A patient with gastroenteritis presents with mild dehydration. Which intervention should the nurse prioritize to address the patient's condition?

B) Encourage oral rehydration with electrolyte solutions

A) Administer antiemetic medication

B) Encourage oral rehydration with electrolyte solutions

D) Initiate intravenous antibiotic therapy

What is the primary nursing intervention for a patient with mild dehydration due to gastroenteritis?

B) Encourage oral rehydration with electrolyte solutions

A) Administer antiemetic medication

B) Encourage oral rehydration with electrolyte solutions

C) Prepare the patient for intravenous fluid therapy

D) Restrict fluid intake to prevent further nausea

What is the primary reason for encouraging a patient with dehydration to consume an oral rehydration solution?

B) To replenish electrolytes and fluids

A) To provide a source of glucose for energy

B) To replenish electrolytes and fluids

C) To prevent nausea and vomiting

D) To lower the patient's elevated white blood cell count

Which intervention should the nurse prioritize to ensure the patient maintains adequate hydration status?

C) Encourage frequent sips of oral rehydration solution

A) Encourage the patient to consume a large meal

B) Administer intravenous fluids

C) Encourage frequent sips of oral rehydration solution

D) Limit fluid intake to prevent overhydration

What is the most appropriate initial nursing action when a patient reports new onset of abdominal tenderness during an assessment?

B) Notify the attending physician

A) Administer prescribed analgesics

B) Notify the attending physician

C) Reassess the patient's vital signs

D) Encourage the patient to ambulate

What is the primary reason for conducting an abdominal ultrasound in this patient?

C) To assess for any acute abdominal issues

A) To confirm the presence of appendicitis

B) To evaluate the patient's hydration status

C) To assess for any acute abdominal issues

D) To observe the gastrointestinal motility

Based on the assessment findings, which of the following nursing interventions is most appropriate to ensure the patient's comfort and support recovery from gastroenteritis?

B) Advise the patient to remain on a bland diet and monitor fluid intake

A) Encourage the patient to eat spicy foods to stimulate appetite

B) Advise the patient to remain on a bland diet and monitor fluid intake

C) Restrict the patient from eating or drinking until the tenderness subsides

D) Administer a diuretic to reduce abdominal tenderness

Which of the following nursing interventions is most appropriate for a patient recovering from gastroenteritis and showing signs of improvement?

A) Encourage the patient to eat a high-fiber diet.

C) Instruct the patient to engage in moderate exercise.

D) Suggest the patient take over-the-counter laxatives to aid digestion.

Which of the following actions should the nurse prioritize to ensure the patient's continued recovery from gastroenteritis?

B) Advise the patient to maintain a bland diet and hydration

A) Encourage the patient to take a walk around the hospital floor

B) Advise the patient to maintain a bland diet and hydration

C) Suggest the patient consume a high-protein diet to regain strength

D) Recommend the patient increase physical activity to improve circulation

gastroenteritis - Nursing Case Study

Pathophysiology

• Primary mechanism: Gastroenteritis is often caused by viral or bacterial infection that targets the gastrointestinal tract, leading to inflammation of the stomach and intestines. This inflammation disrupts normal digestion and absorption processes.

• Secondary mechanism: The infection increases intestinal permeability and stimulates secretion of electrolytes and water into the gut. This results in diarrhea, which can lead to dehydration and electrolyte imbalances if not managed properly.

• Key complication: Dehydration is a common complication due to excessive fluid loss through diarrhea and vomiting. It can cause weakness, dizziness, and, in severe cases, may lead to hypovolemic shock if not promptly treated.

Patient Profile

Demographics:

25-year-old female, office manager

History:

• Key past medical history: No significant past medical history

• Current medications: Multivitamin daily

• Allergies: None

Current Presentation:

• Chief complaint: Abdominal discomfort and diarrhea

• Key symptoms: Mild abdominal cramps, nausea, two episodes of loose stools in the past 12 hours

• Vital signs: Temperature 98.6°F, heart rate 80 bpm, blood pressure 118/76 mmHg, respiratory rate 16 breaths per minute

Section 1

Initial Assessment Findings:

Upon conducting an initial assessment, the nurse noted that the patient appeared slightly fatigued but was alert and oriented to person, place, and time. The patient's skin was warm and dry, with no signs of cyanosis or pallor. Capillary refill time was less than two seconds, indicating adequate peripheral perfusion. An abdominal examination revealed mild tenderness upon palpation, particularly in the lower quadrants, but no guarding or rebound tenderness was present. Bowel sounds were hyperactive, consistent with increased motility typical of gastroenteritis.

The nurse asked the patient about her dietary intake over the past 24 hours, revealing that she had taken minimal solid food but maintained some fluid intake, primarily water. The patient reported feeling slightly dizzy upon standing, suggesting early signs of fluid depletion. The nurse performed orthostatic vital signs to assess for volume status changes, noting a slight decrease in systolic blood pressure and a mild increase in heart rate when the patient moved from a lying to a standing position. This finding further indicated the potential onset of mild dehydration, prompting the nurse to prioritize interventions aimed at fluid replenishment and continued monitoring of the patient's hydration status.

In this early stage of gastroenteritis, the nurse developed a care plan focusing on encouraging oral rehydration with electrolyte solutions and educating the patient on maintaining adequate fluid intake. The nurse also planned for regular reassessment of vital signs and symptom progression, with an emphasis on preventing further dehydration and ensuring patient comfort. These foundational interventions set the stage for evaluating the patient's response to treatment and adjusting care as needed.

Section 2

As the nurse continued to monitor the patient's response to the implemented interventions, there was a notable improvement in the patient's hydration status. The patient was encouraged to sip on an oral rehydration solution, and by the afternoon, reported feeling less dizzy when standing. Upon reassessment, the nurse observed that the patient's heart rate had stabilized to 82 beats per minute, and her orthostatic changes were no longer evident, suggesting improved intravascular volume. The patient’s blood pressure was recorded at 110/70 mmHg, maintaining within the normal range for her baseline.

Throughout the day, the nurse also focused on enhancing the patient's comfort by addressing her abdominal discomfort. The patient was educated on the importance of consuming small, bland meals as tolerated and was provided with a heating pad to alleviate any residual abdominal cramping. The nurse encouraged the patient to rest and reassured her that mild abdominal tenderness was expected as her condition began to resolve.

Later in the evening, lab results returned, which showed a slightly elevated white blood cell count of 11,000/mm³, consistent with the body's inflammatory response to infection. Electrolytes remained within normal limits, reflecting adequate oral intake and the effectiveness of the rehydration strategy. The nursing team decided to continue with the current management plan, closely observing for any new symptoms or signs of complications, while reinforcing dietary and hydration education. The patient demonstrated a keen understanding of the care plan, actively participating in her recovery and expressing readiness to gradually resume normal activities as her symptoms improved.

Section 3

As the following day began, the nurse conducted a routine morning assessment and noted that the patient continued to show signs of recovery. The patient reported having a restful night, with fewer episodes of nausea and no further vomiting. Upon examination, the nurse observed that the patient's skin turgor was improving, and her mucous membranes appeared moist, indicating sustained hydration. Vital signs remained stable, with a heart rate of 80 beats per minute and blood pressure of 112/72 mmHg. The patient was able to tolerate small sips of water and a bland breakfast without any gastrointestinal upset.

However, the nurse noticed a new finding during the assessment: slight tenderness in the right lower quadrant of the abdomen, which was an area previously reported as mildly tender but now seemed more pronounced. Although the patient denied severe pain, the nurse decided to monitor this closely and notified the attending physician to rule out any potential complications, such as appendiceal involvement. The nurse also reviewed the patient's lab results from the previous evening, which showed a slight elevation in the white blood cell count, and considered whether this could be linked to the localized tenderness noted that morning.

The care team decided to keep the patient under observation for an additional 24 hours to ensure the abdominal tenderness did not signify a developing complication. The patient was advised to continue with the oral rehydration solution and bland diet, and the nurse reinforced the importance of reporting any changes in symptoms, such as increased pain or fever, immediately. The patient expressed understanding and appreciation for the attentive care and was optimistic about her continued recovery. The nursing team planned to reassess the need for further diagnostic imaging if the tenderness persisted or if other symptoms emerged.

Section 4

Later that afternoon, the nurse conducted another assessment to evaluate the patient's condition and any changes in symptoms. The vital signs remained stable: heart rate was consistent at 82 beats per minute, blood pressure held steady at 114/70 mmHg, and the patient's temperature was within normal limits at 98.6°F (37°C). The patient's skin turgor continued to improve, and she was able to consume a small lunch consisting of clear broth and toast without any gastrointestinal distress. However, when assessing the abdomen, the nurse noted that the right lower quadrant tenderness persisted and had slightly increased in intensity, though the patient still denied severe pain and had no rebound tenderness or guarding.

In light of these findings, the care team decided to proceed with an abdominal ultrasound to better understand the source of the tenderness. Meanwhile, the nurse ensured that the patient received adequate education on the importance of hydration and maintaining a bland diet to support recovery. The nurse also emphasized monitoring for any new symptoms, such as the onset of fever, increased abdominal pain, or changes in bowel habits, which could indicate complications.

The abdominal ultrasound was conducted promptly, and preliminary results showed no signs of appendicitis or other acute abdominal issues, providing some reassurance to both the patient and the care team. The slight elevation in the white blood cell count was attributed to the body's natural response to the gastroenteritis. The patient was advised to continue with the current treatment plan, and the team planned to reassess and review any further developments the following morning. The patient felt relieved by the ultrasound findings and remained optimistic about her recovery, expressing gratitude for the thorough care she received.

Section 5

The following morning, the nurse conducted a thorough assessment as part of the routine care for the patient with gastroenteritis. The vital signs remained stable: heart rate was 80 beats per minute, blood pressure was 116/72 mmHg, and the temperature was steady at 98.4°F (36.9°C). The patient reported a restful night with no disturbances, and her appetite seemed to be improving. She managed to consume a light breakfast of oatmeal and applesauce without experiencing nausea or discomfort. Upon palpation, the nurse noted that the right lower quadrant tenderness had decreased slightly, indicating a positive response to the conservative management approach.

In reviewing the patient's laboratory results, the white blood cell count had normalized overnight, suggesting that the inflammation was subsiding. The nurse discussed the importance of maintaining hydration and advised the patient to continue with oral rehydration solutions and a bland diet. Additionally, she instructed the patient to avoid any strenuous activities that might aggravate her symptoms. The patient expressed relief and was eager to follow the recommendations to expedite her recovery.

As the day progressed, the patient demonstrated continued improvement. She remained vigilant for any changes in her condition, as instructed by the nursing team. The plan was to monitor her progress closely and, if stable, consider discharge planning. The patient felt confident and supported, optimistic about returning to her usual activities soon. The nursing team remained attentive, ready to address any emerging needs or concerns, ensuring a smooth transition in the patient's recovery journey.