ACUTE GASTROENTERITIS

A Case Study Presented to the Faculty

Of The College of Nursing

In Partial fulfillment of the Requirements

For the Degree of College of Nursing

(SCHOOL)

By;

(NAME OF STUDENT)

(Month, Year Submitted)

INTRODUCTION:

Disorders of intestinal absorption and bowel eliminations can affect health,

comfort, and well-being. Bowel function can be affected by inflammations, infections,
and tumors, obstructions, or changes in structure.

Clients with intestinal disorder often face extensive diagnostic testing, surgery,
and permanent changes in physical appearance and lifestyle. Nursing care is directed
toward meeting the client’s physiologic needs, providing emotional support, and
educating the client to adapt to changes in lifestyle.

RELATED LITERATURE:

• DEFINITION

Gastroenteritis, or enteritis, is an inflammation of the stomach and small

intestine. Enteritis may be cause by bacteria, viruses, parasites, or toxins. Upper GI
symptoms such as anorexia, nausea, and vomiting are common. Diarrhea of varying
intensity have abdominal discomfort are nearly universal features of gastroenteritis.

The infectious organism usually enters the body in contaminated water or food.
For this reason, gastroenteritis often is called “food poisoning.” Viruses commonly
cause acute diarrheal illness. Diarrhea due to rotaviruses or the Norwalk virus occurs
year-round in both adults and children. These illnesses are generally mild and self-
limited, but can have severe consequences in the very young, the very old, or in people
with impaired immune functions.

• MANIFESTATIONS

Gastrointestinal Effects

o Anorexia, nausea, and vomiting

o Abdominal pain and cramping

o Borborygmi

o Diarrhea

General Effects

o Malaise, weakness, and muscle aches

o Headache

o Dry skin and mucous membranes

o Poor skin turgor

o Orthostatic hypotension, tachycardia

o Fever

Anatomy & Physiology of Gastrointestinal System

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral
cavity, where food enters the mouth, continuing through the pharynx, oesophagus,
stomach and intestines to the rectum and anus, where food is expelled. There are
various accessory organs that assist the tract by secreting enzymes to help break down
food into its component nutrients. Thus the salivary glands, liver, pancreas and gall
bladder have important functions in the digestive system. Food is propelled along the
length of the GIT by peristaltic movements of the muscular walls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients,
which can be absorbed into the body to provide energy. First food must be ingested into
the mouth to be mechanically processed and moistened. Secondly, digestion occurs
mainly in the stomach and small intestine where proteins, fats and carbohydrates are
chemically broken down into their basic building blocks. Smaller molecules are then
absorbed across the epithelium of the small intestine and subsequently enter the
circulation. The large intestine plays a key role in reabsorbing excess water. Finally,
undigested material and secreted waste products are excreted from the body via
defecation (passing of faeces).

In the case of gastrointestinal disease or disorders, these functions of the

gastrointestinal tract are not achieved successfully. Patients may develop symptoms of
nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction. Gastrointestinal
problems are very common and most people will have experienced some of the above
symptoms several times throughout their lives.

Details:

Basic structure

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called
epithelium. The contents of the tube are considered external to the body and are in
continuity with the outside world at the mouth and the anus. Although each section of
the tract has specialised functions, the entire tract has a similar basic structure with
regional variations. The wall is divided into four layers as follows:

Mucosa: The innermost layer of the digestive tract has specialised epithelial cells
supported by an underlying connective tissue layer called the lamina propria. The
lamina propria contains blood vessels, nerves, lymphoid tissue and glands that support
the mucosa. Depending on its function, the epithelium may be simple (a single layer) or
stratified (multiple layers). Areas such as the mouth and oesophagus are covered by a
stratified squamous (flat) epithelium so they can survive the wear and tear of passing
food. Simple columnar (tall) or glandular epithelium lines the stomach and intestines to
aid secretion and absorption. The inner lining is constantly shed and replaced, making it
one of the most rapidly dividing areas of the body! Beneath the lamina propria is the
muscularis mucosa. This comprises layers of smooth muscle which can contract to
change the shape of the lumen.

Submucosa: The submucosa surrounds the muscularis mucosa and consists of fat,
fibrous connective tissue and larger vessels and nerves. At its outer margin there is a
specialized nerve plexus called the submucosal plexus or Meissner plexus. This
supplies the mucosa and submucosa.

Muscularis externa: This smooth muscle layer has inner circular and outer longitudinal
layers of muscle fibres separated by the myenteric plexus or Auerbach plexus. Neural
innervations control the contraction of these muscles and hence the mechanical
breakdown and peristalsis of the food within the lumen.

Serosa/ Mesentery: The outer layer of the GIT is formed by fat and another layer of
epithelial cells called mesothelium.

The Individual Components of the Gastrointestinal System

Oral cavity

The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified
squamous oral mucosa with keratin covering those areas subject to significant abrasion,
such as the tongue, hard palate and roof of the mouth. Mastication refers to the
mechanical breakdown of food by chewing and chopping actions of the teeth. The
tongue, a strong muscular organ, manipulates the food bolus to come in contact with
the teeth. It is also the sensing organ of the mouth for touch, temperature and taste
using its specialised sensors known as papillae.

Insalivation refers to the mixing of the oral cavity contents with salivary gland secretions.
The mucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a
limited role in the digestion of carbohydrates. The enzyme serum amylase, a
component of saliva, starts the process of digestion of complex carbohydrates. The final
function of the oral cavity is absorption of small molecules such as glucose and water,
across the mucosa. From the mouth, food passes through the pharynx and oesophagus
via the action of swallowing.

Salivary Glands

Three pairs of salivary glands communicate with the oral cavity. Each is a complex
gland with numerous acini lined by secretory epithelium. The acini secrete their contents
into specialised ducts. Each gland is divided into smaller segments called lobes.
Salivation occurs in response to the taste, smell or even appearance of food. This
occurs due to nerve signals that tell the salivary glands to secrete saliva to prepare and
moisten the mouth. Each pair of salivary glands secretes saliva with slightly different
compositions.

Parotids: The parotid glands are large, irregular shaped glands located under the skin
on the side of the face. They secrete 25% of saliva. They are situated below the
zygomatic arch (cheekbone) and cover part of the mandible (lower jaw bone). An
enlarged parotid gland can be easier felt when one clenches their teeth. The parotids
produce a watery secretion which is also rich in proteins. Immunoglobins are secreted
help to fight microorganisms and a-amylase proteins start to break down complex
carbohydrates.

Submandibular: The submandibular glands secrete 70% of the saliva in the mouth.
They are found in the floor of the mouth, in a groove along the inner surface of the
mandible. These glands produce a more viscid (thick) secretion, rich in mucin and with
a smaller amount of protein. Mucin is a glycoprotein that acts as a lubricant.

Sublingual: The sublinguals are the smallest salivary glands, covered by a thin layer of
tissue at the floor of the mouth. They produce approximately 5% of the saliva and their
secretions are very sticky due to the large concentration of mucin. The main functions
are to provide buffers and lubrication.

Oesophagus

The oesophagus is a muscular tube of approximately 25cm in length and 2cm in

diameter. It extends from the pharynx to the stomach after passing through an opening
in the diaphragm. The wall of the oesophagus is made up of inner circular and outer
longitudinal layers of muscle that are supplied by the oesophageal nerve plexus. This
nerve plexus surrounds the lower portion of the oesophagus. The oesophagus functions
primarily as a transport medium between compartments.

Stomach

The stomach is a J shaped expanded bag, located just left of the midline between the
oesophagus and small intestine. It is divided into four main regions and has two borders
called the greater and lesser curvatures. The first section is the cardia which surrounds
the cardial orifice where the oesophagus enters the stomach. The fundus is the
superior, dilated portion of the stomach that has contact with the left dome of the
diaphragm. The body is the largest section between the fundus and the curved portion
of the J. This is where most gastric glands are located and where most mixing of the
food occurs. Finally the pylorus is the curved base of the stomach. Gastric contents are
expelled into the proximal duodenum via the pyloric sphincter. The inner surface of the
stomach is contracted into numerous longitudinal folds called rugae. These allow the
stomach to stretch and expand when food enters. The stomach can hold up to 1.5 litres
of material.

The functions of the stomach include:

1. The short-term storage of ingested food.

2. Mechanical breakdown of food by churning and mixing motions.
3. Chemical digestion of proteins by acids and enzymes.
4. Stomach acid kills bugs and germs.
5. Some absorption of substances such as alcohol.

Most of these functions are achieved by the secretion of stomach juices by gastric
glands in the body and fundus. Some cells are responsible for secreting acid and others
secrete enzymes to break down proteins.

Small Intestine

The small intestine is composed of the duodenum, jejunum, and ileum. It averages
approximately 6m in length, extending from the pyloric sphincter of the stomach to the
ileo-caecal valve separating the ileum from the caecum. The small intestine is
compressed into numerous folds and occupies a large proportion of the abdominal
cavity. The duodenum is the proximal C-shaped section that curves around the head of
the pancreas. The duodenum serves a mixing function as it combines digestive
secretions from the pancreas and liver with the contents expelled from the stomach.
The start of the jejunum is marked by a sharp bend, the duodenojejunal flexure. It is in
the jejunum where the majority of digestion and absorption occurs. The final portion, the
ileum, is the longest segment and empties into the caecum at the ileocaecal junction.

The small intestine performs the majority of digestion and absorption of nutrients. Partly
digested food from the stomach is further broken down by enzymes from the pancreas
and bile salts from the liver and gallbladder. These secretions enter the duodenum at
the Ampulla of Vater. After further digestion, food constituents such as proteins, fats,
and carbohydrates are broken down to small building blocks and absorbed into the
body"?Ts blood stream.

The lining of the small intestine is made up of numerous permanent folds called plicae
circulares. Each plica has numerous villi (folds of mucosa) and each villus is covered by
epithelium with projecting microvilli (brush border). This increases the surface area for
absorption by a factor of several hundred. The mucosa of the small intestine contains
several specialised cells. Some are responsible for absorption, whilst others secrete
digestive enzymes and mucous to protect the intestinal lining from digestive actions.

Large Intestine

The large intestine is horse-shoe shaped and extends around the small intestine like a
frame. It consists of the appendix, caecum, ascending, transverse, descending and
sigmoid colon, and the rectum. It has a length of approximately 1.5m and a width of
7.5cm. The caecum is the expanded pouch that receives material form the ileum and
starts to compress food products into faecal material. Food then travels along the colon.
The wall of the colon is made up of several pouches (haustra) that are held under
tension by three thick bands of muscle (taenia coli). The rectum is the final 15cm of the
large intestine. It expands to hold faecal matter before it passes through the anorectal
canal to the anus. Thick bands of muscle, known as sphincters, control the passage of
faeces.

The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal
surface is flat with several deep intestinal glands. Numerous goblet cells line the glands
that secrete mucous to lubricate faecal matter as it solidifies.

The functions of the large intestine can be summarised as:

1. The accumulation of unabsorbed material to form faeces.

2. Some digestion by bacteria. The bacteria are responsible for the formation of
intestinal gas.
3. Reabsorption of water, salts, sugar and vitamins.

Liver

The liver is a large, reddish-brown organ situated in the right upper quadrant of the
abdomen. It is surrounded by a strong capsule and divided into four lobes namely the
right, left, caudate and quadrate lobes. The liver has several important functions. It acts
as a mechanical filter by filtering blood that travels from the intestinal system. It
detoxifies several metabolites including the breakdown of bilirubin and oestrogen. In
addition, the liver has synthetic functions, producing albumin and blood clotting factors.
However, its main roles in digestion are in the production of bile and metabolism of
nutrients. All nutrients absorbed by the intestines pass through the liver and are
processed before traveling to the rest of the body. The bile produced by cells of the
liver, enters the intestines at the duodenum. Here, bile salts break down lipids into
smaller particles so there is a greater surface area for digestive enzymes to act.

Gall Bladder

The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior
surface of the liver's right lobe. It consists of a fundus, body and neck. It empties via the
cystic duct into the biliary duct system. The main functions of the gall bladder are
storage and concentration of bile. Bile is a thick fluid that contains enzymes to help
dissolve fat in the intestines. Bile is produced by the liver but stored in the gallbladder
until it is needed. Bile is released from the gall bladder by contraction of its muscular
walls in response to hormone signals from the duodenum in the presence of food.

Pancreas

Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its
head communicates with the duodenum and its tail extends to the spleen. The organ is
approximately 15cm in length with a long, slender body connecting the head and tail
segments. The pancreas has both exocrine and endocrine functions. Endocrine refers
to production of hormones which occurs in the Islets of Langerhans. The Islets produce
insulin, glucagon and other substances and these are the areas damaged in diabetes
mellitus.

The exocrine (secretrory) portion makes up 80-85% of the pancreas and is the area
relevant to the gastrointestinal tract. It is made up of numerous acini (small glands) that
secrete contents into ducts which eventually lead to the duodenum. The pancreas
secretes fluid rich in carbohydrates and inactive enzymes. Secretion is triggered by the
hormones released by the duodenum in the presence of food. Pancreatic enzymes
include carbohydrases, lipases, nucleases and proteolytic enzymes that can break
down different components of food. These are secreted in an inactive form to prevent
digestion of the pancreas itself. The enzymes become active once they reach the
duodenum.

GENERAL DATA

 NAME: Child X
AGE: 7 years old
SEX: Female
CIVIL STATUS: Child
OCCUPATION: ------
ADDRESS: Brgy. Taglin Macalelon Quezon
DATE/TIME OF ADMISSION: February 8, 2007 (11:15pm)
FINAL DIAGNOSIS: AGE

PHYSICAL ASSESSMENT

General Appearance:
conscious and coherent
alert and oriented to time, place and person
lethargic and weak in appearance
needs assistance to move and ambulate
pale in appearance
Head
normocephalic
no mass and lesion
with evenly distributed black hair
dandruff noted
Eyes
with pale conjunctiva
pupils both reactive to light accommodation
with good visual acuity
Ears -
with normal auditory functioning
symmetrical in shape
no deformities
with flaky cerumen
Nose -
centrally located
no nasal discharge
no nasal flaring
Mouth/Throat -
with dry crack pale lips
with dental carries
with dry oral cavity
with poor oral hygiene
with centrally located uvula and tongue
Chest/Lungs -
not in respiratory distress
with normal and equal chest expansion
Abdomen -
(+) guarding on abdomen
With bowel sounds of 3/min
(+) tenderness on hypogastric area
(-) rebound
Genito-Urinary -
voiding freely with bright yellowish urine
no painful or tingling sensation
Extremities -
with good capillary refill
with poor skin turgor
with long dirty nails
with palpable pulses but weak at intervals

HISTORY OF PRESENT ILLNESS

Child X brought to the hospital without exact reason for having the chief
complaint: diarrhea, abdominal pain and vomiting.

PAST MEDICAL HISTORY

Previous Hospitalization-N/A

Immunization- Shereceived just a single dose of BCG.

Past Diseases- chickenpox, cough, colds and fever

FAMILY HEALTH HISTORY

Parents of Child X ( common cough, colds and fever)

I
 5 Siblings(chickenpox, common cough, colds, and fever) and

Child X(common cough, colds, fever, chickenpox, AGE)

No severe cases noted from the health of his family from the past just common,
cough, colds, and fever.

SOCIAL HISTORY

Activities of Daily Living

Child X was spending her days on the school playing with her friends, sometimes on the
backyard. She eats food and drink water even though she’s not sure about its
safeties

Geographical Data

Their house is located approximately one kilometer away from the highway road and
town proper especially the church and Brgy. Health Center. Their source of
electricity is MERALCO. They just burn their garbage at their backyard.

• PATHOPHYSIOLOGY

CONTAMINATED FOOD

DIGESTED FOOD

BACTERIAL OR VIRAL INFECTION

INFLAMMATION, TISSUE DAMAGE

EXOTOXIN / ENDOTOXIN DAMAGE TISSUE MORE DIRECTLY

DAMAGE INFLAMMATION INVADE INTESTINAL MUCOUSA OF

THE SMALL BOWEL OR COLON

IMPAIR INTESTINAL ABSORPTION MICROSCOPIC ULCERATION

 AND CAN CAUSE SECRETION OF

SIGNIFICANT AMOUNTS OF BLEEDING

ELECTROLYTES AND WATER INTO

THE BOWEL FLUID CAUDATE

DIARRHEA WATER AND ELECTROLYTE

SECRETION

FLUID LOSS

Feb 8, 2007 (Day 1)

- admitted, with the chief complaint of abdominal pain, diarrhea and vomiting

- monitoring of vital signs,

February 9 (Day 2)

-pale and weak in appearance

- with dry lips and oral cavity

- with flabby soft abdomen, (-)tenderness on epigastric and hypocastric area,

(-)rebound

- instructed on liquid diet

- CBC done

- temperature increased

February 10(Day 3)

-Pale and weak in appearance

-febrile 38.4oC

- with mild on and off abdominal pain

- seen and examined by Pediatricts, given meds

- urinalysis done

February 11(Day 4)

- weak and pale in appearance

- with dry lips and skin

February 12 (Day 7)

-conscious and coherent

 - with stable vital signs

-slight pale in appearance

- S/E by attending Physician with discharge order, and home meds prescription

- went home with fair condition

URINALYSIS RESULT

Macroscopic:

Color: bright yellow

Transparency: slightly turbid

Specific gravity: 1. 030

Chemical Test:

Sugar (-)

Albumin +1

Microscopic:

RBC: 4-5

WBC: 8-10

Epith. Cells: +1

Urates: +1

COMPLETE RESULTS REFERENCE INTERPRETATION SIGNIFICANCE

BLOOD COUNT VALUE

Hemoglobin 12.16 g/dl Male: 14-18 g/dl decreased Decreased in various anemias,
severe or prolonged
hemorrhage, and with excessive
fluid intake

Hematocrit 36 vol % Male: 40-50 vol% decreased Decreased in severe anemias

or acute massive blood loss
WBC Count 12,400/cumm 5,000-10,000/cumm increased Increased in acute infectious
disease predominantly in the
DIFFERENTIAL 40-60% increased neutrophilic fraction,possible for
COUNT stress or sepsis
35-40% decreased
Neutrophils
84%
Lymphocytes
16%
TOTAL
100%

CUES/DATA NSG. GOAL/OBJECTIVE INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

S:”nanghihina Activity At the end of the 1. Asses level of 1. Provides Goal completely
ako kaya di intolerance shift, patient reports activity tolerance baseline for met
nalang ako related to decrease in fatigue and degree of further
gumagalaw fatigue, and reports fatigue, lethargy, assessment At the end of
masyado, at lethargy, and increased ability to and malaise when and criteria for the shift pt:
lalo malaise participate in performing assessment of >Exhibits
sumasakit activities routine ADLS effectiveness increased in
itong tyan of activities events
ko”as 2. Assist with interventions
verbalized by activities and >Participates in
the pt. hygiene when 2. Promotes activities and
fatigued. exercise and gradually
O: hygiene within increases
3. Encourage rest pt level of
-weak and when fatigued or tolerance exercises within
pale in when abdominal physical limits
appearance pain or discomfort 3. Conserves >Reports
occurs. energy and increased
-with body protects the
malaise 4. Assist with strength and
liver well being
selection and
-with facial pacing of desired 4. Stimulates
grimace >Reports
activities and pt interest in absence of
when moving exercises selected abdominal pain
activities and discomfort
5. Provide diet
high in 5. Provides >Plans activities
carbohydrates calories for to allow ample
with protein intake energy and periods of rest
consistent with protein for
liver function. healing >Takes
vitamins as
6. Administer 6. provides prescribed
supplemental additional
vitamins (A, B nutrients
complex, C, and
K)
CUES/DATA NSG. GOAL/OBJECTIVE INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

S:”Sobrang Chronic pain Goal: Increased level 1. Perform a 1.to assess Goal
sakit nitong and of comfort comprehensive characteristics, Completely met
tyan discomfort assessment of the location, onset,
ko(pointing related to Objective: pain frequency, At the end of
at epigastric enlarged quality and the nsg.
At the end of the 2.Provide quiet Intervention pt:
area), intestine nursing intervention, severity of pain.
pasumpong environment, calm
pt. Pain will be activities.Maintain bed 2.Reduces >Reports pain
sumpong decreased with the and discomfort
minsan nga rest when patient metabolic
rate of 3 in the 0-10 experiences demands and if present
napapaiyak pain scale
ako sa abdominal discomfort protects the liver >Maintains bed
sobrang 3.Observe record and 3.Provides rest and
sakit eh”, as report presence and baseline to decreases
verbalized character of pain and detect further activity in
by the discomfort deterioration of presence of
patient status and to pain
4. Reduce sodium evaluate
O: and fluid intake if >Takes
interventions medication as
-with the rate prescribed
4.Minimizes prescribed
of 7 in the 0- 5. Assist client in the further formation
10 pain use of relaxation >Reports
scale of ascites decreased pain
techniques and
encourage 5. To provide and abdominal
-with facial discomfort (pain
grimace ambulation as relief of
individually indicated causative is rated as 3 in
upon 0-10 p1in scale)
palpation factors
6. Administer
medication as 6.Reduces >reduces
-with
guarding prescribed. irritability of the sodium and
behavior on gastrointestinal fluid intake to
(ranitidine/analgesic) tract and prescribed
abdomen levels if
decreases
-irritable at abdominal pain indicated to
frequent and discomfort treat ascites
intervals
CUES/DATA NSG. GOAL/OBJECTIVE INTERVENTIO RATIONALE EVALUATION
DIAGNOSIS N

S:No Risk for Goal: Maintenance 1. Record 1.Provides Goal completely

Subjective imbalanced of normal body temperature baseline to met:
complaint body temperature, free regularly detect fever and
temperature: from infection to evaluate At the end of
O: hyperthermia 2. Encourage interventions the nsg.
related to OBJECTIVE: fluid intake Intervention pt:
-Temp:38.4 2.corrects fluid
>normal on inflammatory At the end of nsg. 3. Apply cool -Exhibits normal
process of loss from
other days Intervention, pt. sponges or perspiration and temp and
cirrhosis Temp. will be in icebag for reports absence
-with flushing fever and
normal range (37oC) elevated temp. increases pt of chills or
face sweating
4. Administer level of comfort
-skin warm to antibiotics as (temp:37oC)
touch 3.Promotes
prescribed reduction of -Demonstrates
-with poor 5.Avoid fever and adequate intake
skin turgor exposure to increases pt of fluids
infections comfort
-sweating -Exhibits no
6.Keep patient 4.Ensures evidence of
at rest while appropriate local or
temp is serum systemic
elevated concentration of infection
antibiotics to
7. Asses for treat infection
abdominal pain,
tenderness 5.minimize risk
of further
infection and
further increases
in body temp
and metabolic
rate

6.reduces
metabolic rate

7.may occur with

bacterial
peritonitis
DRUG CLASSIFICATI INDICATION/ INTERACTI ADVERSE NURSING
NAME ON ON/ ACTION
CONTRAINDICAT REACTION CONSIDERATI
ION ON

Ampicil Cephalosporin, INDI: PO (axetil), Amino CV: Phlebitis, 1.Assess for

lin second Suspenion glycosides: thrombophlebitis, infections befor
generation (children, 3 may cause and after
months-12years). synergistic GI: administration
(Anti-infective) activity Pseudomembrano
1. pharynginitis or against some us colitis, nausea, 2. For IM use
tonsillitis due to organisms; anorexia, inject deep into
pyogenes. may increase vomiting, a large muscle
diarrhea, mass.
2. Acute bacteraial nephrotoxicit
otitis media due to y. Monitor HEMATOLOGIC:
S. pneumoniae, H. patient's transient
influenzae, M. renal function neutropenia,
catarrhalis, or S. closely eosinophilia,
pyogens. ACTION: hemolytic anemia,
Second- thrombophocytop
3. Acute bacterial
maxillary sinusitis generation enia,
due to S. cephalospori OTHER:
pneumoniae or H. n that inhibits hypersensitivity
influenzae. cell-wall reactions, serum
synthesis, sickness,
4. Uncomplicated promoting anaphylaxis
UTIs osmotic
instability;
5. Perioperative
usually
prevention
bactericidal
6. Early Lyme
disease

7.Secondary
bacterial infection
of acute bronchitis

CONT:
1.Contraindicated
in patients
hypersensitive to
drugs or other
cephalosporin's.

2. Use cautiously
in patients
hypersensitive to
penicillin because
of possibility of
cross-sensitivity
with other beta-
lactam antibiotics

3. Use cautiously
to breast-feeding
women and in
patients with
history of colitis or
renal insufficiency
DRUG CLASSIFICA INDICATION/ INTERACTI ADVERSE NURSING
NAME TION ON/
CONTRAINDICA ACTION REACTION CONSIDERA
TION TION

Atrovent Bronchodilator INDI: 1. Antiholinergi CNS: dizziness, 1. If patient is

s/ Bronchospasm in cs: May pain, headache, using a face
(ipratropi anticholinergic chronic bronchitisincrease nervousness. mask for
um s and emphysema. anticholinerg nebulizer, take
bromine) ic effects. CV: palpitations, care to
2. Rhinorrhea Avoid using hypertension, prevent
DOSAGE caused by chest pain.
: together. leakage
allergic and around the
nonallergic ACTION: EENT: blurred
Atrovent vision, rhinitis, mask because
neb q6o perennial rhinitis eye pain or
Inhibits sinusitis,
3. Rhinorrhea Cholinergic epistaxis. temporary
caused by the receptors in blurring of
common cold. bronchial GI: nmausea, GI vision may
smooth distress, dry occur
4. Rhinorrhea muscle,resul mouth.
caused by 2. Safety and
ting in
seasonal allergic decreased MUSCULOSKEL efficiency of
rhinitis. ETAL: use beyond 4
concentratio days in
CONT: 1. In ns of cyclic Back pain. patients with a
patients guanosine common cold
RESPIRATORY:
hypersensitive to monophosp upper respiratory haven't been
drug, atrophine, hate. tract infection, established.
or its derivatives Produce bronchitis ,
and in those local 4. Patient with
cough, dyspnea,
hypersensitive to bronchodilati bronchospasm, a severe
soy lecitin or on peanut allergy
increased
related food could have an
sputum.
products, such anaphylactic
as soybeans and SKI: rash reaction after
peanuts. using Atrovent
OTHER: flulike inhalation
2. Use cautiously symptoms, aerosol
to patients with hypersensitivity metered-dose
angle closure reaction. inhaler (MDI).
glaucoma, Get a
prostatic thorough
hyperplasia, or allergy history
bladder-nekc from patient
obstruction. before giving
any drug.
3. Safety and
efficacy of
nebulization or
inhaler in
children younger
than age 12
haven't been
established.