nursing case study of gastroenteritis

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Gastroenteritis Nursing Diagnosis and Nursing Care Plan

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

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
• 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.

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.

Nursing Care Plan for Gastroenteritis 3

Deficient Knowledge

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.

Nursing Care Plan for Gastroenteritis 4

Hyperthermia

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.

• 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.

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.

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

Anna Curran. RN, BSN, PHN

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7 Gastroenteritis Nursing Care Plans

Use this nursing care plan and management guide to help care for patients with gastroenteritis . Enhance your understanding of nursing assessment , interventions, goals, and nursing diagnosis , all specifically tailored to address the unique needs of individuals facing gastroenteritis. This guide equips you with the necessary information to provide effective and specialized care to patients dealing with gastroenteritis.

Table of Contents

What is gastroenteritis, nursing problem priorities, nursing diagnosis, nursing goals, 1. managing diarrhea and restoring normal function, 2. preventing dehydration, 3. promoting adequate nutritional balance, 4. initiating patient education and health teachings, 5. administering medications and providing pharmacologic support, 6. monitoring diagnostic and laboratory procedures, 7. assessing and monitoring for potential complications, recommended resources.

Gastroenteritis (also known as Food Poisoning; Stomach Flu ; Traveler’s Diarrhea ) is the 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 cases of bacterial and parasitic infections require antibiotic therapy.

Nursing Care Plans and Management

The nursing care plan goals for patients with gastroenteritis include preventing dehydration by promoting adequate fluid and electrolyte intake, managing symptoms such as nausea and diarrhea , and preventing the spread of infection to others. In addition, the nursing care plan should focus on educating the patient on proper hygiene and food handling practices to prevent future episodes of gastroenteritis. This care plan for gastroenteritis focuses on the initial management in a non-acute care setting.

The following are the nursing priorities for patients with gastroenteritis:

• Manage dehydration and electrolyte imbalances.
• Alleviate symptoms of nausea, vomiting , and diarrhea.
• Prevent further spread of infection and transmission to others.
• Provide dietary recommendations and guidance for fluid intake.
• Monitor for complications, such as severe dehydration or bacterial infection.
• Educate patients on proper hygiene practices and handwashing .
• Offer supportive care to aid in recovery and symptom relief.
• Administer appropriate medications, if necessary.
• Schedule follow-up appointments for monitoring and assessment of progress.
• Collaborate with healthcare professionals for coordinated care and management.

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with gastroenteritis based on the nurse ’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Goals and expected outcomes may include:

• The client will have a negative stool culture.
• The client will pass soft, formed stool no more than 3 x a day.
• The client will verbalize understanding of the causes of gastroenteritis, mode of transmission, and management of symptoms.
• The client will have an increased nutritional intake and an absence of nausea and vomiting .

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with gastroenteritis may include:

Diarrhea is a common symptom of acute gastroenteritis caused by bacterial, viral, or parasitic infections because these microorganisms can damage the lining of the digestive tract and lead to inflammation, which can cause fluid and electrolytes to leak from the body. This results in loose, watery stools that can lead to dehydration if not treated promptly.

Ask the client about a recent history of drinking contaminated water, eating food inadequately cooked, and ingestion of unpasteurized dairy products: Eating contaminated foods or drinking contaminated water may predispose the client to intestinal infection.

Evaluate the pattern of defecation. The 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 the 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 cleaned properly after a bowel movement to prevent skin irritation and transmission of microorganisms.

Encourage increase fluid intake of 1.5 to 2.5 liters/24 hours 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 are 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.

One of the primary concerns in managing gastroenteritis is preventing dehydration , as excessive fluid loss from vomiting and diarrhea can quickly lead to a dangerous imbalance in the body’s fluid levels. Dehydration can be especially problematic for certain populations, such as young children, older adults, and individuals with weakened immune systems. Therefore, it is crucial to take proactive measures to prevent dehydration in patients with gastroenteritis.

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 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 darker urine color, denotes fluid volume 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 fluid volume deficit.

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 of 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 . A fluid volume 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 hours 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 of 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 of fluid volume deficit.

Patients with acute gastroenteritis may experience imbalanced nutrition due to decreased appetite, nausea, vomiting, and diarrhea. These symptoms can cause reduced food intake and nutrient absorption, leading to a negative balance of energy and nutrients that the body needs for normal function and repair. Additionally, if the symptoms persist, patients may not be able to maintain their usual food intake, leading to further nutrient deficiencies.

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 .

There may be a lack of knowledge among patients with acute gastroenteritis due to several reasons, including limited access to healthcare information, a lack of understanding about the causes and symptoms of the condition, and the perception that diarrhea is a common and self-limiting ailment that does not require medical attention. Additionally, different pathogens can cause acute gastroenteritis, and their symptoms can vary, making it difficult for patients to identify the specific cause of their illness. While medical treatment is crucial in managing gastroenteritis, patient education and health teachings play a vital role in improving outcomes and preventing further complications.

Assess the 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 of transmitting the infection to others.

Assess the client’s knowledge of 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 symptom management that the client has found helpful in the past.

Teach the client about symptoms that must be reported immediately to the healthcare provider such as black tarry stools, blood or pus in the feces , fever greater than 38.3° C (101° F), increased dizziness, lightheadedness, or thirst, and 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, persistent vomiting, and diarrhea may indicate intestinal bleeding and worsen 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 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.

It is important for healthcare professionals to carefully assess each patient with gastroenteritis, considering the severity of symptoms, the presence of complications, and the individual’s overall health status. Based on this evaluation , appropriate medications and pharmacologic support can be provided to optimize patient care and facilitate a swift recovery. The primary goals of pharmacologic intervention in these patients are to alleviate symptoms, control the infection if present, and prevent complications.

1. Antiemetics . Used to control nausea and vomiting.

• Ondansetron. Helps alleviate nausea and vomiting by blocking certain receptors in the brain and gastrointestinal tract.
• Promethazine . Works as an antihistamine and helps relieve nausea and vomiting symptoms.
• Metoclopramide. Helps reduce nausea and vomiting by increasing the movement of the stomach and intestines.

2. Antidiarrheals . Used to reduce the frequency and severity of diarrhea.

• Loperamide. Slows down bowel movements and helps control diarrhea.
• Bismuth subsalicylate. Helps relieve diarrhea and may also have some antimicrobial effects.

3. Antibiotics. Prescribed in cases of bacterial gastroenteritis to treat the underlying infection.

• Ciprofloxacin . A fluoroquinolone antibiotic effective against many bacterial pathogens.
• Azithromycin . A macrolide antibiotic that targets certain bacterial species causing gastroenteritis.

4. Probiotics. Used to restore the natural balance of gut bacteria.

• Lactobacillus acidophilus. Helps promote the growth of beneficial bacteria in the gut.

5. Electrolyte solutions . Used to rehydrate and restore electrolyte balance.

• Oral rehydration solutions (ORS). Contain electrolytes and glucose to replace lost fluids and prevent dehydration.
• Intravenous fluids . Administered in severe cases of dehydration when oral intake is not possible.

Monitoring the results of diagnostic and laboratory procedures is crucial in patients with gastroenteritis to guide appropriate treatment and ensure optimal patient care . It’s important to note that the specific tests and procedures ordered may vary depending on the patient’s symptoms, medical history , and the suspected cause of gastroenteritis. The healthcare provider will determine the most appropriate diagnostic approach for each individual case.

1. Stool Culture and Examination If a stool culture or examination reveals the presence of bacterial pathogens or parasites, the specific organism identified helps guide targeted therapy. Monitoring subsequent cultures or examinations can assess the effectiveness of treatment and determine if the infection has been cleared.

2. Viral Testing For patients with viral gastroenteritis, monitoring viral test results can confirm the presence of a specific virus, such as norovirus or rotavirus. This information can guide infection control measures in healthcare settings and help manage outbreaks.

3. Complete Blood Count (CBC) Monitoring the CBC helps evaluate the patient’s response to treatment. Decreasing white blood cell (WBC) counts may indicate resolution of infection, while persistently elevated WBC counts could suggest ongoing inflammation or the need for further investigation.

4. Electrolyte Panel Regular monitoring of electrolyte levels is essential, especially in patients with severe gastroenteritis or dehydration. Abnormal electrolyte levels, such as low sodium or potassium , may require correction through fluid replacement or targeted interventions.

5. Kidney Function Tests Continued monitoring of kidney function tests, such as BUN and creatinine , can assess the impact of dehydration on renal function. Improvements in kidney function values indicate rehydration and effective management of gastroenteritis.

6. Liver Function Tests Monitoring liver function tests is crucial if liver inflammation or injury is suspected. Serial measurements of liver enzymes, such as ALT and AST, can help evaluate the resolution of liver involvement and guide further management if necessary.

7. Clinical Assessment Alongside laboratory and diagnostic results, ongoing clinical assessment plays a vital role in monitoring patients with gastroenteritis. Monitoring symptoms such as diarrhea frequency, vomiting, abdominal pain , and general well-being helps gauge the patient’s response to treatment and identify any signs of complications.

Assessing and monitoring for potential complications is an important aspect of managing patients with gastroenteritis. While most cases of gastroenteritis resolve without complications, certain individuals may be at higher risk or develop complications. Early recognition of potential complications allows for prompt intervention and appropriate management. It’s essential for healthcare providers to maintain regular follow-up visits or consultations to assess the patient’s progress, reevaluate symptoms, and address any emerging concerns or complications.

1. Assess for signs and symptoms of dehydration. One of the primary complications of gastroenteritis is dehydration, which can occur due to excessive fluid loss from vomiting and diarrhea. Monitoring hydration status through clinical assessment, such as evaluating skin turgor, mucous membranes, and urine output, is essential. Laboratory tests, including electrolyte levels and kidney function tests, can help identify electrolyte imbalances and assess renal function.

2. Monitor patient’s electrolyte Imbalances. Severe and prolonged diarrhea and vomiting can disrupt the balance of electrolytes in the body, leading to imbalances such as hyponatremia (low sodium ) or hypokalemia (low potassium). Regular monitoring of electrolyte levels through laboratory tests can guide appropriate interventions and prevent complications associated with electrolyte disturbances.

3. Monitor patient’s weight daily. In cases of prolonged or severe gastroenteritis, malnutrition can occur due to inadequate nutrient absorption and decreased oral intake. Monitoring weight loss, assessing dietary intake, and considering nutritional supplementation or support may be necessary, especially in vulnerable populations such as children and older adults.

4. Monitor signs of secondary infections. Gastroenteritis can weaken the immune system, making individuals more susceptible to secondary infections. Monitoring for signs of bacterial superinfection, such as worsening abdominal pain , high fever, or the persistence of symptoms despite appropriate treatment, is important. Additional diagnostic tests or cultures may be needed to identify secondary infections.

5. Monitor patient’s hemodynamic stability. Severe cases of gastroenteritis can lead to hemodynamic instability, particularly in young children or those with compromised health. Monitoring vital signs, including blood pressure , heart rate , and perfusion indicators, can help identify signs of circulatory compromise or shock.

6. Monitor organ dysfunction. Although rare, certain infections associated with gastroenteritis, such as certain strains of E. coli or certain viral infections, can lead to organ dysfunction. Monitoring liver function tests, renal function, and other organ-specific markers may be necessary to identify any signs of organ involvement or complications.

7. Monitor patient’s neurological status. Some viral gastroenteritis infections, such as rotavirus, may cause neurological complications, including seizures or encephalopathy. Monitoring for any neurological symptoms or changes in mental status is crucial, especially in young children.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

More nursing care plans related to gastrointestinal disorders:

• Appendectomy
• Bowel Incontinence (Fecal Incontinence)
• Cholecystectomy
• Constipation
• Diarrhea Nursing Care Plan and Management
• Cholecystitis and Cholelithiasis
• Gastroenteritis
• Gastroesophageal Reflux Disease (GERD)
• Hemorrhoids
• Ileostomy & Colostomy
• Inflammatory Bowel Disease (IBD)
• Intussusception
• Liver Cirrhosis
• Nausea & Vomiting
• Pancreatitis
• Peritonitis
• Peptic Ulcer Disease
• Subtotal Gastrectomy

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The following is a scenario of a patient with toxic megacolon:

Mary Cole, a 50-year-old female with a known history of ulcerative colitis (UC) and anemia, was driven to the emergency department (ED) by her daughter, Cindy, on April 11, 2019, just after 1000. The reason for her visit was due to complaints of severe abdominal pain/swelling and bloody diarrhea over the past four days.

Vital signs were taken in the ED showing a blood pressure (BP) of 96/50, heart rate (HR) 113 bpm, respiratory rate (RR) of 29, tympanic temperature of 38.9°C, oxygen saturation (O2 sat.) of 97% on room air, and a pain of 9/10 (using the verbal numeric pain scale) located in her left lower abdominal quadrant that is sharp, constant, and aggravated by movement. Mary states, “my stomach hurts so much I can barely take the pain”. She claims that she has been taking extra-strength Advil (ibuprofen 400mg) for the pain. Her vitals were reassessed after 20 minutes showing a decrease in BP to 85/47, HR 130, RR 29, tympanic temperature of 38.9°C, O2 sat. 96%, and pain still at 9/10.

Upon further assessment, Mrs. Cole appeared uncomfortable and was quietly crying and lying on her left side with her knees flexed and arms holding her abdomen. She was alert and oriented to person, place, time, and situation and was demonstrating appropriate responses and PERRLA. Her face was flushed and her skin felt warm and dry to touch. There was slight skin tenting at her clavicle and she admitted to not being able to “eat or drink very much over the past few days” due to her abdominal pain and discomfort. She claims to have been having diarrhea that “looks kind of bloody” and hasn’t been voiding as often as she “normally does”, approximately twice a day over these past few days. Her abdomen is visibly distended and tender/firm upon palpation. Upon auscultation, she has hypoactive bowel sounds in all four quadrants and her pain is noted to be in the left lower quadrant. She is tachycardic and has a clear S1S2 heartbeat with diminished pedal pulses;  tachypnea is noted, lung sounds are clear in all lobes. Her strengths in both upper and lower extremities are slightly weak and her daughter states that her mother has been “dizzy when getting up and has difficulty walking at times”.

While in the ED, the nurse inserted an 18-gauge intravenous (IV) to the left antecubital fossa (AC) and administered a 1 L normal saline (NS) bolus. Mary’s labs (CBC, CMP, cultures) were drawn, an x-ray and abdominal CT scan were performed, and a stool sample was ordered. She was administered 1 mg of morphine sulfate IV push at 1115 for her pain. In 15 minutes, her pain was reassessed and was reported as 8/10 using the numeric pain scale. She received an additional dose of 2 mg morphine sulfate IV push and reassessed after 15 minutes, stating a pain of 6/10; continuous pain assessment and management were performed. She was ordered NPO for bowel rest. The ED nurse administered 500 mg of metronidazole IV to prevent septic complications.

Mary’s labs revealed the following: elevated C-reactive protein of 16, positive antineutrophil cytoplasmic antibodies (ANCA), Hgb: 7.8, Hct: 23%, Platelets: 100,000, WBC: 13000, potassium: 3.3, sodium: 128, pH: 7.26, HCO3: 18, CO2: 31 (metabolic acidosis), lactic acid of 3.8, and the stool showed presence of blood and WBCs. Mary’s abdominal CT revealed colonic dilation of more than 6 cm in the transverse colon. Once results were in from the labs, x-ray, and CT scan, Mary was diagnosed with toxic megacolon resulting from a flare-up of UC and sent to the intensive care unit (ICU) for close observation and monitoring.

Once in the ICU, an NG tube was placed for gastric decompression due to the CT result of a 6 cm dilation of the colon. Her labs were closely monitored for electrolyte imbalance and further decline due to possible perforation of the colon (i.e. Hgb, Hct). Nursing priorities included focused assessments, monitoring for signs/symptoms of shock (perforation) such as rigid abdomen, severe abdominal pain, nausea/vomiting (N/V), fever, chills, and rectal bleeding. Mary was prescribed 400 mg of hydrocortisone IV to decrease inflammation and her pain was being monitored and managed with scheduled IV infusion of acetaminophen (Ofirmev) 1000 mg every 6 hours and 1 mg morphine sulfate IV push for breakthrough pain. Lactic acid was monitored every two hours until the levels fell below 2; she received Zosyn IV running at 25 mL/hr every four hours. Medical treatment was continued in cooperation with the gastroenterologist, intensivist, and surgeons to monitor for sepsis and the need for surgical intervention.

When Mary was stable, she was transferred to the direct observation unit (DOU) floor for observation and case management. On the floor, the patient was educated regarding toxic megacolon and taught about the need to continue her UC medication—Vedolizumab (Entyvio)—which, if taken correctly, should decrease the chance of  recurrence of UC flare-up and risk of toxic megacolon. Lastly, she met with case management and was educated on ulcerative colitis support groups and an appointment was schedule in May with her primary healthcare provider for follow-up.

Open-Ended Questions:

• Which areas of our nursing assessment should we closely monitor and what are we looking for?
• What are the major concerns with toxic megacolon related to bowel perforation?
• What other possible diagnoses should be considered and ruled out?
• What are the primary nursing diagnosis for Mrs. Cole?
• Areas of nursing assessment we want to closely monitor include a focused GI assessment, signs and symptoms of shock, and pain (related to dilation of colon).We would also monitor our lab values for any further indications that may show infection, fluid/electrolyte imbalances, and decrease in Hct/Hgb. It is important to remain cognizant of further deviations from the norm in order to prevent bowel perforation and/or treat the patient in a timely manner to reduce the chance of further complications (i.e. shock from perforation, sepsis).
• Biggest concern related to bowel perforation from toxic megacolon is infection from bacteria being released into abdomen; this places the patient at risk for septic shock.
• Other possible diagnosis that needed to be ruled out include: bowel obstruction peritonitis, pancreatitis, peptic ulcer, and kidney stones.
• Risk for infection
• Deficient fluid volume
• Risk for decreased cardiac tissue perfusion
• Dysfunctional gastrointestinal motility

Basson, M. D. (2018). Ulcerative colitis workup: approach considerations, serologic markers, other laboratory studies. Medscape . Retrieved from https://emedicine.medscape.com/article/183084-workup#showall Feuerstein, J. D., & Cheifetz, A. S. (2014). Ulcerative colitis: Epidemiology, diagnosis, and management. Mayo Clinic Proceedings, 89 (11), 1553-1563. http:dx.doi.org/10.1016/j.mayocp.2014.07.002

Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2014). Brunner & suddarth’s textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins.

Unbound Medicine, Inc. (2014). Nursing Central (1.22) [Mobile application software]. Retrieved from <http://itunes.apple.com> Woodhouse, E. (2016). Toxic megacolon: A review for emergency department clinicians. Journal of Emergency Nursing, 42 (6), 481-486. https://doi.org/10.1016/j.jen2016.04.007

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Viral gastroenteritis (nursing).

Nathan D. Stuempfig ; Justin Seroy ; Jeannie R. Labat-Butler .

Affiliations

Last Update: June 12, 2023 .

• Learning Outcome
• List the types of viruses that cause gastroenteritis
• Describe the presentation of viral gastroenteritis
• Summarize the treatment of viral gastroenteritis
• Recall the role of the nurse in the care of a patient with viral gastroenteritis
• Introduction

Acute infectious gastroenteritis is a common illness seen around the world. Viral pathogens cause most of these cases. Acute diarrheal disease is generally self-limiting in industrialized nations but can have significant morbidity for young and elderly patients. In underdeveloped countries, viral diarrheal diseases are a significant cause of death, especially in infants  [1] [2] . According to the Centers for Disease Control, viral gastroenteritis infections can account for over 200,000 deaths of children per year worldwide. Viral gastroenteritis is a known cause of nausea, vomiting, diarrhea, anorexia, weight loss, and dehydration. Isolated cases can occur, but viral gastroenteritis more commonly occurs in outbreaks within close communities such as daycare centers, nursing facilities, and cruise ships. Many different viruses can lead to symptomatology, though in routine clinical practice the true causative virus is generally not identified. Regardless of the viral cause, treatment is generally uniform and directed toward symptomatic improvement with a focus on hydration status  [1] [2] . In the United States and other industrialized countries, the disease is most often self-limited and resolves in 1 to 3 days. However, in susceptible patients including young children, elderly patients, and the immunocompromised, hospitalization can occur without proper supportive care leading to increased morbidity and mortality  [3] [4] .

• Nursing Diagnosis
• Fluid imbalance
• Risk for malnutrition
• Risk for dehydration
• Irritability

Several different viruses including rotavirus, norovirus, adenovirus, and astroviruses account for most cases of acute viral gastroenteritis. Most are transmitted via the fecal-oral route, including contaminated food and water. Transmission has also been shown to occur via fomites, vomitus, and possibly airborne methods. Norovirus is more resistant to chlorine and ethanol inactivation than other viruses.

Rotavirus is a double-stranded RNA virus named for the wheel-like appearance of its viral capsid on an electron micrograph. Rotavirus infection is universal among humans, and almost all children acquire antibodies by age 3  [5] . Rotavirus infection usually presents with acute vomiting followed by several days of diarrhea, crampy abdominal pain, anorexia, and low-grade fevers. Infants and young children who develop severe dehydration are more likely to have an infection from rotavirus than other viral gastroenteritis pathogens. Viral shedding of infectious particles can occur in the stool for up to 10 days  [6] . Adults are more likely to develop an asymptomatic infection with a rise in antibody titer. Immunosuppressed individuals can experience more prolonged and severe disease, with longer viral shedding  [7] . Rotavirus pathogenesis is complicated with several possible mechanisms including malabsorption from mucosal damage, viral enterotoxin secretion, and enteric secretions in response to the virus. Rotavirus increases electrolyte secretion from the small intestine and decreases glucose cotransport of these electrolytes  [8] .

Throughout recorded history, rotavirus has been the leading cause of episodic infantile illness worldwide. However, in 2006 an oral vaccine was introduced. Since the introduction and utilization of this vaccine, the United States and many other industrialized countries have seen a sharp decline in the number and severity of gastroenteritis cases caused by rotavirus. Before 2006, it was estimated that over 3.5 million infants were affected annually in the United States and that rotavirus led to 440,000 deaths annually worldwide in children less than five years old  [9] . Since the routine vaccination of children, each year has seen a 58% to 90% reduction in cases  [10] . Before vaccination, the United States saw an estimated 55,000-70,000 hospitalizations of children under five due to rotavirus. This number has decreased by 40,000-50,000 since the vaccine became available, according to the Centers for Disease Control. Although the incidence of rotavirus in the United States has been historically seasonal, with peak seasonality being from December to April, this pattern has become very inconsistent since vaccination became common  [11] . Now, the virus tends to infect sporadically throughout the year in the United States. Despite the widespread use of the vaccine in developed countries, rotavirus is still the leading cause of infantile diarrheal illness worldwide. The Centers for Disease Control estimated that there were still 215,000 rotavirus-related deaths in 2013. More than 40% of World Health Organization member countries have initiated large-scale vaccination of children. This number is anticipated to rise in the next few years. In turn, infection and mortality caused by rotavirus are expected to continue declining.

Norovirus is a single-stranded RNA member of the calicivirus family  [12] . It is the most common cause of epidemic diarrheal illness, accounting for over 90% of viral gastroenteritis outbreaks and approximately 50% of cases worldwide  [13] . Norovirus can withstand freezing, heating, and common disinfectant products containing alcohol or chlorine  [14] . It is a frequent cause of outbreaks within somewhat closed communities such as nursing homes, schools, military populations, athletic teams, and cruise ships.

Norovirus presents most commonly with abdominal cramps and nausea followed by vomiting and/or diarrhea. Onset can be abrupt. Symptoms also include myalgias, malaise, and low-grade fevers up to 39 C. Diarrhea is non-bloody and can consist of multiple bowel movements per day. The illness is self-limiting, and most patients have recovered in 72 hours without sequelae  [1] . Elderly individuals and immunocompromised patients may have a more severe and prolonged illness. 

Norovirus infection causes histopathologic changes in the jejunum of blunted villi with intact mucosa  [15] . These changes occur quickly and usually resolve by two weeks after the onset of illness. Fat and d-xylose absorption decrease as does brush border enzyme activity leading to diarrhea  [15] . Unlike rotavirus, there does not seem to be enterotoxin production.

Since the advent of the rotavirus vaccine, norovirus has become the most common cause of viral gastroenteritis in the United States, responsible for 19 to 21 million total illnesses per year. It is estimated to cause 56,000-71,000 hospitalizations and 570-800 deaths annually in the United States  [13] . Because of its relative stability in the environment, norovirus is implicated in nearly 50% of all foodborne outbreaks  [13] . Norovirus is present throughout the year, despite initially being thought of as a disease that peaked in the winter months.

Other viral causes of acute viral gastroenteritis include adenovirus, Sapovirus, and Astrovirus  [16] . Each of these viruses can cause anywhere between 2 to 9% of viral gastroenteritis cases, with developing countries seeing a slightly higher burden of disease from the astrovirus group. These viruses tend to affect children more than adults.

• Risk Factors

The most frequent cause of diarrheal disease worldwide is acute viral gastroenteritis. Men and women are affected equally. Norovirus is the most common viral cause. It is responsible for 90% of epidemic diarrheal cases worldwide and approximately 50% of all viral gastroenteritis cases. It accounts for 19 to 21 million cases of diarrheal illness annually in the United States alone. Norovirus causes 50% of all foodborne diarrheal outbreaks  [13] . Prior to routine vaccination, rotavirus was the most common cause of diarrheal illness in the pediatric population with roughly 3.5 million cases per year in the United States. Nearly all children possessed rotavirus antibodies by age three. Worldwide, rotavirus accounted for 440,000 deaths per year  [9] . However, since the implementation of vaccination in 2006, the number of cases seen annually in the United States has declined 50% to 90% per year  [11] . As more countries adopt the standard practice of rotavirus vaccination, the overall number of cases is expected to continue to decrease. Other viral causes such as adenovirus, Sapovirus, and astrovirus account for 2 to 9% of cases worldwide, with a higher bias for children than adults  [16] .

Acute gastroenteritis is defined by loose or watery diarrhea that consists of 3 or more bowel movements in a day. Other symptoms may include nausea, vomiting, fever, or abdominal pain  [3] . Symptoms usually last for less than a week, most often improving after 1 to 3 days. Any signs of illness that persist past two weeks are classified as chronic and therefore do not meet the requirements for acute gastroenteritis. Patients often present with complaints of a relatively sudden onset of symptoms, usually over the course of 1 to 2 hours. Other people in the family or close contacts may have similar complaints. Mild fever and mild abdominal pain are common. Vomiting is present in most but not all cases. Concerning symptoms include high fever, bloody diarrhea, protracted vomiting, or severe abdominal pain. These may indicate to the clinician that another disease process may be the cause. It is important to elicit information relevant to causes other than viral gastroenteritis, such as bacterial agents or other acute abdominal pathology including acute appendicitis, bowel obstruction, and diverticulitis. Travel history, recent antibiotic use, disease exposure, occupational exposures, and immune status should all be considered. Particular attention should be paid to infants, elderly patients, and individuals who are immunosuppressed due to disease or medication usage. 

Upon physical exam, it is important to address any abnormal vital signs. Mild fever is common in viral gastroenteritis, but high fever (greater than 39 C) should trigger concern for causes that are not viral in origin. Additionally, tachycardia and tachypnea may be present due to fever and dehydration. An assessment for dehydration is of the utmost importance, especially in patients who demonstrate extremes of age, chronic illness, or immunosuppression. These patient groups are at a much higher risk for severe complications due to dehydration. Another physical exam finding may include mild, diffuse abdominal tenderness. Significant tenderness to palpation, guarding, rebound, or point-specific tenderness should lead the clinician to consider other causes of symptomatology.

Due to the lack of readily available viral testing capabilities in most clinics and emergency departments, acute viral gastroenteritis is a clinical diagnosis. Therefore, patients who appear clinically well-hydrated and who lack risk factors for severe disease do not necessarily warrant further testing. Diagnostics are used to help rule out other causes of the patient’s symptoms. Complete blood counts may reveal a mild leukocytosis in a patient with viral gastroenteritis. Other serum inflammatory markers may also show mild elevation. Patients who are suffering from significant dehydration may demonstrate hemoconcentration on complete blood count testing as well as electrolyte disturbances on chemistry panels. Dehydration may also present as acute kidney injury, evidenced by changes in the BUN and creatinine on a chemistry panel.

Imaging studies of the abdomen most often appear normal. CT scans may reveal mild, diffuse colonic wall thickening or other inflammatory changes of the bowel. However, there are no specific findings, and CT scanning should be performed to rule out other, more severe etiologies. Stool studies may be obtained, but readily available laboratory testing assays assess only for bacterial causes and do not diagnose specific viral causes. Patients with bloody stool, high fever, severe abdominal pain, or severe dehydration warrant stool studies as these symptoms are not consistent with simple viral gastroenteritis.

• Medical Management

The treatment of viral gastroenteritis is based on symptomatic support  [3] [4] . The most important goal of treatment is to maintain hydration status and effectively counter fluid and electrolyte losses. Fluid therapy is a fundamental part of treatment. Intravenous fluids may be administered to those individuals who appear dehydrated or to those unable to tolerate oral fluids. Antiemetic medications such as ondansetron or metoclopramide may be used to assist with controlling nausea and vomiting symptoms. Patients demonstrating severe dehydration or intractable vomiting may require hospital admission for continued intravenous fluids and careful monitoring of electrolyte status. Electrolyte abnormalities may be addressed on an individual level, although often these are caused by an overall fluid volume depletion which, when corrected, will also cause electrolytes to normalize. Both saline and lactated Ringer’s solutions appear to be effective for the treatment of dehydration due to viral gastroenteritis. 

Debate exists over antidiarrheal medication usage. Medications such as diphenoxylate/atropine or loperamide are not recommended in patients who are 65 or older. Younger patients may benefit from antimotility medications  [4] . However, some feel that if a patient can maintain a well-hydrated status, antidiarrheal treatment should not be initiated. For oral rehydration, some studies have shown that commercially available oral rehydration solutions containing electrolytes are superior to sports drinks and other forms of oral rehydration  [2] . However, a recent study using children with mild dehydration demonstrated no differences between children receiving oral rehydration solutions versus ad lib oral intake  [17] . No specific nutritional recommendations are universal for patients with viral gastroenteritis. A diet of banana, rice, apples, tea, and toast is often advised, but several studies have failed to show any significant outcome difference when compared to regular diets  [18] .

Most patients who present to outpatient clinics or the emergency department with acute viral gastroenteritis can be discharged home safely. Adults often benefit from antiemetic medications at home although home antiemetic medication is not recommended in young children. Patients who may benefit from hospital observation or admission are those that demonstrate signs or symptoms of dehydration, intractable vomiting, severe electrolyte disturbances, significant renal failure, severe abdominal pain, or pregnancy.

• Nursing Management
• Assess vital signs
• Encourage intake of fluids
• Educate caregiver about viral gastroenteritis
• Assess infant/child for abdominal pain, nausea
• Assess ins and outs
• Assess for signs of dehydration
• Educate about handwashing and proper hygiene measures
• Educate about the importance of clean water for cooking
• Encourage the parent to follow up with medical care
• Educate caregiver about the rotavirus vaccine
• Outcome Identification
• Able to eat
• No diarrhea
• No abdominal symptoms
• Normal mentation
• Coordination of Care

Many patients with gastroenteritis present to the emergency room. However, because there are so many causes of gastroenteritis, the emergency department physician, nurse practitioner, and internist need to rule out other serious disorders first become making a diagnosis of viral gastroenteritis, which is a clinical diagnosis aided with laboratory data.

Food poisoning due to bacterial toxins frequently causes symptoms very similar to viral gastroenteritis, though the treatment for food poisoning often parallels that of viral gastroenteritis. Bacterial and protozoal causes of gastroenteritis can potentially mimic symptoms of viral gastroenteritis but often require a different treatment approach and may carry higher morbidity potential.

If there is any doubt about the diagnosis, the infectious disease expert should be consulted before discharging the patient. Most patients with viral gastroenteritis improve with supportive measures including hydration and bowel rest.

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Disclosure: Nathan Stuempfig declares no relevant financial relationships with ineligible companies.

Disclosure: Justin Seroy declares no relevant financial relationships with ineligible companies.

Disclosure: Jeannie Labat-Butler declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Stuempfig ND, Seroy J, Labat-Butler JR. Viral Gastroenteritis (Nursing) [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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