinflammation of GItract).
After 6 hours ofnursing
interventions, thepatient will report
reduce of pain from6/10 to 2/10.
Observednonverbal cuesand painbehaviors.Assessed forthe level of pain.
Providedcomfortmeasures suchas properpositioning,quietenvironmentand calmactivities.
Instructed andencouraged useof relaxationtechniques suchas deepbreathingexercise.
Encourageddiversionalactivities(watching TV,listening toradio,socializationwith others.)
It can helpdetermine thedegree of pain.
To promotenonpharmacological painmanagement
To promoterelaxation.
To distractattention andreduce tension.
Goal met.
Patient reportedreduce of painfrom 6/10 to3/10.
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POTENTIAL
Assessment Diagnosis Planning Intervention Rationale Evaluation
O:
3 BM
Good skinturgor
Slightly moisttongue
Weakness
Slightlyelevated RBC
Risk for DeficientFluid Volume
related toexcessive lossthrough feces.
After 6 hours ofnursingintervention, thepatient willdemonstratebehaviors orlifestyle changes to
preventdevelopment offluid volume deficit.
Discussedindividual riskfactors,potentialproblems andspecificinterventions.
Monitoredintake andoutput.Encouragedclient tomaintain diaryof food/fluidintake; numberand amount ofvoiding and
stool. Encouraged
increase oralintake of fluids.
Assess level ofconsciousness,skin turgor,mucous
To prevent orlimit occurrenceof fluid deficit.
To ensure
accurate pictureof fluid status.
To replace fluid
loss.
Will determinedegree ofhydration andadequacy ofinterventions.
Goal met.
Patientdemonstratedbehaviors orlifestylechanges toprevent
developmentof fluid volumedeficit.
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membranes,skin color andtemperature,capillary refill,eyes, andfontanels every4 hours.
Assessment Diagnosis Planning Intervention Rationale Evaluation
S: Wala kasiakong ganangkumain eh. Dahilnga wala akongpanlasa.O:
Altered tastesensation
Hyperactive
Risk forImbalancedNutrition: less thanbody requirementrelated to alteredtaste sensation asevidenced byaversion to eating.
After 6 hours ofnursinginterventions, thepatient willdemonstratebehaviors, lifestylechanges to regaintoward goal.
Determinedclients ability tochew, swallowand taste food.
Discussedeating habits,including foodpreferences,intolerances, or
To recognize allthe factors thatcan affectingestion.
To appeal toclients tastes
Goal met. Patient
demonstratedbehaviors,lifestylechanges toregain towardgoal.
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bowel sound
Poor appetite
Aversion toeating
aversions.
Assessedweight
Promotedpleasant,relaxingenvironment,includingsocialization.
Minimizedunpleasantodors or sights.
Encouragedclient to choosefoods or havefamily memberto bring foodsthat seemappealing.
To establishbaselineparameters.
To enhanceintake.
May have anegative effecton appetite andeating.
To stimulateappetite.
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DRUG STUDY
Name of
Drug:
Classification: Mechanism of
Action:
Indication: Contraindication: Adverse
Reaction:
Nursing
responsibilities:
Brand name:
>Ciprofloxacin
Generic
name:
>Cipro, Cipro
XR, Proquin
XR
Dosage:
>500mg
Frequency:
>BID
Route:
>Oral
>Antibiotic
>Antibacterial
>Inhibition oftopoisomerase(DNAgyrase),enzymeswhich inhibitsrelaxation ofsupercoiled DNA
and promotesbreakage ofdouble strandedDNA.
>Ciprofloxacin
Is used to treat
infection of the
lungs, airways,
bones and joints
caused by
susceptible
bacteria.
> Ciprofloxacin is
also frequently
used to treaturinary infections
caused by
bacteria such as
E.coli.
> Ciprofloxacin is
> Ciprofloxacin is
contraindicated in
person with a
history of
hypersensitivity to
ciprofloxacin, any
member of the
quinolone class of
micro bacterial
agents, or any of
the product
components.>co administration
of Ciprofloxacin
with other drugs
primarily
metabolized by
>Nausea
>Vomiting
>Stomach
pain
>Diarrhea
>Fever
>Headache
>Difficulty of
breathing
and
swallowing.
>Feeling anurgent need
to urinate.
>Rapid
irregular or
pounding
>Monitor Blood
pressure
>Prevention and
treatment of
infection like
fever and pain
are reduced.
>Tell patient that
ciprofloxacin can
cause side effect
that may impair
his and reaction.>Tell patient that
be careful if he
plans to drive or
do anything that
requires him
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effective in
threatening
infectious
diarrheas caused
by E.coli,
Campylobacter
jejuni, Shigella
bacteria.
CYPIA2 result in
increased plasma
concentration of
these drug and
could lead to
clinically significant
adverse event of
the co-administered
drug.
heartbeat. awake and alert.
>Instruct patient
to take
Ciprofloxacin
with a full of
glass of water.
Name of
Drug:
Classification: Mechanismof Action:
Indication: Contraindication: Adverse
Reaction:
Nursing
Responsibilities:
Brand name:
>Omeprazole
Generic
name:
>Mepraz
>Proton Pump
inhibitor
> Pump
inhibitors act
by irreversibly
blocking the
hydrogen/pota
ssium
adenosine
>Short-term
treatment of
active
duodenal
ulcer.
>First line
therapy of
>Omeprazole
delayed-release
capsule are
contraindicated in
patient with
hypersensitivity to
any component of
CNS:
>Headache
>Dizziness
>Vertigo
>Dream
abnormalities
>Anxiety
History :
Hypersensitivity to
Omeprazole or any
of components;
Pregnancy and
Lactation.
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Dosage:
>20mg
>40mg
Frequency:
>OD
Route:
>Oral
triphosphate
enzymes
system (the
H+/K+
ATPase,or
more
commonly
gastric proton
pump)of the
gastric parietal
cells. The
proton pump
is the terminal
stage in
gastric acid
secretion,
being directly
responsible for
secreting H+
ions into the
gastric
heartburn or
symptom of
(GERD)
>Short-term
treatment of
active benign
gastric ulcer.
>Long-term
therapy:
Treatment of
pathologic
hyper
secretory
condition
(Zollinger-
Ellison
syndrome,
multiple
adenomas,
systemic
Mastocytosis)
the formulation. Dermatologic:
>Rash
>Urticaria
>Inflammation
>Pruritus
>Alopecia
>Dry skin
GI:
>Diarrhea
>Abdominal
pain
>Nausea and
Vomiting
>Constipation
>Dry mouth,
and tongue
>Atrophy
Respiratory:
>URI
symptoms
>Cough
Physical:
>Skin lesions,
reflexes, affect
urinary output,
abdominal exam;
respiratory
auscultation.
>Report any adverse
reaction.
>administer before
meals caution patient
to swallow capsule
whole or not to open,
chew or crush
Them.
>Arrange for further
evaluation of patient
after 8weeks of
therapy for gastro
reflux disorders not
intended for
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lumen, making
it an ideal
target for
inhibiting acid
secretion.
. >Epistaxis
Other:
>Cancer in
preclinical
studies
>Back pain
>Fever
maintenance
therapy.
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Name of
drug:
Classification: Mechanism of
Action:
Indication: Contraindication: Adverse
Reaction:
Nursingresponsibilities:
Brand name:
>Hidrasec
Generic name:
>Racecadotril
Dosage:
>100mg
Frequency:
>TID
Route:
>Oral
>Anti-
diarrheals
>Hidrasec is an
inhibitor of
enkephalinase,
the enzymes
responsible for
breaking down
enkephalins. It is
a selective but
reversible
inhibitor and
protects
endogenous
enkephalins
which are
physiologically
active in the
digestive.
>Treatment
of acute
diarrhea.
>Adjunct to
oral or
parenteral
rehydration
in the
treatment
of acute
watery
diarrhea in
infant and
in adult.
>Renal or Hepatic
impairment
fructose
intolerance,
glucose and
galactose
malabsorption
syndrome or
sucrose
isomaltase
deficiency.
>Dizziness
>Nausea and
Vomiting
>Constipation
>Drowsiness
>Headache
>Monitor Blood
Pressure
>Hidrasec
30mg.If
rehydration by
rehydration
solution is
prescribe, the
conditions of use
and the method of
reconstitution
should be
explained clearly
and precisely.
>Maintain feeding
during period of
diarrhea:
Excluding certain
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product especially
fruits, green
vegetables, spicy
food and also
iced foods or
drinks; giving
prefer to grilled
meat and rice ;
withdrawal of milk
and dairy product
should be
considered in
each individual
case.
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Discharge Planning
Medication: upon discharge client was advised to continue intake of:
Omeprazol tablet 20 mg once a day.
Hidrasec capsule 100 mg three times a day Ciprofloxacil tablet 500 mg every 12 hours
Exercise:
Carry out daily activities as tolerated.
Do activities of daily living as tolerated.
Treatment:
A.L was advised for increase fluid intake and take medication as schedule and as prescribed for fast recovery.
Health teaching:
Proper hygiene to avoid complication.
Frequent hand washing is advised.
Proper food preparation and handling to avoid infection.
Diet:
Follow religiously the prescribed diet to regain strength and improve health status; these include BRAT (banana,rice, apple, tea) diet.
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Spiritual:
Advise family to ask assistance and guidance from the divine providence for speedy recovery.
Reference:
Nandas Pocket Guide Diagnoses, Prioritized Interventions and rationales, Marilynn E. Doengnes,Mary Frances
Moorhouse, Alice C. Murr, Daviss Nursing Resource Center.
Mims Drug Guide
http://www.steadyhealth.com/articles/What_does_high_white_blood_cells_count_indicate__a723.html
http://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.html
http://www.petplace.com/dogs/structure-and-function-of-the-gastrointestinal-tract-in-dogs/page1.aspx
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