gastroenteritis /gas′trō·en′tərī″tis/ [Gk, gaster + enteron, intestine, itis, inflammation] , an inflammation of the stomach and intestines accompanying numerous GI disorders. Symptoms are anorexia, nausea, vomiting, fever (depending on causative factor), abdominal discomfort, and diarrhea. The condition may be caused by bacterial enterotoxins, bacterial or viral invasion, chemical toxins, or miscellaneous conditions, such as lactose intolerance. The onset may be slow, but more often it is abrupt and violent, with rapid loss of fluids and electrolytes caused by persistent vomiting and diarrhea. Hypokalemia and hyponatremia, acidosis, or alkalosis may develop. Treatment is supportive and includes bed rest, sedation, IV replacement of electrolytes, and antispasmodic medication to control vomiting and diarrhea. With a precise diagnosis, medication and treatment can be specific and curative, such as an antitoxin prescribed for gastroenteritis resulting from a bacterial endotoxin. After the acute phase, water may be given by mouth. If it produces no vomiting or diarrhea, clear fluids may be added, followed, if tolerated, by a diet of foods that appeal to the patient and do not cause symptoms. Also called enterogastritis. ▪ 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. ▪ PATIENT CARE 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.
