Nursing Assignment on Gastroenteritis: Activities of Living and Nursing Care Plan

This nursing assignment focuses on the case study of Mr Keith, an 86-year old male patient who has been admitted to the medical with diagnoses of dehydration and gastroenteritis. The essay discusses the Activities of Living in relation to the condition of the patient and develops a nursing care plan for the patient including one issue in relation to every Activity of Living.

Running head: GASTROENTERITIS 1
NURSING ASSIGNMENT
Student’s Name
Institutional Affiliation
Course
Instructor
Date

GASTROENTERITIS 2
Introduction
Human medical conditions and illnesses impacts on the activities of living and the
general mechanisms of functioning of the patient. The essay will focus on the case study of
Mr Keith, an 86-year old male patient who has been admitted to the medical with diagnoses
of dehydration and gastroenteritis. He has an history of diarrhoea and abdominal cramping
for two days. He has an history of vomiting for one day. Currently, Mr. Keith is presenting
with watery diarrhoea, abdominal pain, a mild temperature of 37.70 C, mild dehydration, and
headache. Additionally, he also has complaints of lethargy. With regard to the diagnosis,
presenting complaints, and manifestations in the case study, the essay will discuss the
Activities of Living in relation to the condition of the patient. The essay will discuss three
Activities of Living providing an overview of how they may be impacted by the patient’s
illness and diagnosis.
The essay will discuss the assessment of Mr. Keith’s in relation to the identified three
Activities of Living including the kind of care and interventions would be provided and
implemented to Mr. Keith. The three Activities that will be discussed in the essay are eating
and drinking, elimination, and personal cleaning and dressing. The essay will develop a
nursing care plan for the patient including one issue in relation to every Activity of Living.
Therefore, the nursing care plan will have three issues arising from the case study. In the
development of the nursing care plan, the essay will formulate a goal or plan for the
improvement of every issue including the identification of the strategies that can be
implemented to meet each goal or plan. Lastly, the essay will discuss the evaluative measures
or strategies that will be implemented in the determination of whether each goal or plan was
met or not.

GASTROENTERITIS 3
Activities of Living (AoLs)
Gastroenteritis which is also called infectious diarrhea, is the inflammation of the
humans’ gastrointestinal tract particularly the small intestines and the stomach.
Gastroenteritis can be caused by bacteria, viruses or parasites which are usually invasive. The
pathogens cause cell damage and produce toxins leading to various manifestations seen in a
patient with gastroenteritis. In most instances, the virus that is responsible for gastroenteritis
is norovirus. The condition can also be attributed to food poisoning following bacterial
infection. Some of the common signs and symptoms of gastroenteritis include sudden and
watery diarrhea, abdominal pain, vomiting which is sometimes projectile, and mild fever.
Other additional signs and symptoms of gastroenteritis include lack of energy, lethargy, loss
of appetite, headaches, aching limbs, and feeling of sickness (Biagi et al., 2012).
Activities of Living are essential in an individual’s life since they maximumly
promote independence. They are used in the assessment of the relative independence of an
individual or the potential for independence for determination of the interventions that are
appropriate in increasing his or her level of independence (Ahmed et al., 2014). Additionally,
the assessment of the Activities of Living in an individual helps in the identification of any
ongoing support that should be provided the patient for the compensation of his dependency.
Some of the major activities of living include maintenance of a safe environment,
breathing, communication, mobilisation, eating and drinking, sleeping, and elimination
(Bunn, Jimoh, Wilsher, & Hooper,2015). Other activities of living that are essential in the life
of the patient include washing and dressing, controlling temperature, expression of sexuality,
working and playing, and death and dying. The Activities of Living are influences by a wide
range of factors namely biological, sociocultural, psychological, politico-economic,
environmental, and sociocultural factors (Labbe, & Juneja, 2013).

GASTROENTERITIS 4
Activity of Living 1: Eating and drinking
Gastroenteritis affects eating and drinking based on its signs and symptoms like
degradation, loss of appetite, watery diarrhoea, vomiting, and lethargy. In the initial stages of
gastroenteritis, the patient is usually at a great risk of dehydration. The significant risk of
dehydration in gastroenteritis is often attributed to the excessive loss of body fluids and
electrolytes through vomiting and diarrhea (Hall, Curns, McDonald, Parashar, & Lopman,
2012).
Once the patient is experiencing diarrhea and vomiting, he may not be in a position to
comfortably use much fluids or food orally. The patient may have small oral intakes that may
reduce the symptoms. Loss of appetite by the patient largely impacts his nutritional and
feeding patterns resulting in poor feeding leading to weight loss. The patient may have avoid
eating and drinking due to the fear of vomiting and diarrhea. The abdominal pain also reduces
the patient’s desire for eating and drinking hence causing inadequate nutrition which is less
that the body requirements or needs (Parashar, Nelson, & Kang, 2013).
The inadequate fluid intake may consequently on the urinary functioning leading to
low or no urine output by the patient. The lack of energy and lethargy in gastroenteritis may
make the patient unable to prepare his own meals and take drinks. He may need assistance in
the preparation and intake of fluids and drinks. Gastroenteritis also impairs the general
functioning of the patient’s body system leading the feeling of sickness which consequently
impairs his level of appetites resulting in reduced food and fluid intake. Therefore,
gastroenteritis affects eating and drinking since the patient may withdraw from meals based
on the physiological, biological, and psychological factors associated with the disease (Park,
Richardson, Holleman, & Larson, 2013).
The activity of Living 2: Elimination

GASTROENTERITIS 5
The inflammatory response involved in gastroenteritis causes inflammation of the
small intestines and the stomach which consequently impacts on the patterns of elimination
of the patient. First, the damage of the villous brush border of the small intestines causes
malabsorption of the intestinal contents hence resulting in osmotic diarrhea. Secondly, the
production and release of toxic substances that bind on the specific enterocyte receptors is
often responsible for the release of the chloride ions (Payne et al., 2013).
The secretion of toxic substances stimulates an excessive loss of water and
electrolytes from the body resulting in the watery diarrhea. Additionally, the direct invasion
of the walls of the gastrointestinal tract by microorganisms’ trigger inflammation which the
upsets the existing balance between the rate of nutrient absorption into the body and the
secretion of wastes from the body. These mechanisms negatively impact the elimination
patterns of the patient (Payne et al., 2013).
Diarrhea is the key factor that is often involved in the definition of the patterns of
elimination of a patient. Diarrhea refers to the passage of watery or loose stools for more than
three times in a day. The pattern of stool in an individual may change. Since the
gastroenteritis causes diarrhea affects elimination of the patient by increasing the frequency
of bowel opening or emptying (Wittenberg, 2012). The gastroenteritis alters the nature of
human stool from normal to loose and watery hence impacting on the elimination as an
activity of living in the life of the patient.
Gastroenteritis may lead to the change of the colour of the patient’s stool from
normal to bloody which is abnormal (Pruvost et al., 2013). Since gastroenteritis is causes lack
of energy and lethargy, the patient may not be able to escort himself to the washrooms but
instead he may end up emptying the bowels on himself or on the beddings. Consequently,
this is a clear indication of an impaired elimination as an activity of living. This then calls for

GASTROENTERITIS 6
support of patient in elimination and maintenance of the general cleanliness and hygiene
(Staroverov et al., 2014).
Activity of Living 3: Cleaning and Dressing
Like any other illness or medical condition, gastroenteritis impacts on the activities of
living of patients especially cleaning and dressing. Following the pathogenesis and
pathophysiology of gastroenteritis, the patient experiences diarrhea, abdominal pain,
vomiting, dehydration, and loss of appetite which are the key contributors of patient’s
lethargy and lack of energy. Lethargy may make the patient unable to perform cleaning and
dressing leading to dirt, poor hygiene, poor grooming, and poor general appearance of the
patient (Johnston et al., 2013).
Patient assessment in relation to the Activities of Living
Eating and drinking are fundamental in the life of the patient since they promote
health and well being. The patient with gastroenteritis has difficulties in eating and drinking.
In the assessment of the patient, some of the factors that should be looked at include fluid loss
through diarrhea and vomiting, loss of appetite, loss of weight, lack of energy, tiredness,
lethargy, and inability to perform normal tasks which are essential in his daily life. These
factors are important in the formulation and implementation of the appropriate interventions
and measures of management (Bok, & Green, 2012).
When assessing the patient for elimination, one should consider both bowel
movements and the urine. The screening should cover the following; details about the habits
of normal bowel movements, last time when the patient opened the bowels, past bowel
problems, and the frequency of bowel opening (Bromfield et al.,2014). It is also good to
check the nature, colour, amount, and smell of the stool produced by the patient. Regarding

GASTROENTERITIS 7
urine, one should consider various characteristics such as colour, odour, volume, clarity, and
frequency of urination. To assess the cleaning and dressing in the patient, one should check
for various factors like the general appearance, general cleanliness of the compound and other
equipment used by the patient, and grooming (Guarino et al., 2012).
Patient treatment in relation to the Activities of Living
Regarding eating and drinking, the patient presented with diarrhea, abdominal pain,
and vomiting. To treat this, the patient can be given broad spectrum antibiotics to treat the
primary cause. The antibiotics are also important in the management of the abdominal pain,
diarrhoea, and vomiting. The patient should be given adequate fluids to prevent and
management dehydration. The management of these symptoms would help in the elimination
patterns of the patient since it would help in the reduction of diarrhea and improve urine
output due to improved hydration of the patient. The cleaning and dressing can be managed
by allocating an assistant to help the patient in cleaning, dressing, and maintenance of the
general hygiene (Bresee et al., 2012).
Nursing Care Plan
Activity of
Living
Issue or
problem
Goals Strategies Evaluation
measures
Eating and
drinking
Dehydration Patient
understands the
cause of
dehydration and
rationale for the
prescribed
treatment
modalities.
Administration
of intravenous
fluids (Zhang,
& Li,2017).
Prescription and
administration
Assessment of
the patient to
rule out
presence of the
signs of
dehydration.

GASTROENTERITIS 8
Patient uses
approximately
1500-2000 mL
of clear fluids
within a period
of 24 hours.
Patient reports
reduced
frequency of
diarrhea within
one and half
days.
Patient
verbalizes
relieved
abdominal
cramping and
pain and less or
no diarrhea
of broad-
spectrum
antibiotics for
the treatment of
the primary
cause of the
problem (Allen‐
Durrance &
Campos 2018).
Educating the
patient on the
condition, its
treatment and
the mode of
action of the
treatment
(Zhang, &
Li,2017).
Checking the
skin turgor and
integrity to
check for
improvement.
Elimination Increased bowel
movements and
diarrhea
Encouraging
and providing
the patient with
clear and fluids
every two hours
while the
patient is awake
(Jalanka-
Tuovinen et al.,
2014).
Educating the
patient on the
Assessing the
patient to check
for the
frequency of
bowel
movements and
relieved

GASTROENTERITIS 9
clear fluids that
he should
consume and
those to avoid.
Educating the
patient about
the potential
factors that
contribute to
increased bowel
movements and
diarrhea
(Jalanka-
Tuovinen et al.,
2014).
diarrhea
Cleaning and
dressing
Self-care deficit Patient
identifies some
of the useful
resources for
optimizing the
independence
and autonomy.
Patient
demonstrates
changes in
lifestyle to meet
the needs of
self-care.
Patient able to
recognizes
individual needs
or weaknes.
Patient is able
to safely
executes the
Helping the
patient in
cleaning and
dressing.
Enlightening
the patient
about the need
of maintaining
cleanliness and
dressing
(Jalanka-
Tuovinen et al.,
2014).
Rendering
supervision for
all the activities
until he exhibits
the skill
effectively and
well secured in
independent
care (Ciccarelli,
Stolfi, &
Caramia, 2013).
Assessing the
patient for
cleanliness and
oral hygiene.

GASTROENTERITIS 10
activities of
self-care to
utmost
capability
Regularly re-
evaluate the
patient to be
certain that he is
keeping the
level of skill
level remains
safe and secure
the
environment.
Conclusion
Different medical conditions affect the patient’s activities of living in different ways. The
essay has focused on the case study of Mr Keith with a diagnosis of dehydration and
gastroenteritis. Mr. Keith is a male patient with 86 years. Some of the activities of living of
the patient that have been affected by the gastroenteritis are eating and drinking, elimination,
and cleaning and dressing. Gastroenteritis is an inflammatory disorder of the small intestines
and the stomach which is caused by both bacterial and viruses especially noroviruses.
Gastroenteritis has negative impacts on the Activities of Living of the patient including eating
and drinking, elimination, cleaning and dressing. Some of the common signs and symptoms
of gastroenteritis include diarrhea, vomiting, dehydration, lethargy, and mild fever. The essay
has developed a nursing care plan for the patient including one issue in relation to every
Activity of Living. In the development of the nursing care plan, the essay has formulated a
goal or plan for the issue including the identification of the interventions that can be
implemented to achieve each goal. Regarding the nursing care plan, there are key evaluative
measures or strategies that can be implemented to determine whether each goal or plan have
been achieved or not. The signs and symptoms of gastroenteritis can be managed using

GASTROENTERITIS 11
multiple approaches which can be individual-initiated or collaborative. One of the
collaborative approaches of the managements include fluid therapy, administration of
antibiotics, nutritional management, and other significant modification which are essential in
relieving the manifestations. Generally, the gastroenteritis affects the activities of living such
as elimination by altering the frequency and nature of bowel movements. It also affects the
ability of the patient to perform other tasks such as cleaning and dressing.

GASTROENTERITIS 12
References
Ahmed, S. M., Hall, A. J., Robinson, A. E., Verhoef, L., Premkumar, P., Parashar, U. D., ...
& Lopman, B. A. (2014). Global prevalence of norovirus in cases of gastroenteritis: a
systematic review and meta-analysis. The Lancet infectious diseases, 14(8), 725-730.
Allen‐Durrance, A. E., & Campos, S. (2018). Management of Dehydration. Textbook of
Small Animal Emergency Medicine, 1126-1131.
Biagi, P., Abate, L., Mellone, C., Salvadori, S., Peccetti, A., & Ginori, A. (2012).
Eosinophilic gastroenteritis: a case report and review of the literature. Italian Journal
of Medicine, 6(4), 327-331.
Bok, K., & Green, K. Y. (2012). Norovirus gastroenteritis in immunocompromised
patients. New England Journal of Medicine, 367(22), 2126-2132.
Bresee, J. S., Marcus, R., Venezia, R. A., Keene, W. E., Morse, D., Thanassi, M., ... &
Slutsker, L. (2012). The etiology of severe acute gastroenteritis among adults visiting
emergency departments in the United States. Journal of Infectious Diseases, 205(9),
1374-1381.
Bromfield, S. G., Bowling, C. B., Tanner, R. M., Peralta, C. A., Odden, M. C., Oparil, S., &
Muntner, P. (2014). Trends in hypertension prevalence, awareness, treatment, and
control among US adults 80 years and older, 1988–2010. The Journal of Clinical
Hypertension, 16(4), 270-276.
Bunn, D., Jimoh, F., Wilsher, S. H., & Hooper, L. (2015). Increasing fluid intake and
reducing dehydration risk in older people living in long-term care: a systematic
review. Journal of the American Medical Directors Association, 16(2), 101-113.

GASTROENTERITIS 13
Ciccarelli, S., Stolfi, I., & Caramia, G. (2013). Management strategies in the treatment of
neonatal and pediatric gastroenteritis. Infection and drug resistance, 6, 133.
Guarino, A., Dupont, C., Gorelov, A. V., Gottrand, F., Lee, J. K., Lin, Z., ... & Salazar-Lindo,
E. (2012). The management of acute diarrhea in children in developed and developing
areas: from evidence base to clinical practice. Expert opinion on
pharmacotherapy, 13(1), 17-26.
Hall, A. J., Curns, A. T., McDonald, L. C., Parashar, U. D., & Lopman, B. A. (2012). The
roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in
the United States, 1999–2007. Clinical Infectious Diseases, 55(2), 216-223.
Jalanka-Tuovinen, J., Salojarvi, J., Salonen, A., Immonen, O., Garsed, K., Kelly, F. M., ... &
de Vos, W. M. (2014). Faecal microbiota composition and host–microbe cross-talk
following gastroenteritis and in postinfectious irritable bowel syndrome. Gut, 63(11),
1737-1745.
Johnston, B. C., Donen, R., Pooni, A., Pond, J., Xie, F., Giglia, L., ... & Guyatt, G. H. (2013).
Conceptual framework for health-related quality of life assessment in acute
gastroenteritis. Journal of pediatric gastroenterology and nutrition, 56(3), 280-289.
Labbe, R. G., & Juneja, V. K. (2013). Clostridium perfringens gastroenteritis. In Foodborne
Infections and Intoxications (Fourth Edition) (pp. 99-112).
Parashar, U. D., Nelson, E. A., & Kang, G. (2013). Diagnosis, management, and prevention
of rotavirus gastroenteritis in children. Bmj, 347(7204), 1-10.
Park, S. K., Richardson, C. R., Holleman, R. G., & Larson, J. L. (2013). Frailty in people
with COPD, using the National Health and Nutrition Evaluation Survey dataset
(2003–2006). Heart & Lung: The Journal of Acute and Critical Care, 42(3), 163-170.

GASTROENTERITIS 14
Payne, D. C., Vinje, J., Szilagyi, P. G., Edwards, K. M., Staat, M. A., Weinberg, G. A., ... &
Wikswo, M. (2013). Norovirus and medically attended gastroenteritis in US
children. New England journal of medicine, 368(12), 1121-1130.
Pruvost, I., Dubos, F., Chazard, E., Hue, V., Duhamel, A., & Martinot, A. (2013). The value
of body weight measurement to assess dehydration in children. PloS one, 8(1),
e55063.
Staroverov, S. A., Volkov, A. A., Larionov, S. V., Mezhennyy, P. V., Kozlov, S. V., Fomin,
A. S., & Dykman, L. A. (2014). Study of transmissible gastroenteritis virus antigen-
conjugated immunogenic properties of selenium nanoparticles and gold. Life Science
Journal, 11(11), 456-460.
Wittenberg, D. F. (2012). Management guidelines for acute infective diarrhoea/gastroenteritis
in infants. SAMJ: South African Medical Journal, 102(2), 104-107.
Zhang, M., & Li, Y. (2017). Eosinophilic gastroenteritis: A state‐of‐the‐art review. Journal
of gastroenterology and hepatology, 32(1), 64-72.