4 Gastroenteritis or Food Poisoning Nursing Care Plans

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Gastroenteritis; Food Poisoning; Stomach Flu; Traveler’s Diarrhea is inflammation of the lining of the stomach and small and large intestines. The most common cause of this disease is infection obtained from consuming food or water. A variety of bacteria, viruses, and parasites are associated with gastroenteritis. Viral gastroenteritis also called stomach flu is a very contagious form of this disease. Food-borne gastroenteritis or food poisoning is associated with bacteria strains such as Escherichia coli, Clostridium, Campylobacter, and salmonella. The ingestion of foods contaminated with chemicals (lead, mercury, arsenic) or the ingestion of poisonous species of mushrooms or plants or contaminated fish or shellfish can also result in gastroenteritis. Symptoms of this disease include fever, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort. The treatment is symptomatic, although in cases of bacterial and parasitic infections require antibiotic therapy.

Nursing Care Plans

Hospitalization may be needed for clients who experience severe dehydration as a result of the vomiting and diarrhea. This care plan for Gastroenteritis focuses on the initial management in a non-acute care setting.

Here are four (4) nursing care plans (NCP) for Gastroenteritis:

1. Diarrhea

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Diarrhea: Passage of loose, unformed stools.

May be related to

• - Bacterial, viral or parasitic infections.

Possibly evidenced by

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• - Abdominal pain.
• - Abdominal cramping.
• - Frequency of stools (more than 3x a day).
• - Hyperactive bowel sounds.
• - Loose stools.
• - Urgency.

Desired Outcomes

• - Client will have a negative stool culture.
• - Client will pass soft, formed stool no more than 3 x a day.

Nursing Interventions	Rationale
Ask the client about a recent history of: - Drinking contaminated water. - Eating food inadequately cooked. - Ingestion of unpasteurized dairy products.	Eating contaminated foods or drinking contaminated water may predispose the client to intestinal infection.
Evaluate pattern of defecation.	Defecation pattern will promote immediate treatment.
Assess for abdominal pain, abdominal cramping, hyperactive bowel sounds, frequency, urgency, and loose stools.	These assessment findings are commonly connected with diarrhea. If gastroenteritis involves the large intestine, the colon is not able to absorb water and the client’s stool is very watery.
Submit client’s stool for culture.	A culture is a test to detect which causative organisms cause an infection.
Teach the client about the importance of hand washing after each bowel movement and before preparing food for others.	Hands that are contaminated may easily spread the bacteria to utensils and surfaces used in food preparation hence hand washing after each bowel movement is the most efficient way to prevent the transmission of infection to others.
Educate the client about perianal care after each bowel movement.	The anal area should be gently clean properly after a bowel movement to prevent skin irritation and transmission of microorganism.
Encourage increase fluid intake of 1.5 to 2.5 liters/24 hour plus 200 ml for each loose stool in adults unless contraindicated.	Increased fluid intake replaces fluid lost in liquid stools.
Encourage the client to restrict the intake of caffeine, milk and dairy products.	These food items can irritate the lining of the stomach, hence may worsen diarrhea.
Encourage the client to eat foods rich in potassium.	When a client experience diarrhea, the stomach contents which is high in potassium get flushed out of the gastrointestinal tract into the stool and out of the body, resulting in hypokalemia.
Administer antidiarrheal medications as prescribed.	Bismuth salts, kaolin, and pectin which are adsorbent antidiarrheals are commonly used for treating the diarrhea of gastroenteritis. These drugs coat the intestinal wall and absorb bacterial toxins.

2. Deficient Knowledge

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Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

• - Lack of recall of previously learning information.
• - New disorder and treatment.
• - Unfamiliarity with information resources.

Possibly evidenced by

• - Asking questions.
• - Lack of information.
• - Lack of questions.
• - Verbalizes misconceptions or inaccurate information.

Desired Outcomes

• - Client will verbalize understanding of causes of gastroenteritis, mode of transmission, and management of symptoms.

Nursing Interventions	Rationale
Assess client’s knowledge of gastroenteritis, its mode of transmission, and its treatment.	Clients who experience diarrhea and vomiting may not correlate the symptoms with an acquired intestinal infection. The client may not realize the risk for transmitting the infection to others.
Assess the client’s knowledge on safe food preparation and storage.	The client may not understand the relationship of gastroenteritis to the consumption of inadequately cooked food, food contaminated with bacteria during preparation, and foods that are not maintained at appropriate temperatures.
Determine the client’s usual methods of managing diarrhea or vomiting.	An effective teaching plan will include methods of symptoms management that the client has found helpful in the past.
Teach the client about symptoms that must be reported immediately to the healthcare provider: - Black tarry stools. - Blood or pus in the feces. - Fever greater than 38.3° C (101° F) - Increased dizziness, lightheadedness, or thirst. - Inability to drink fluids. - Vomiting or Diarrhea that gets worse or continues for more than five days (3 days for the older adult or immunocompromised client).	The client needs to understand that changes in the stool, high fever, and persistent vomiting and diarrhea may indicate intestinal bleeding and worsening of the infection. Signs of fluid volume deficit and the inability to replace fluids by the oral route may require hospitalization for fluid replacement.
Educate the client and the family about the causes of and treatments for gastroenteritis.	Knowledge about the possible cause of this episode of gastroenteritis will help the client initiate to prevent future episodes. The client needs to recognize that the use of antibiotics is controversial in managing diarrhea. The client needs to understand the importance of fluid replacement.
Educate the client about the importance of hand washing after toileting and perianal hygiene and before preparing food for others.	Good hand washing will prevent the spread of infectious agents.
Educate the client about food preparation and storage methods to reduce contamination by microorganisms.	Ground meats are the most common source of foodborne pathogens. These meats should be cooked to an internal temperature of 160°F and should have no evidence of pink color. Raw meats should be kept separate from other ready-to-eat foods. All utensils and surfaces that have been in contact with the raw meat need to be washed with hot, soapy water. Raw fruits and vegetables must be washed before eating if they will not be cooked. Only pasteurized milk, fruit juices, and ciders should be consumed. Bacteria contamination or growth is more likely to occur in foods that are not maintained at appropriate temperatures until eaten.

3. Risk For Fluid Volume Deficit

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Risk for Fluid Volume Deficit: At risk for experiencing vascular, cellular, or intracellular dehydration.

May be related to

• - Diarrhea.
• - Inadequate fluid intake.
• - Vomiting.

Possibly evidenced by

• [not applicable].

Desired Outcomes

• - Client is normovolemic as evidenced by systolic BP 90 mm Hg or greater, absence of orthostasis, HR 60 to 100 beats per minute, urine output greater than 30 ml per hour, and normal skin turgor.

Nursing Interventions	Rationale
Assess the client’s skin turgor and mucous membranes for signs of dehydration.	A loss of interstitial fluid causes the loss of skin turgor. Assessment of the skin turgor in adults is less accurate since their skin normally loses its elasticity. Therefore the skin turgor assessed over the sternum in the forehead is best. Several longitudinal furrows and coating may be noted along the tongue.
Assess the volume and frequency of vomiting.	Vomiting is associated with fluid loss.
Assess the consistency and number of bowel movements.	Gastroenteritis is associated with an increased frequency of very loose or watery bowel movements. The inflammation in the large intestine limits the colon’s ability to absorb water, leading to fluid volume deficit.
Assess the color and amount of urine.	A decrease in urine volume and concentrated urine, as evidenced by a darker urine color, denotes fluid deficit.
Assess the client’s PR and BP.	A reduction in circulating blood volume can cause hypotension and tachycardia. The change in HR is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and may be irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia.
Assess the client’s temperature.	Fever that occurs with gastroenteritis increases fluid loss through perspiration and increased respiration.
Monitor BP for orthostatic changes (changes seen when changing from a supine to a standing position).	Postural hypotension is a common manifestation in fluid loss. The incidence increase with age. Note the following orthostatic hypotension significances: - Greater than 10 mm Hg: circulating blood volume decreases by 20%. - Greater than 20 to 30 mm Hg drop: circulating blood volume is decreased by 40%.
Instruct the client to monitor weight daily and consistently with the same scale, preferably at the same time of the day, and wearing the same amount of clothing.	The client with gastroenteritis may experience weight loss from fluid loss with diarrhea and vomiting. Instruction facilitates accurate measurement and assessment provides useful data for comparisons and helps in following trends.
Encourage regular oral hygiene.	Fluid deficit can cause a dry, sticky mouth. Attention to mouth care promotes interest in drinking and reduces the discomfort of dry mucous membranes.
Encourage increase fluid intake of 1.5 to 2.5 liters/24 hour plus 200 ml for each loose stool in adults unless contraindicated.	Increased fluid intake replaces fluid lost in the liquid stool. Being creative in selecting fluid sources (e.g., flavored gelatin, frozen juice bars, sports drink) can facilitate fluid replacement. Oral hydrating solutions (e.g., Rehydrate) can be considered as needed.
For the client who is unable to take sufficient oral fluids, consider the need for hospitalization and the administration fo parental fluids as ordered.	Fluids are needed to maintain hydration status. Determining the type and amount of fluid to be replaced and the infusion rates will vary depending on the client’s clinical status.
Administer antiemetic medications as ordered	These drugs will reduce vomiting and the risk for fluid volume deficit.

4. Imbalanced Nutrition: Less Than Body Requirements

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Imbalanced Nutrition: Less Than Body Requirements:Intake of nutrients insufficient to meet metabolic needs.

May be related to

• - Nausea.
• - Vomiting.

Possibly evidenced by

• - Anorexia.
• - Inadequate food intake.
• - Perceived inability to ingest food.
• - Rumbling in the lower abdomen.

Desired Outcomes

• - Client will have an increased nutritional intake and absence of nausea and vomiting.

Nursing Interventions	Rationale
Measure client weight.	This will accurately monitor the response to therapy.
Monitor and record the number of vomiting, amount and frequency.	These data will help in initiating nursing actions and subsequent treatment.
Monitor the client’s food intake.	To determine the amount of food that is consumed.
Provide a diverse diet according to his needs.	This will stimulate the appetite of the client.
Provide parenteral fluids, as ordered.	To ensure adequate fluid and electrolyte levels.
Refer to a dietitian if indicated.	Collaboration with the dietician in order to guide the client about proper nutrition.

5. Other Possible Nursing Care Plans

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Nursing diagnoses you can use to make another care plan for Gastroenteritis. Check out our Nursing Diagnosis page for more info.

• - Imbalanced Nutrition: Less than Body Requirements due to insufficient intake and excessive output;
• - Risk for Deficient Fluid Volume (if diarrhea does not occur or intake of fluids is insufficient but does not have any signs of dehydration);
• - Hyperthermia RT inflammatory process.

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References and Sources : nurseslabs.com