Gastroenteritis

موضوع: Gastroenteritis الإثنين يناير 03, 2011 11:50 am

Gastroenteritis

Gastroenteritis and Nursing Intervention

Definition
Gastroenteritis
is a catchall term for infection or irritation of the digestive tract,
particularly the stomach and intestine. It is frequently referred to as
the stomach or intestinal flu, although the influenza virus is not
associated with this illness. Major symptoms include nausea and
vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes
also accompanied by fever and overall weakness. Gastroenteritis
typically lasts about three days. Adults usually recover without
problem, but children, the elderly, and anyone with an underlying
disease are more vulnerable to complications such as dehydration.

D e f i n i tion
Gastroenteritis
is an uncomfortable and inconvenient ailment, but it is rarely
life-threatening in the United States and other developed nations.
However, an estimated 220,000 children younger than age five are
hospitalized with gastroenteritis symptoms in the United States
annually. Of these children, 300 die as a result of severe diarrhea and
dehydration. In developing nations, diarrheal illnesses are a major
source of mortality. In 1990, approximately three million deaths
occurred worldwide as a result of diarrheal illness.
The most common
cause of gastroenteritis is viral infection. Viruses such as rotavirus,
adenovirus, astrovirus, and calicivirus and small round-structured
viruses (SRSVs) are found all over the world. Exposure typically occurs
through the fecal-oral route, such as by consuming foods contaminated
by fecal material related to poor sanitation. However, the infective
dose can be very low (approximately 100 virus particles), so other
routes of transmission are quite probable.
Typically, children are
more vulnerable to rotaviruses, the most significant cause of acute
watery diarrhea. Annually, worldwide, rotaviruses are estimated to
cause 800,000 deaths in children below age five. For this reason, much
research has gone into developing a vaccine to protect children from
this virus. Adults can be infected with rotaviruses, but these
infections typically have minimal or no symptoms.
Children are also
susceptible to adenoviruses and astroviruses, which are minor causes of
childhood gastroenteritis. Adults experience illness from astroviruses
as well, but the major causes of adult viral gastroenteritis are the
caliciviruses and SRSVs. These viruses also cause illness in children.
The SRSVs are a type of calicivirus and include the Norwalk,
Southhampton, and Lonsdale viruses. These viruses are the most likely
to produce vomiting as a major symptom.
Bacterial gastroenteritis is
frequently a result of poor sanitation, the lack of safe drinking
water, or contaminated food-conditions common in developing nations.
Natural or man-made disasters can make underlying problems in
sanitation and food safety worse. In developed nations, the modern food
production system potentially exposes millions of people to
disease-causing bacteria through its intensive production and
distribution methods. Common types of bacterial gastroenteritis can be
linked to Salmonella and Campylobacter bacteria; however, Escherichia
coli 0157 and Listeria monocytogenes are creating increased concern in
developed nations. Cholera and Shigella remain two diseases of great
concern in developing countries, and research to develop long-term
vaccines against them is underway.

Causes and symptoms
Gastroenteritis
arises from ingestion of viruses, certain bacteria, or parasites. Food
that has spoiled may also cause illness. Certain medications and
excessive alcohol can irritate the digestive tract to the point of
inducing gastroenteritis. Regardless of the cause, the symptoms of
gastroenteritis include diarrhea, nausea and vomiting, and abdominal
pain and cramps. Sufferers may also experience bloating, low fever, and
overall tiredness. Typically, the symptoms last only two to three days,
but some viruses may last up to a week.
A usual bout of
gastroenteritis shouldn't require a visit to the doctor. However,
medical treatment is essential if symptoms worsen or if there are
complications. Infants, young children, the elderly, and persons with
underlying disease require special attention in this regard.
The
greatest danger presented by gastroenteritis is dehydration. The loss
of fluids through diarrhea and vomiting can upset the body's
electrolyte balance, leading to potentially life-threatening problems
such as heart beat abnormalities (arrhythmia). The risk of dehydration
increases as symptoms are prolonged. Dehydration should be suspected if
a dry mouth, increased or excessive thirst, or scanty urination is
experienced.
If symptoms do not resolve within a week, an infection
or disorder more serious than gastroenteritis may be involved. Symptoms
of great concern include a high fever (102 ° F [38.9 °C] or above),
blood or mucus in the diarrhea, blood in the vomit, and severe
abdominal pain or swelling. These symptoms require prompt medical
attention.

Diagnosis
The symptoms of gastroenteritis are
usually enough to identify the illness. Unless there is an outbreak
affecting several people or complications are encountered in a
particular case, identifying the specific cause of the illness is not a
priority. However, if identification of the infectious agent is
required, a stool sample will be collected and analyzed for the
presence of viruses, disease-causing (pathogenic) bacteria, or
parasites.

Treatment
Gastroenteritis is a self-limiting
illness which will resolve by itself. However, for comfort and
convenience, a person may use over-the-counter medications such as
Pepto Bismol to relieve the symptoms. These medications work by
altering the ability of the intestine to move or secrete spontaneously,
absorbing toxins and water, or altering intestinal microflora. Some
over-the-counter medicines use more than one element to treat symptoms.
If
over-the-counter medications are ineffective and medical treatment is
sought, a doctor may prescribe a more powerful anti-diarrheal drug,
such as motofen or lomotil. Should pathogenic bacteria or parasites be
identified in the patient's stool sample, medications such as
antibiotics will be prescribed.
It is important to stay hydrated and
nourished during a bout of gastroenteritis. If dehydration is absent,
the drinking of generous amounts of nonalcoholic fluids, such as water
or juice, is adequate. Caffeine, since it increases urine output,
should be avoided. The traditional BRAT diet-bananas, rice, applesauce,
and toast-is tolerated by the tender gastrointestinal system, but it is
not particularly nutritious. Many, but not all, medical researchers
recommend a diet that includes complex carbohydrates (e.g., rice,
wheat, potatoes, bread, and cereal), lean meats, yogurt, fruit, and
vegetables. Milk and other dairy products shouldn't create problems if
they are part of the normal diet. Fatty foods or foods with a lot of
sugar should be avoided. These recommendations are based on clinical
experience and controlled trials, but are not universally accepted.
Minimal
to moderate dehydration is treated with oral rehydrating solutions that
contain glucose and electrolytes. These solutions are commercially
available under names such as Naturalyte, Pedialyte, Infalyte, and
Rehydralyte. Oral rehydrating solutions are formulated based on
physiological properties. Fluids that are not based on these
properties-such as cola, apple juice, broth, and sports beverages-are
not recommended to treat dehydration. If vomiting interferes with oral
rehydration, small frequent fluid intake may be better tolerated.
Should oral rehydration fail or severe dehydration occur, medical
treatment in the form of intravenous (IV) therapy is required. IV
therapy can be followed with oral rehydration as the patient's
condition improves. Once normal hydration is achieved, the patient can
return to a regular diet.

Alternative treatment
Symptoms
of uncomplicated gastroenteritis can be relieved with adjustments in
diet, herbal remedies, and homeopathy. An infusion of meadowsweet
(Filipendula ulmaria) may be effective in reducing nausea and stomach
acidity. Once the worst symptoms are relieved, slippery elm (Ulmus
fulva) can help calm the digestive tract. Of the homeopathic remedies
available, Arsenicum album, ipecac, or Nux vomica are three said to
relieve the symptoms of gastroenteritis.
Probiotics, bacteria that
are beneficial to a person's health, are recommended during the
recovery phase of gastroenteritis. Specifically, live cultures of
Lactobacillus acidophilus are said to be effective in soothing the
digestive tract and returning the intestinal flora to normal. L.
acidophilus is found in live-culture yogurt, as well as in capsule or
powder form at health food stores. The use of probiotics is found in
folk remedies and has some support in the medical literature. Castor
oil packs to the abdomen can reduce inflammation and also reduce spasms
or discomfort.

Prognosis
Gastroenteritis is usually
resolved within two to three days and there are no long-term effects.
If dehydration occurs, recovery is extended by a few days.

Prevention
There
are few steps that can be taken to avoid gastroenteritis. Ensuring that
food is well-*****d and unspoiled can prevent bacterial
gastroenteritis, but may not be effective against viral gastroenteritis.

observations
Onset
is often sudden, with abdominal pain and cramping, nausea and vomiting,
diarrhea with or without blood and mucus, anorexia, general malaise,
and muscle aches. Dehydration, hypokalemia, and hyponatremia occur with
persistent vomiting and diarrhea. Diagnosis relies on identification of
the causative agent through stool and blood cultures, Gram's stain, and
direct swab rectal cultures. Complications of gastroenteritis include
dehydration, shock, vascular collapse, and renal failure. In rare
instances, complications may lead to death. Infants, small children,
the elderly, and debilitated individuals are at greatest risk.

interventions
Most
gastroenteritis is self-limiting and does not require therapy. Adequate
rehydration is the primary treatment. Fluids are limited until vomiting
ceases, then oral rehydration is instituted. IV fluid and electrolyte
replacement may be necessary if dehydration is severe. Antidiarrheal
agents may be used to slow diarrhea. Antibiotic agents may be used for
gastroenteritis with systemic involvement. Antimicrobials are not
generally recommended for simple gastroenteritis because these drugs
may prolong the carrier state and contribute to the emergence of
drug-resistant organisms. Antiemetics may be used for moderate to
severe vomiting unless the causative agent is viral or bacterial, in
which case antiemetics are not given to avoid impairment of GI
motility.

nursing considerations
Nursing focus is on
the replacement and monitoring of fluid and electrolytes. Accurate
monitoring of intake and output is essential. Strict medical asepsis
should be instituted when indicated by the causative agent. The
importance of rest and increased fluid intake should be stressed along
with the self-limiting nature of the disease. Education about proper
food handling and storage is necessary after acute symptoms have ceased