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NANDA NURSING

Friday, July 1, 2011

Nursing Diagnosis and Nursing Intervention for Gastroenteritis

Nursing Diagnosis and Nursing Intervention for Gastroenteritis

Gastroenteritis Nursing Diagnosis Nursing Intervention
Gastroenteritis is inflammation of the gastrointestinal tract, involving the stomach, intestines, or both; usually resulting in diarrhea, abdominal cramps, nausea and possibly vomiting. Gastroenteritis is frequently termed "stomach flu" or "gastric flu" because the most frequent cause of gastroenteritis is viral. However, this loose terminology confuses some people because influenza viruses (flu viruses) do not cause gastroenteritis.


Nursing Diagnosis and Nursing Intervention for Gastroenteritis

Nursing Diagnosis

Deficient Fluid Volume

Related to
  • excessive loss through feces
  • vomiting and restricted intake
  • nausea
Goal:
Fluid requirements will be met with the criteria there are no signs of dehydration

Nursing Intervention for Gastroenteritis
  1. Give oral fluids and parenteral rehydration in accordance with the program
    R /: As an attempt rehydration to replace fluids that come out with feces.

  2. Monitor intake and output.
    R /: Provides information to determine the status of fluid balance fluid needs replacement.

  3. Assess vital signs, signs / symptoms of dehydration and the results of laboratory examination.
    R /: Assessing hydration status, electrolyte and acid base balance.

  4. Collaborative implementation of definitive therapy
    R /: Provision of drugs is causally important after the cause of diarrhea in mind.

Nursing Diagnosis

Acute Pain

Related to
  • hyperperistaltic
  • perirectal fissures irritation
Goal :
Pain is reduced by the criteria there are no blisters on the perirectal

Nursing Intervention for Gastroenteritis
  1. Set a comfortable position for a client, for example with knee flexion.
    R /: Lowering the surface tension and reduce abdominal pain.

  2. Perform the transfer of activity to provide comfort such as back massage and warm compresses abdomen.
    R /: Increase relaxation, shifting the focus of attention of clients and improve coping abilities.

  3. Clean the rectal area with mild soap and water after defecation and provide skin care
    R /: Protect skin from the acidity of the feces, preventing irritation.

  4. Collaboration drug or analgesic and anticholinergic as indicated
    R /: Analgesic as anticholinergic agents for anti-pain and spasm of the lower GI tract can be given according to clinical indication.

  5. Assess complaints of pain by Visual Analog Scale (scale 1-5), changes in the characteristics of pain, verbal and non verbal clues
    R /: Evaluating the development of pain to determine the next intervention.

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