Gastroenteritis is a digestive tract irritation caused by a direct viral, bacterial, or parasitic infection or by consuming preexisting toxins found in food. Gastroenteritis is also sometimes referred to as a stomach bug, stomach flu, gastrointestinal flu, foodborne illness, and traveler’s diarrhea.
The most prevalent symptom of gastroenteritis is diarrhea. Moreover, symptom alleviation and fluid therapy are the cornerstones of treatment.
Dehydration is a complication of gastroenteritis, although it can be avoided if the fluid lost during vomiting and diarrhea is replenished. Therefore, nurses or other healthcare providers should provide intravenous treatment to patients diagnosed with severe gastroenteritis.
Pathophysiology of Gastroenteritis
The following are the fundamental processes of acute gastroenteritis:
- There is deterioration in the intestine’s villi brush border, resulting in malabsorption of intestinal contents and excessive diarrhea.
- Toxins are released and connect to specific enterocyte receptors, triggering the release of chloride ions into the intestinal epithelium, resulting in secretory diarrhea.
- Several sodium-coupled solute co-transport systems remain constant, permitting effective salt and water reabsorption even with chronic diarrhea.
- Classic oral rehydration solution (ORS) uses a specific sodium-glucose transporter (SGLT-1) to enhance the reabsorption of sodium, which contributes to passive water reabsorption by giving a 1:1 ratio of sodium to glucose.
Types of Gastroenteritis
Viral Gastroenteritis. Viral gastroenteritis is an infection of the intestines induced by most notable viruses such as norovirus or rotavirus. This condition is sometimes referred to as the stomach flu. Furthermore, close interaction with individuals who have the virus or are exposed to contaminated food or water transmits this extremely contagious infection.
Bacterial Gastroenteritis. Bacterial gastroenteritis occurs when bacteria invade the intestine. This condition causes inflammation in the stomach and intestines. While viruses are the primary cause of gastrointestinal infections, bacterial infections are also prevalent. The infection might arise following prolonged contact with animals. An individual can also become infected by ingesting contaminated water or food or the poisonous compounds produced by bacterial microorganisms. The most prevalent causes of bacterial gastroenteritis are Campylobacter, Escherichia coli (E. coli), and Salmonella.
Parasitic Gastroenteritis. Parasitic gastroenteritis is triggered by a parasitic infection of the gastrointestinal system. Cryptosporidium and Giardia are the two most frequent parasites that cause parasitic gastroenteritis.
- Cryptosporidium is a common cause of waterborne infections and is distributed through drinking water and recreational water sources such as pools.
- Giardia is disseminated through water, contaminated soil, and food. This contamination might emerge from the waste products of an infected animal or human.
These parasites have strong exterior shells that permit them to withstand certain circumstances for extended periods.
Risks Factors to Gastroenteritis
The following people are the most vulnerable to gastroenteritis:
- Infants and young toddlers with a developing immune system
- The elderly, who have weaker immune systems, and notably those in nursing facilities
- Children at daycare, students in schools, and students living in dorms
- Individuals with a compromised immune system, such as those who have HIV/AIDS or undergoing chemotherapy
- Travelers.
Signs and Symptoms of Gastroenteritis
The most common clinical manifestation of gastroenteritis is diarrhea, in which the bowel movements (feces or stools) become watery, and patients require frequent and urgent toilet visits. Although diarrhea is the most prevalent symptom of gastroenteritis, there are numerous other signs and symptoms. Other symptoms and indicators of gastroenteritis include:
- Vomiting and nausea
- Cramps and abdominal discomfort
- Chills and a mild fever
- Loss of appetite
- Muscle pains and headaches
- Tiredness and generalized malaise
- Urinary Incontinence
- Malnutrition (if the patient is an infant)
Symptoms may emerge one to three days after infection, depending on the cause, and range from mild to severe gastroenteritis. Symptoms typically last a few days, although they might last up to ten days.
Dehydration can also arise as a result of significant fluid loss from the body due to gastroenteritis. Dehydration signs and symptoms include:
- Severe thirst
- When pinched, the skin ‘tents up.’
- Urine with a dark color and a strong odor
- Lips and mouth dryness, as well as a lack of tears
- Dysuria or oliguria – the patient has difficulty urinating in the previous eight hours or passing only a small amount of urine
- Sunken cheeks or eyes
- Cold, clammy hands and feet
- Lethargy, dizziness, and floppiness
- Newborns: dry nappies (for more than 4-6 hours) and a sunken fontanelle (the soft region on top of a baby’s head)
Diagnosis of Gastroenteritis
Medical History. The doctor may ask the following questions to obtain relevant information:
- What are the patient’s symptoms?
- Duration: how long has the patient been suffering from symptoms?
- Frequency: How often does the patient experience these symptoms?
- Recent encounters with extremely sick individuals
- Recent vacation in another town or country
- Present and previous medical issues
- The patient’s prescription and over-the-counter medications
Physical Examination. The doctor may perform the following during a physical assessment:
- Look for symptoms of dehydration, and monitor the patient’s blood pressure and pulse.
- Check the patient for indications of fever.
- Listen for sounds in the patient’s abdomen with a stethoscope.
- Observe the patient’s abdomen for discomfort or pain.
Fecalysis. Fecalysis is a series of tests performed on a stool (feces) specimen to diagnose certain digestive system diseases. Infection from parasites, viruses, or bacteria, inadequate nutrient absorption, and cancer are examples of these disorders.
Sigmoidoscopy. Healthcare professionals may perform some tests to rule out other disorders. As a result, the doctor may recommend that the patient with gastroenteritis undergo sigmoidoscopy. To look for symptoms of inflammatory bowel illness, a thin, flexible tube with a tiny camera is inserted from the anus into the lower large intestine. The sigmoidoscopy is a 15-minute procedure that typically does not require sedation.
Complications of Gastroenteritis
Dehydration. One of the most common complications of gastroenteritis is dehydration. It occurs due to the body losing water and electrolytes that are not restored when the patient vomits or has diarrhea. Dehydration is especially dangerous for young children, the elderly, and individuals with compromised immune systems. Dehydration can also cause more severe health issues, such as:
- Hypovolemic Shock
- Heat Stroke
- Seizures
- Urinary and Kidney Problems
Changes in the digestive system. Researchers discovered that gastroenteritis could alter the microbiota equilibrium in the body. These changes indicate that the patient’s gut will reduce the variety and quantity of healthy microbes.
Crohn’s disease and colitis. Some individuals with gastroenteritis may develop ulcerative colitis or Crohn’s disease, which are inflammatory diseases of the digestive tract.
Aortic aneurysm. Gastroenteritis increases the likelihood of having an aortic aneurysm, which is a bulging in the wall of the primary blood vessel that transports blood out of the heart to the rest of the body. In one Swedish research published in the British journal, Emerging Infectious Diseases, scientists found that a person’s risk of developing an aortic aneurysm increased three months after being infected with salmonella.
Other complications of gastroenteritis include the following:
- Malabsorption
- Temporary lactose intolerance
- Severe diarrhea
- Salmonella infections can cause systemic illnesses such as meningitis, arthritis, and pneumonia.
- Sepsis caused by Salmonella, Yersinia, and Campylobacter organisms
- Toxic megacolon
- Guillain-Barré Syndrome, after getting infected with Campylobacter organisms.
Treatment for Gastroenteritis
- Medications. The following medications are used to treat gastroenteritis:
- Antipyretics. This medicine can be used to treat gastroenteritis-related fever and pain.
- Antidiarrheal medications. Antidiarrheal medications can be used to alleviate diarrhea. However, it is preferable for the body to cleanse itself of the virus or bacteria causing gastroenteritis in most circumstances.
- Oral Rehydration Salts (ORS). In both developed and developing countries, the American Academy of Pediatrics (AAP), the European Society of Pediatric Gastroenterology and Nutrition (ESPGAN), and the World Health Organization (WHO) all recommend oral rehydration solution (ORS) as the preferred treatment for children with mild-to-moderate gastroenteritis.
- Nasogastric feeding. Nasogastric (NG) feeding is a safe and efficient alternative for patients who cannot tolerate rehydration salts through oral administration.
- Intravenous hydration. In severe dehydration, IV access should be provided, and patients should be given a bolus of 20-30 mL/kg lactated Ringer (LR) or normal saline (NS) solution within 60 minutes.
- Dietary changes. Generally, a regular diet could be restored as soon as possible for children with gastroenteritis; early feeding minimizes illness severity and enhances nutritional outcomes.
Prevention of Gastroenteritis
To avoid contracting and transmitting gastroenteritis, the patient should be advised to take the following precautions:
- Hand washing should be done frequently and thoroughly, especially before eating or preparing food and after using the restroom or coming into touch with an infected individual.
- Make sure that the children wash their hands regularly and thoroughly.
- If possible, avoid direct contact with the infected individuals.
- Stay at home and keep children out of daycare or school until symptoms subside.
- Clean an infected person’s garments, bedding, and belongings
- Disinfect kitchen surfaces, particularly after handling raw meat, chicken, or eggs
- Avoid eating raw or undercooked meat, poultry, and fish.
- Drinking untreated water should be avoided.
- Eat raw meats, fish, and shellfish only if they have been freshly prepared and come from a reputable source.
- Wash all fresh products, including fruits and vegetables, thoroughly.
- Ensure that every infant or child in the family receives a rotavirus vaccine, reducing the chance of acquiring rotavirus gastroenteritis.
- Drink only bottled or boiling water while traveling and avoid ice cubes, especially in underdeveloped nations.
Gastroenteritis Nursing Diagnosis
Nursing Care Plan for Gastroenteritis 1
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to vomiting and nausea secondary to gastroenteritis as evidenced by anorexia, insufficient food consumption, a reported inability to eat, and growling in the abdominal area.
Desired Outcome: The patient will consume more nutrients from foods and supplements and have less nausea and vomiting.
| Gastroenteritis Nursing Interventions | Rationales |
| Assess the patient’s weight regularly. | Since dehydration and weight loss are two of the most prevalent side effects of chronic gastroenteritis, it is critical to regularly weigh the patient to assess if they are losing too much weight attributable to dehydration. This intervention will also accurately assess the patient’s reaction to therapy. |
| Keep track of the amount and frequency of vomiting. | Vomiting is a common symptom of gastroenteritis, and measuring the volume and frequency is vital since this information will aid in initiating nursing activities and subsequent therapy. This approach also seeks to avoid the severe consequence of excessive vomiting. |
| Keep an eye on the patient’s food consumption. | The caregiver must ensure that the patient is maintaining a healthy diet. This intervention also aims to determine how much food the patient consumes. Furthermore, the patient must not eat less than what the body requires to speed up his or her recovery. |
| Provide a wide variety of foods based on the patient’s preferences. | This method will stimulate the patient’s appetite, and eating a sufficient amount of food will prevent excessive weight loss. |
| If the patient cannot consume oral nourishment, administer parenteral fluids as directed. | When oral administration of meals and nutrients is not possible, this intervention ensures that the patient still receives enough fluid and maintains normal electrolyte levels. |
| If the patient’s nutrition is affected due to gastroenteritis, refer them to a dietician as soon as possible. | Consultation with a dietitian is required to help the patient towards good nutrition. |
Nursing Care Plan for Gastroenteritis 2
Nursing Diagnosis: Diarrhea related to infections caused by bacteria, viruses, or parasites secondary to gastroenteritis as evidenced by abdominal pain and cramps, more than three stools per day, overactive bowel movements, watery stool, and urgency
Desired Outcomes:
- The patient’s feces culture will yield unfavorable results from laboratory tests.
- The patient will release soft, formed stool not more than three times each day.
| Gastroenteritis Nursing Interventions | Rationales |
| Inquire about the patient’s recent history of the following: If the patient consumes untreated water.If the patient consumes undercooked food.The last time when the patient has consumed raw dairy products. | Consumption of contaminated foods or water may expose the patient to intestinal infection. This intervention will help the doctor know the possible cause of intestinal infection. Thus, he will be able to treat the patient’s condition appropriately. |
| Examine the patient’s feces pattern. | If the doctor is knowledgeable of the patient’s feces pattern, he will be able to prescribe appropriate treatment immediately. |
| Examine the patient for abdominal discomfort, cramps, hyperactive bowel movements, recurrence, urgency, and watery stool. | These assessment findings are frequently associated with diarrhea. When gastroenteritis affects the large intestine, the colon cannot absorb water, resulting in excessively watery feces. |
| Submit the stool of the patient for culture. | A culture is a test that determines which microorganisms trigger an infection. |
| Teach the patient the necessity of cleaning their hands after every bowel movement and before cooking meals for others. | Contaminated hands can rapidly spread microorganisms to utensils and surfaces used in food preparation. Thus hand washing after each bowel movement is the most effective strategy to avoid infection transmission to others. |
| After each bowel movement, educate the patient about perianal hygiene. | The anal area should be thoroughly cleaned to avoid skin irritation and microorganism dissemination after a bowel movement. |
| Advise the patient to drink 1.5 to 2.5 liters of liquids per 24 hours, adding 200 ml for every watery stool, otherwise contraindicated. | Fluid lost in liquid stools is replaced by increasing fluid intake. |
| Advise the patient to limit his or her consumption of coffee, milk, and dairy products. | These foods can upset the stomach lining and so aggravate diarrhea. |
| Encourage patients to consume potassium-rich meals. | When a patient experiences persistent diarrhea, the potassium-rich stomach contents are flushed out of the gastrointestinal system into the feces and out of the body, leading to hypokalemia. |
| Advise the patient to take antidiarrheal drugs as directed by the health care provider. | Adsorbent antidiarrheals are often used to manage gastroenteritis diarrhea. This class of antidiarrheal medications coats the gut membrane and absorbs bacterial toxins. |
Nursing Care Plan for Gastroenteritis 3
Nursing Diagnosis: Deficient Knowledge related to an inability to recollect previously learned information, ignorance about a new disorder and treatment, and lack of familiarity with information resources secondary to gastroenteritis as evidenced by asking frequent inquiries, a lack of information, and verbalizing misconceptions or erroneous information.
Desired Outcome: The patient will demonstrate comprehension of gastroenteritis risk factors, transmission mechanism, and symptom management.
| Gastroenteritis Nursing Interventions | Rationale |
| Examine the patient’s understanding of gastroenteritis, its mechanism of transmission, and its treatment. | Patients who experience vomiting and diarrhea may not associate their symptoms with an acquired intestinal infection. The patient may be unaware of spreading the infection to the people around them. |
| Examine the patient’s understanding of safe food processing and storage. | The patient may be unaware of the connection between gastroenteritis and the ingestion of undercooked food, food contaminated with microorganisms during preparation, and foods not stored at acceptable temperatures |
| Assess the patient’s typical techniques for diarrhea or vomiting management. | A successful teaching plan will incorporate symptom management strategies that the patient has found helpful in the past. |
| Educate the patient about symptoms that must be disclosed to a healthcare professional immediately: Stools made of black tarry. Feces with blood or pus. A fever of more than 38.3° C (101° F) Dizziness, lightheadedness, or thirst have increased. Inability to consume fluids. Vomiting or diarrhea that worsens or lasts longer than five days and three days for the elderly or immunocompromised client. | The patient must recognize that abnormalities in his or her stool, a high temperature, and continuous diarrhea and vomiting may suggest intestinal bleeding and infection progressing. Fluid volume deficit symptoms and the inability to replenish fluids orally may need hospitalization for replacement therapy. |
| Educate the patient and his or her family on the symptoms and treatment of gastroenteritis. | Understanding the possible causes of this gastroenteritis episode will assist the patient in initiating preventative measures to avoid repeat occurrences. The patient must understand that antibiotics for the treatment of diarrhea are controversial. The patient must comprehend the significance of fluid replacement. |
| Educate the patient on the necessity of washing hands after using the restroom and after perianal hygiene, and before preparing meals for other people. | Good handwashing practices prevent the transmission of microorganisms. |
| Educate the patient on proper food handling and storage techniques to avoid microorganism contamination. | The most common source of foodborne pathogens is ground meat. Raw meats should be stored apart from ready-to-eat items. All utensils and surfaces that have come into contact with raw meat must be thoroughly cleaned with warm water and soap. Bacteria infestation or proliferation is more likely to occur in foods not kept at the appropriate temperature until consumed. |
Nursing Care Plan for Gastroenteritis 4
Nursing Diagnosis: Hyperthermia related to dehydration secondary to gastroenteritis as evidenced by a body temperature that is higher than usual, warm, flushed skin, elevated heart rate and respiratory rate, decreased appetite, lethargy or fatigue, and convulsions.
Desired Outcomes:
- The patient will be able to maintain his or her body temperature below 39° C (102.2° F).
- The patient’s heart rate and blood pressure will remain within normal ranges.
| Gastroenteritis Nursing Interventions | Rationale |
| Assess the patient for indications of hyperthermia. | Examine for signs and symptoms of hyperthermia, such as flushed skin, weakness, rash, respiratory difficulty, palpitations, lethargy, migraine, and irritability. Keep an eye out for reports of excessive perspiration, hot and dry skin, or being overheated. Early detection of these signs will help to avoid serious problems. |
| As a result of gastroenteritis, look for signs of dehydration, which can develop into hyperthermia. | Dehydration symptoms include excessive thirst, a wrinkled tongue, dry lips, dry oral mucosa, low skin turgor, reduced urine output, elevated urine concentration, and a weak, rapid pulse. Dehydration must be immediately addressed since it could be fatal when too many fluids and electrolytes are lost in the body. |
| Determine the causes of hyperthermia and analyze the client’s history, diagnosis, or procedures. | Understanding the temperature variations or the cause of hyperthermia will aid in the therapy and nursing interventions. Gastroenteritis can cause dehydration and hyperthermia. If the health care practitioner understands the reason for hyperthermia, he or she can give suitable treatment. |
| Monitor the patient’s fluid intake and urine output. | This strategy tries to monitor and prevent dehydration and dehydration-related hyperthermia. Since gastroenteritis can cause hyperthermia due to dehydration, the nurse must ascertain if the patient is drinking enough fluids and, if not, educate the patient. |
| Keep the patient’s body temperature stable. | If the patient has gastroenteritis and a fever, measure their body temperature at least every two hours, follow proper fever-reduction techniques, and advise them to take antipyretics and antibiotics as directed. |
Nursing Care Plan for Gastroenteritis 5
Risk for Fluid Volume Deficit
Nursing Diagnosis: Risk for Fluid Volume Deficit related to diarrhea, insufficient fluid intake, nausea, and vomiting secondary to gastroenteritis.
As a risk nursing diagnosis, the Risk for Deficient Volume is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
Desired Outcome: The patient will be normovolemic as demonstrated by a systolic blood pressure of 90 mm Hg or above, the absence of orthostasis, a heart rate of 60 to 100 beats per minute, and urinary output of more than 30 ml per hour, and normal skin turgidity.
| Gastroenteritis Nursing Interventions | Rationale |
| Assess for any symptoms of dehydration in the patient’s skin turgor and mucous membranes. | Skin turgor decreases due to a lack of interstitial fluid. Adults’ skin turgor evaluation is less reliable since their skin decreases flexibility over time. As a result, the skin turgor measured over the sternum in the forehead is the best. Along with the tongue, there could be several longitudinal furrows and covers. |
| Determine the amount and frequency of vomiting. | Vomiting is linked to fluid loss. It is beneficial to monitor vomiting to prevent severe complications of fluid volume deficit. |
| Examine the frequency and consistency of bowel motions. | A high prevalence of very loose or watery bowel movements is connected with gastroenteritis. The large intestine’s irritation reduces the colon’s absorbing capacity, resulting in a fluid volume deficit. |
| Monitor the patient’s pulse rate and blood pressure levels. | Hypotension and tachycardia can result from a decrease in circulating blood volume. HR fluctuation is a corrective method for maintaining cardiac function. The pulse is generally weak and inconsistent if there is an electrolyte imbalance. Hypovolemia causes hypotension. |
| Monitor the patient’s temperature. | Fever from gastroenteritis causes extreme fluid loss through sweating and increased breathing. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
