Managing a possible Case of Gastroenteritis: A Nursing Case Study
The effective delivery of optimal nursing care requires a comprehensive treatment plan that addresses both the patient's symptoms and the security of the immediate environment. This report presents a case study of appropriate evidence-based nursing practices in treating an elderly female patient presenting with abdominal discomfort in a residential care setting.
The client presents with new onset faecal incontinence, diarrhoea and increasing abdominal discomfort and cramps. These symptoms suggest a possible gastrointestinal disturbance (Crisp & Taylor, 2009) and present a number of possible diagnoses. While the client's nursing care plan indicates that she is normally continent, her confidential disclosure to the nurse suggests that her symptoms may be more prolonged. Another relevant client characteristic is her advanced age of 85 years.
The client's proximity to the dirty utility room in the aged care facility and the report of similar symptoms from a patient in the adjoining dementia unit suggests a diagnosis of gastroenteritis. Possible causes for this may be the result of cross contamination via the oral-faecal route of transmission, or through consuming contaminated foods and water (Kirk, Hall, Veitch, Becker, 2010). The physical location of the dirty utility room proximal to the eating and food preparation areas appears inappropriate and may be the source of a possible viral infection through food contamination. This health risk presented by the design of the facility should be reviewed by the appropriate agency (Department of Health and Ageing, 2007). The most often cited causes of gastroenteritis are salmonella infections and clostridium difficile (Andrew & Simor, 2010).
While the symptoms are very evident, they are broad and may apply to other diagnoses that must be considered as part of the nursing care assessment. Inflammatory bowel disease is especially common for clients over the age of 60 (del Val 2011) and even Crohn's Disease, while less likely, must be taken into consideration. Other potential causes of the symptoms may be simple dietary imbalance leading to constipation or adverse drug effects. A recent study conducted by Gurwitz et al. showed the high prevalence of adverse drug effects in long-term care facilities (2005).
Gastroenteritis cases do not generally deteriorate quickly but if left untreated could have potentially life-threatening consequences. Depending on the client's current health condition, which may be compromised due to her advanced age, the client may experience dehydration, abdominal pain, fevers, vomiting, diarrhoea and loss of appetite (Crisp & Taylor, 2009). Extreme dehydration from excessive fluid loss through vomiting and diarrhoea may lead to delirium and psychological distress (Thomas et al., 2008). If the virus remains untreated, the infection may spread to other organs and produce a whole-body inflammation or sepsis (Halvorson, Cedfeldt & Hunter, 2010).
The combination of hypoglycemia due to vomiting and loss of appetite, hypovolemia and immune compromise could trigger a cardiac arrest in the client (Vanden Hoek et al., 2010). Irrespective of the specific progression of the gastroenteritis symptoms, studies have shown that the elderly are at a relatively high risk of adverse outcomes from gastroenteritis. Van Asten and colleagues recently documented significant increases in morbidity, hospitalizations and deaths during gastroenteritis outbreaks among the elderly (2011). While residents of long-term facilities such as nursing homes account for less than one percent of the U.S. population, 17% of all deaths attributable to gastroenteritis of unknown etiology can be traced to that population. According to Frenzen, nursing home residents are more than four times more likely to die from gastroenteritis than other elderly (2003). Clearly, the potential consequences for the client in question are severe.
Of immediate concern to the patient are fluid resuscitations measures to replenish fluid and electrolyte loss. This will help to reestablish haemodynamic stability, adequate nutrition, fluid balance, and stable vital signs. Patient goals are to implement nursing interventions to care for the two residents who are already elderly and immunocompromised. These interventions include ensuring comfort, (Department of Health and Ageing, 2007) and addressing the abdominal pain with medication to prevent potential patient falls. (Crisp & Taylor, 2009) After addressing the immediate concerns, the nursing care should focus on preventing other patients from becoming infected with the gastrointestinal pathogen. This involves identification of the pathogen through a tissue biopsy. Only few cases of gastroenteritis are caused by bacterial…