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PRELIMINARY REPORT
GASTROENTRITIS DISEASE IN THE GI ROOM
MELATI 3 DR. SOEKARJO GENERAL HOSPITAL

By :
SUCI ILHAMI SOMANTRI
P20620523091
2A Applied Bachelor of Nursing and Nursing Profession

BACHELOR OF APPLIED NURSING PROGRAM

AND THE PROFESSION OF NURSING
NURSING DEPARTMENT
MINISTRY OF HEALTH
POLYTECHNIC
TASIKMALAYA
A. Theoretical Concept
1. Understanding Disease
Gastroenteritis / GEA is an inflammation of the digestive tract (including the
stomach and intestines) which is generally caused by a viral or bacterial infection, and in
rarer cases by parasites and fungi. In the community, gastroenteritis is known as muntaber.
Gastroenteritis is a condition where the feces resulting from defecation are liquid or semi-
liquid in consistency and contain more water than feces in general. Accompanied by
nausea, vomiting and frequency of bowel movements more than 3 times a day.
Gastroenteritis / GEA is a change in the frequency of bowel movements to be more
frequent than normal or a change in stool consistency to be more runny or both in less
than 14 days. Generally accompanied by several digestive tract disorders such as nausea,
vomiting, abdominal pain, sometimes accompanied by fever.
Gastroenteritis or diarrhea is still a health problem, not only in developing
countries but also in developed countries. Acute gastroenteritis is defined as defecation
with liquid or soft stools in larger quantities than normal, lasting more than 14 days.
(Suharyono 2009),
Chronic gastroenteritis is one that lasts more than 14 days. Gastroenteritis or
diarrhea can be caused by infection or non-infection. The most common cause of
gastroenteritis is infectious gastroenteritis. Infectious gastroenteritis or diarrhea can be
caused by viruses, bacteria, and parasites. (Priyanto 2009),
According to World Health Organization (WHO), diarrhea is the occurrence of
defecation with a consistency that is more liquid than usual, with a frequency of three or
more times in a 24-hour period. Diarrhea is an environmental-based disease caused by
infection with microorganisms including bacteria, viruses, parasites, protozoa, and is
transmitted pekalorally. Diarrhea can affect all age groups, both toddlers, children, and
adults with various social classes.

2. Etiology
The etiology or cause of GEA can vary, both in adults and in children. Tanto et al.
(2018) stated that there are a number of factors that cause GEA, including:
1. Gastrointestinal tract infection is the main factor in the occurrence of GEA, especially
in children. The infection can be caused by several things, namely: viruses (such as
astrovirus, rotavirus adenovirus, and the like); bacteria (such as shigella dysentriae,
salmonella thypi, clostridium perfrigens. vivro cholera, M aeromonas, yersinia
enterocolytica, and the like) and parasites (such as protozoan worms). and
2. Food malabsorption is the malabsorption of food which means protein and
carbohydrates, factors other than infection, such as fat malabsorption,
3. Food poisoning is another factor besides digestive tract infection and food
malabsorption. Food poisoning can occur because the food consumed is poisonous,
stale, and food that causes allergies to consumers.
4. Drug factors (antibiotics) and antacids that contain ingredients such as laxatives and
magnesium.
Similar opinions state that GEA can occur due to the most common cause, namely
viruses (rotavirus and norovirus). In addition, E. Coli and Salmonella bacteria can also
trigger GEA. Salmonella bacteria are usually spread through undercooked poultry and
eggs or through reptiles and live pet birds (Dilonardo, 2021).
In many cases, the virus that causes GEA is spread in several ways, including:
1. Contact with someone who has the virus
2. Contaminated food or drink;
3. Unwashed hands after going to the bathroom or changing diapers;
4. Other unusual ways such as drinking water containing heavy metals such as arsenic,
cadmium, lead and the like; eating foods that contain a lot of acid such as citrus and
tomatoes; eating seafood that contains toxins; and certain medications such as
antibiotics, antacids and the like (Dilonardo, 2021).

3. Anatomy and Physiology

a. Anatomy

1) Mouth
Consists of 2 parts:
a) The narrow outer part / vestibule is the space between the gums, teeth, lips
and cheeks.
The outside of the mouth is covered by skin and the inside is covered by
mucous membrane (mucosa). The orbicularis oris muscle covers the lips.
The levator anguli oris lifts and the depressor anguli oris depresses the
corners of the mouth.
b) Cheek
Lined from the inside by mucosa containing papillae, the muscle found in
the cheeks is the buccinator muscle.
c) Tooth
2) The oral cavity or inner part is the oral cavity which is bordered on the sides by
the maxillary bone, palate and mandible at the back connecting with the pharynx.
a) Palate
Consisting of 2 parts, namely the hard palate (palate durum) which is composed of palata
crowns from the side of the maxillary bone and further
 back which consists of 2 palates. The soft palate (palate molar) is located
behind which is a hanging fold that can move, consisting of fibrous tissue
and mucous membrane.
b) Tongue
Consisting of striated muscle fibers and covered by mucous
membranes, the work of these tongue muscles can be moved in all
directions. The tongue is divided into 3 parts, namely: Radix Lingua = base
of the tongue, Dorsum Lingua = back of the tongue and Apex Lingua
+11tip of the tongue. At the base of the tongue that is back there is an
epiglottis. The back of the tongue (dorsum lingua) contains taste buds or
taste nerve endings. Fenukun Lingua is a mucous membrane found at the
bottom approximately in the middle, if not moved upwards the mucous
membrane appears.
c) Salivary gland
It is a gland that has a duct called ductus wartoni and ductus stansoni.
There are 2 salivary glands, namely the lower jaw salivary gland
(submaxillary gland) which is located under the middle of the upper jaw
bone, the lower tongue salivary gland (sublingual gland) which is located
in front under the tongue. Under the lower jaw salivary gland and the lower
tongue salivary gland is called the sublingual coroncle and its secretions
are in the form of salivary glands. Around the oral cavity there are 3
salivary glands, namely the parotid gland which is located below the front
of the ear between the left and right mastoid processes of the mandibular
bone, its duct is the ductus stensoni, this duct exits the parotid gland into
the oral cavity through the cheek (buccinator muscle). The submaxillary
gland is located under the back of the oral cavity, its duct is the ductus
watoni which empties into the oral cavity 12 empties into the floor of the
oral cavity. The salivary glands are underlain by involuntary nerves.
d) Tongue Muscles
The intrinsic muscles of the tongue originate from the lower jaw
(mandibular, oshitoid and steloid process) spreading into the tongue
forming a network joining the intrinsic muscles found on the tongue. M
genioglossus is the strongest muscle of the tongue originating from the
inner middle surface spreading to the root of the tongue.

2) Pharynx (throat)
It is an organ that connects the oral cavity with the esophagus. In the
pharyngeal arch there are tonsils, which are a collection of lymph glands that contain
many lymphocytes.
3) Esophagus
The esophagus is about 25 cm long and runs through the chest close to the
vertebral column, behind the trachea and heart. It curves forward, pierces the
diaphragm and connects to the stomach. The entrance of the esophagus into the
stomach is the cardia.
4) Gaster (Stomach)
It is part of the channel that can expand the most, especially in the epigastric
region. The stomach consists of the upper 13 parts of the fundus uteri connected to
 the esophagus through the pyloric orifice, located under the diaphragm in front of the
pancreas and spleen, attached to the left of the fundus uteri.
5) Intestinum minor (small intestine)
It is part of the digestive system that originates from the pylorus and ends at the
cecum, length + 6 meters. The layers of the small intestine consist of: Ø mucosal
layer (inner), circular muscle layer (m.circular) Ø longitudinal muscle (m.
Longitudinal) and serosa layer (outer).
There are 2 types of small intestine movements, namely
a) Mixing contractions (segmentation)
These contractions are stimulated by stretching of the small intestine, namely
the pressure of chyme.
b) Pusher Contraction
The chyme is propelled through the small intestine by peristaltic waves.
The peristaltic activity of the small intestine is partly due to the entry of
chyme into the duodenum, but also by the so-called gastroenteric waves
which are caused by the distension of the stomach, especially by the
myenteric plexus from the stomach down the wall of the small intestine.
The border of the small intestine and colon is the ileocecal valve which
functions to prevent the flow of feces into the small intestine. The degree of
contraction of the iliocecal sphincter is mainly regulated by reflexes
originating from the cecum. Reflection from the cecum to the iliocecal
sphincter is mediated by the myenteric plexus. The intestinal wall is rich in
blood vessels that transport substances absorbed to the liver through the
portal vein. The intestinal wall releases mucus (which lubricates the intestine)
and water (which helps dissolve fragments of digested food). The intestinal
wall also releases small amounts of enzymes that digest proteins, sugars, and
fats. Very strong irritation of the intestinal mucosa, such as occurs in some
infections, can cause what is called "peristaltic rush" which is a very strong
peristalsis that travels far in the small intestine in a few minutes. The minor
intestine consists of:
a) Duodenum (small intestine)
Length + 25 cm, shaped like a horseshoe curved to the left. In this
curve there is the pancreas. And the right side of the duodenum there is a
mucous membrane that proves to be called the papilla of vater. In this
papilla veterinary duct flows the bile duct (ductus choleducus) and the
pancreatic duct (ductus pancreaticus).
b) Jejunum and ileum
Has a length of around + 6 meters. The upper two fifths are the
jeyenum with a length of ± 2-3 meters and the ileum with a length of ± 4 – 5
meters. The grooves of the jeyenum and ileum are attached to the posterior
abdominal wall by means of a fan-shaped fold of peritoneum known as the
mesentery.
The root of the mesentery allows the branches of the superior
mesenteric artery and vein, lymph vessels and nerves to enter and exit into
the space between the 2 layers of peritoneum that form the mesentery. The
connection between the jejunum and ileum does not have a clear boundary.
 The lower end of the ileum is connected to the cecum with the cecum by a
hole called the ileoseical orifice, this orifice is strengthened by the
ileoseical sphincter and in this part there is a valve of the cecal or baukini
valve. Small intestine mucosa. The very wide epithelial surface through
mucosal folds and microvilli facilitates digestion and absorption. These
folds are formed by the mucosa and submucosa which can enlarge the
intestinal surface. In cross-section, the villi are covered by epithelium and
crypts which produce various tissue hormones and enzymes that play an
active role in digestion.

6) Large Intestine (Large Intestine)

Length ± 1.5 meters width 5-6 cm. The layers of the large intestine from the
inside out: mucous membrane, circular muscle layer, longitudinal muscle layer,
and connective tissue. The layers of the large intestine consist of:
a) Seikum
Under the cecum there is the vermiform appendix which is shaped like a
worm so it is also called a worm tuft, 6 cm long.
b) Ascending colon
Length 13 cm located under the right abdomen extending upward
from the ileum to below the liver. Below the liver it swells to the left, this
curve is called the hepatic flexure, continued as the transverse colon.
c) Appendix (appendix)
The part of the large intestine that emerges like a funnel from the end of
the cecum.
d) transverse colon
Length ± 38 cm, extending from the ascending colon to the
descending colon under the abdomen, on the right there is the hepatic
flexure and on the left there is the linear flexure.
e) Descending colon
Length ± 25 cm, located under the left abdomen, extending from top
to bottom from the lineal flexure to the front of the left ileum, connecting
with the sigmoid colon.
f) Sigmoid colon
It is a continuation of the descending colon located obliquely in the
left pelvic cavity, shaped like the letter S. Its lower end is connected to
the rectum. Function of the colon: Absorbing water and electrolytes and
chyme and storing feces until they can be excreted. There are 2 types of
colon movements: 1) Mixing movements (Haustration) which are
combined contractions of smooth and longitudinal muscles but the outer
part of the large intestine that is not stimulated protrudes outward like a
bag. 2) Propulsive movements "Mass Movement", which are contractions
of the large intestine that push feces towards the anus.

6) Rectum and Anus

Located below the sigmoid colon that connects the major intestine with the anus,
located in the pelvic cavity in front of the sacrum and coccyx. The anus is part of the
 digestive tract that connects the rectum with the outside world (outside air). Located
between the pelvis, its walls are strengthened by 3 sphincters:
a) Internal Anal Sphincter
b) Levator Ani Sphincter
c) External Anal Sphincter
Start the defecation process due to mass movement. Mechanism:
a) Descending colon contractions
b) Rectal reflex contraction
c) Signoid reflex contraction
d) Anal sphincter relaxation

4. Signs and Symptoms

Symptoms of gastroenteritis will appear between 1-3 days and last for 1-2 days, but
can also be up to 10 days after being infected with the virus. Gastroenteritis attacks the
intestines in humans, so the following symptoms appear:
• Abdominal pain and cramps.
• Watery diarrhea, but not mixed with blood. If diarrhea is mixed with blood, the
infection that occurs may be different and more severe.
• Nausea and vomiting.
• Loss of appetite.
• Weight loss.
• Sometimes fever, headache, and muscle pain occur.

5. Pathophysiology
Gastroenteritis according to Mardalena (2018), is caused by the entry of
viruses, bacteria and parasites which then cause infection in cells and produce
Enterotoxins or Cytotoxins which will damage cells and attach to the intestinal wall.
Transmission of gastroenteritis is usually through feces and also food or
6. Pathway
(carbohydrates, fats, and (carbohydrates, fats, and bacteria proteins)
proteins

Hypovolemia Nutrition Defisit

 7) Supporting examinations
Most patients with diarrhea without dehydration or mild dehydration do not
require further supporting examinations, but this is different in cases with severe
dehydration. In cases with severe dehydration, various supporting examinations are
required, such as microbiological stool examinations, blood testcomplete and
electrolyte examination.
• Complete Blood Test
Blood test with phlebotomy to see the presence of leukocytosis can indicate the
occurrence of bacterial gastroenteritis.
• Electrolyte Examination
Based on the sodium levels in plasma, the types of dehydration can be divided into
three types, namely hyponatremia dehydration (<130 mEq/L), isonatremia (130-
150 mEq/L), and hypernatremia (>150 mEq/L). Isonatremia dehydration can
manifest as hypovolemic shock, while hypernatremia dehydration at
concentrations>165 mmol/L can trigger seizures.
• Blood Gas Analysis (ABG)
In severe cases, metabolic acidosis may occur, so blood gas analysis should be
performed in these cases. If dehydration is very severe, it may occur acute renal
failure,so that kidney function should be checked, namely by measuring serum
urea and creatinine levels.
• Microbiology Examination
Complete stool examination (FL) is performed to determine the definitive etiology.
In Entamoeba histolytica infection, trophozoites and red blood cells can be found.
In Clostridium difficile infection, fecal leukocytes >5/field of view can be found,
and gram-positive bacilli with subterminal oval spores can be seen. In
Pseudomembranous colitis, fecal leukocytes can be found.[21]
• Radiological Examination
Radiological examinations such as photo of abdomenn not indicated in acute
gastroenteritis. If the clinician suspects another diagnosis, a CT scan can be
performed. A CT scan can be performed in cases where abdominal pain is very
severe, and perforation, intestinal obstruction, or toxic megacolon (Hirschsprung's
disease toxic).[2]

8) Complications
Sattar & Shashank (2021) stated that when GEA is not treated immediately and
adequately, the most common complications that can occur are dehydration and
electrolyte deficiency. Another common complication is a change in diarrhea from
acute to chronic which can cause lactose intolerance or excessive bacterial growth in
the small intestine. Similar opinions state that the main complications in people with
GEA, especially in the elderly

B. Nursing Care Concept

1. Assessment
a) Client identity
b) Nursing history
 Early attacks: restlessness, increased body temperature, anorexia then
diarrhea occurs. Main complaints: increasingly liquid stool, vomiting, loss of
water and electrolytes, dehydration symptoms occur, weight loss, decreased skin
tone and turgor, dry mucous membranes of the mouth and lips, frequency of
bowel movements more than 4x with consistent runny stools.
c) Past medical history
History of illness suffered, history of inflammation
d) Family Psychosocial History
e) Basic needs
1. Elimination Pattern
Experiencing changes, namely defecating more than 4 times a day
2. Nutritional Pattern
It starts with nausea, vomiting, anorexia, causing decreased bowel
movements.
3. Rest and Sleep Patterns
It will be disturbed due to abdominal distension which will cause discomfort.
4. Activity Patterns
Will be disturbed due to weak body condition and pain due to abdominal
dysentery.

f) Supporting investigation
1. Blood
Ht increased, leukocytes decreased
2. Feces
Bacteria or parasites
3. Electrolyte
Sodium and Potassium decreased
4. Urinalysis
Concentrated urine, increased BJ
5. Blood Gas Analysis
Metabolic antidote (if there is a lack of fluids)
g) Focus Data
1. Subjective
a) Weakness
b) Soft to liquid diarrhea
c) Anorexia nausea and vomiting
d) Intolerant to diet
e) Stomach cramps to pain (pain in the lower right quadrant, lower middle
abdomen)
f) Thirsty, decreased urination
g) Pulse increases, blood pressure decreases, respiration rate decreases
rapidly and deeply (compensatory acidosis).

2. Objective
a) Weak, restless
 b) Decreased fat/muscle mass, decreased tone
c) Decreased turgor, pale, sunken eyes
d) Abdominal tenderness
e) Urine less than normal
f) Hyperthermia
g) Hypoxia / Cyanosis, Dry mucosa, Intestinal peristalsis is more than
normal.
2. Nursing Diagnosis
Nursing diagnosis is a clinical judgment regarding the patient's response to health problem
(SDKI DPP PPNI Working Group Team, 2018)
Diagnosis based on SDKI is:
A. Diarrhea (D.0020)
Definition: frequent, soft, unformed stools Major Symptoms and
Signs: Subjective: - Objective:
a) Defecation more than 3 times in 24 hours
b) Soft or liquid feces Minor Symptoms and Signs:
Subjective:
a) Urgency
b) Abdominal pain/cramps Objective:
a) Increased peristaltic frequency, hyperactive bowel sounds
B. Acute Pain ( D.0077)
Definition: a sensory or emotional experience associated with actual or functional
tissue damage, of sudden or slow onset and of mild to moderate intensity.
weight loss that lasts less than 3 months
Subjective Major Symptoms and
Signs:
a) Complaining of pain
Objectively:
a) Looks grimacing
b) Be protective (e.g. alert, avoid painful positions)
c) Nervous
d) Increased pulse rate
e) Difficulty sleeping
Minor symptoms and
signs: Subjective: -
Objective:
a) Increased blood pressure
b) Breathing pattern changes
c) Appetite b changes
d) Disturbed thought process
e) Withdraw
f) Focus on yourself
g) Diaphoresis
C. Nutritional deficit (D.0019)
Definition: nutrient intake is insufficient to meet metabolic needs.
 Major Symptoms and
Signs: Subjective: -
Objective:
a) Weight loss of at least 10% below the ideal range Minor
Symptoms and Signs:
Subjective:
a) Get full quickly
b) After eating
c) Abdominal pain cramps
d) Decreased appetite Objective:
a) Hyperactive bowel sounds
b) Weak chewing muscles
c) Weak muscles
d) Pale mucous membranes
e) Ulcer
f) Serum albumin decreased
g) Excessive hair loss
h) Diarrhea
D. Hypovolemia (D.0023)
Definition: Decreased intravascular, interstitial and/or intracellular fluid volume
Major Symptoms and Signs:
Subjective: -
Objective:
a) Increased pulse rate
b) Pulse feels weak
c) Decreased blood pressure
d) Narrow pulse pressure
e) Decreased skin turgor
f) Dry mucous membranes
g) Decreased urine volume
h) Hematocrit increased
Minor Symptoms and Signs:
Subjective:
a) Feeling weak
b) Complaining of thirst Objective:
a) Decreased venous filling
b) Altered mental status
c) Body temperature increases
d) Increased urine concentration, sudden weight loss
E. Hyperthermia (D.0130)
Definition: body temperature increases above the body's normal range.
Major Symptoms and
Signs: Subjective: -
Objective:
 a) Normal body temperature above normal
values Minor Symptoms and Signs:
Subjective: - Objective:
a) Red skin
b) Seizures
c) Tachycardia
d) Tachypnea
e) Skin feels warm

3. Nursing Interventions

No DX Objectives and Outcome Intervention

. Nursing Criteria
1. Diarrhea due to Elimination of feces Diarrhea Management
gastrointestinal (04033) After carrying (I.03101) Observation:
irritation out nursing actions for 1. Identify the causes of
(D.0020) 3x7 hours, it is diarrhea
expected to achieve 2. Identification of feeding
the following outcome history
criteria: 1. Control of 3. Identify the symptoms of
feces excretion invagination
2. Complaints 4. Monitor stool color,
of volume, frequency, and
prolonged consistency.
defecation 5. Monitor for signs and
and difficult symptoms of
hypovolemia.
3. Strainin
6. Monitor for irritation and
g during
ulceration of the skin in
defecati
the perianal area.
on
7. Monitor the amount of
4. Urgency diarrhea discharge
5. Abdomi 8. Therapeutic food
nal pain preparation safety
6. Abdomi monitoring:
nal 1. Give fluid supplements
cramps
7. Stool
consisten
cy
8. Frequency
of
defecation
9. Intestinal oral, for example
peristalsis sugar salt solution,
oralit, or pedialyte
2. Insert an intravenous
(IV) cannulation line

3. Give intravenous fluids

if necessary.

4. Take a blood sample

for a complete blood
count and electrolytes.

Education:
1. Encourage small,
frequent meals
gradually.
2. It is recommended to
avoid spicy, gas-
forming foods and
foods containing
lactose.
3. Recommend
continuing
breastfeeding
Collaboration:
1. .Collaboration in
administering
antimotility drugs
2. Collaboration in
administering
antispasmodic drugs

3. Collaboration in
administering stool
hardening drugs such
as attapulgite
2. Acute pain Pain level (L.07214) Pain management
related to After nursing actions for
injuring (I.08238) Observation:
3x7 hours, it is expected
agent
physiological to achieve the following 1. Identification of
outcome criteria: location,
(D.0077)
characteristics,
1. Ability to duration, frequency,
complete quality, intensity of
n activity pain

2. Complaints of 2. Identification of pain

pain scale

3. Grimace 3. Identifying non-

verbal pain responses
4. Protective attitude
4. Identification of
5. Nervous aggravating factors
and relieve pain
6. Difficulty sleeping
5. Identification of
7. Withdraw
knowledge and
8. Focus on yourself beliefs about pain
9. Diaphoresis 6. Identifying cultural
influences on pain
10. Feeling depressed response
(down)
7. Identify the impact of
11. Feelings of fear pain on quality of life
experienced
8. Monitor the success
recurrent injury
of complementary
12. Anorexia therapies that have
been given
13. Perineum feels
pressured 9. Monitor the side
14. The uterus feels effects of using
round therapeutic
analgesics:
15. Muscle tension
1. Provide non-
16. Dilated pupils
pharmacological
17. Vomit techniques to
reduce pain (eg:
18. Nauseous
TENS, hypnosis,
19. Pulse rate acupressure,
music
20. Breathing pattern
therapy,
21. Blood pressure biofeedback,
aromatherapy
22. Thinking process massage
23. Focus therapy, guided
imagery
24. Urinary function techniques,
hot/cold
25. Behavior
compresses, play
therapy)
26. Appetite 2. Controlling
environmental
27. Sleep patterns factors that
aggravate pain (eg:
room temperature,
lighting, noise)
3. Facilitate rest and
sleep
4. Consider the type
and source of pain
when selecting a
pain relief strategy
Education:
1. Describe the causes,
periods, and triggers
of pain.
2. Explain pain relief
strategies
3. Encourage self-
monitoring of pain
4. Recommend using
analgesics
appropriately
5. Teach
pharmacological
techniques to reduce
pain Collaboration:
1. Collaboration in
providing
analgesics, if
necessary
3. Nutritional Nutritional Status (L. 1. Nutrition management
Deficit related to 03030) After nursing
(I.03119) Observation:
inability to actions are carried out for
digest food 3x7 hours, the expected 2. Identification of
(D.0019) outcome criteria are: nutritional status
1. Portion of food 3. Identify food
consumed allergies and
2. Chewing muscle intolerances
strength 4. Identify preferred
3. Swallowing foods
muscle strength
5. Identify calorie needs
4. Serum albumin and nutrient types
5. Verbalization of 6. Identify the need for
the desire to hose use
increase nasogastric
nutrition
7. Monitor food
6. Knowledge of
intake
options
healthy food 8. Weight monitor
7. Knowledge about 9. Monitor the results of
healthy beverage
the Therapeutic
choices
laboratory tests:
8. Knowledge about
healthy nutritional 1. Perform oral
intake Hygiene before
eating, if necessary
9. Preparation of
storage 2. Facilitate
healthy food determining dietary
guidelines (eg:
10. Preparation of food pyramid)
storage
healthy drink 3. Servefood
attractively and at
11. Attitude towards
theright
food/drinks
according to temperature.
health goals 4. Provide high fiber
Feelings of being foods to prevent
fast constipation.
5. Provide foods high
in calories and high
in protein
6. Provide food
supplements, if
necessary.
7. Stop feeding
hrough the
nasogastric tube if
oral intake can be
tolerated
Education:
1. Teach sitting
position, if
able.
2. Teach
programmed
diet

Collaboration:
1. Collaboration in
administering
medication before
meals (eg:pain
relievers,
antiemetics), if
necessary.
2. Collaborate with a
nutritionist to
Determine the
number of calories
and types of
nutrients needed, if
necessary.
4. Hypovolemia is Fluid status (L.03028) Hypovolemia Management
related to active After nursing actions (I.03116)
fluid loss.
have been carried out for Observation:
(D.0023)
3x7 hours, it is expected 1. Check for signs and
to achieve the following Symptoms
outcome criteria: hypovolemia (eg:
increased pulse rate,
1. Pulse power weak pulse, blood
pressure down,
2. Skin turgor pressure pulse narrow,
3. Urine output skin turgor down,
membrane mucosa dry,
4. Venous filler urine volume
5. Orthopnea
6. Dyspnea
7. Paroxysmal decreased,
nocturnal dyspnea hematocrit
(PND) increased, thirsty,
weak)
8. Eternal anarsarka
2. Monitor fluid intake
9. Peripheral edema and output
10. Weight Therapeutic:
11. Jugular venous 1. Calculate the needs
distension fluid
12. Additional breath
sounds 2. Provide modified
position Education:
13. Pulmonary
congestion 1. Recommend increasing
oral fluid intake
14. Feeling weak
2. Advise to avoid sudden
15. Complaints of
position changes
thirst
Collaboration:
16. Urine
1. Collaboration in
concentration
administering isotonic
17. Pulse rate IV fluids
(eg: NaCL, RL)
18. Blood pressure
2. Collaboration in
19. Pulse pressure administering
20. Mucous hypotonic IV
membrane fluids (eg: 2.5%
glucose,
21. Jugular 0.4% NaCl)
Venous
3. Collaboration in
Pressure (JVP)
administering colloid
22. Hb levels fluids
(albumin, plasmanate)
23. Ht Level
4. Collaboration in blood
24. Central product provision
Venous
Pressure
25. Hepatojugular
reflux
26. Weight
27. Hepatomegaly
28. Oligura
29. Fluid intake
30. Mental status
31. Body Temperature
5. Hyperthermia Thermoregulation Hyperthermia management
related to disease (L.14134) After carrying (I.15506)
process (D.0130)
out nursing actions for Observation:
3x7 hours, it is expected 1. Collaboration in
to achieve the following providing medication
beforeEat (eg: Pain
outcome criteria:
reliever, antiemetic), if
1. Shivering necessary

2. Red skin 2. Collaboration with a

nutritionist to
3. Seizures determine the number
4. Acrocyanosis of calories and types
5. Oxygen of nutrients needed, if
consumption necessary
6. Piloerection Therapeutic:
7. Vasoconstriction 1. Provide a cool
i peripheral environment
8. Cutis memorata 2. Loosen or remove
clothing
9. Pale
3. Wet and fan the body
10. Tachycardia
surface
11. Tachypnea
4. Give oral fluids
12. Bradycardia
5. Change linen daily or
13. Cyanolic nail bed more requently if you
experience
14. Hypoxia hyperhidrosis
15. Body temperature (excessive sweating).

16. Skin temperature 6. Perform external

cooling (eg:
17. Blood glucose hypothermia blanket
levels or cold compress on
forehead, neck, chest,
18. Capillary refill abdomen, axilla)
19. Ventilation 7. Avoidadministration
20. Blood pressure of antipyreticsmor
aspirin
 8. Give oxygen, if
necessary
Education:
1. Encourage bed rest
Collaboration:
1. Collaborative giving
fluids and electrolytes
 BASIC HUMAN NEEDS IN GASTROENTERITIS PATIENTS

A.Basic Concept of Human

Humans are living beings consisting of a complete and unique bio-

psycho-social-spiritual. Humans are higher beings that come from lower
beings, so that eventually all living beings can be returned to some of their
original forms (Darwin). As for needs, they are something that is very
important, beneficial, or necessary to maintain homeostasis in life.
Alone. Abraham Maslow a psychology from America developed a
theory about basic human needs which is better
known as the term Hie Maslow's hierarchy of basic human needs. The
hierarchy includes five categories of basic needs, namely:
1. Physiological needs
Physiological needs have the highest priority in Maslow's
hierarchy. Generally, a person who has several unmet needs will fulfill
their physiological needs first compared to other needs. Humans have
eight types of needs, namely:
a. Oxygen requirements and gas exchange
b. Fluid and electrolyte needs
c. Food needs
d. Urine and fecal elimination needs
e. The need for rest and sleep
f. Activity needs
g. Body temperature health needs
a. Sexual needs, these needs are not necessary to maintain continuity
life somebody but important to maintain the
continuity of humanity.
2. Safety and security needs The safety and security needs referred to are
safe from various aspects, both physiological and psychological. These
needs include:
a. Need protection self from air cold, heat, accidents
and infections
b. Free from fear and anxiety
 c. Free from feelings of threat due to new or unfamiliar experiences
3. The need for love, belonging and being owned (Love and belonging needs)
These needs include:
a. Giving and receiving affection
b. Feelings of belonging and meaningful relationships with others
c. Warmth
d. Friendship
e. Getting a place or being recognized in the family, group and social
environment
4. Self-esteem needs These needs include:
a. Feelings of irresponsibility towards others
b. Competent
c. Respect for yourself and others

5. Needs for Self

Actualization These needs
include:
a. Be able to know yourself well (know and understand your potential)
b. Learn to meet your own needs
c. Not emotional
d. Have high dedication
e. Creative
f. Having high self-confidence, and so on.
1. Diarrhea
 Assessment: Monitor the frequency and consistency of the patient’s stool, and observe for signs of
dehydration, such as dry mouth and decreased skin elasticity.
 Intervention:
o Provide oral rehydration solutions (ORS) or water as instructed to prevent dehydration.
o Educate the patient to avoid foods that may trigger diarrhea, like spicy and fatty foods.
o Monitor fluid and electrolyte balance, and collaborate with the doctor on any necessary
antidiarrheal medications.
 Evaluation: Observe any changes in the frequency of diarrhea and signs of dehydration after
intervention.
2. Acute Abdominal Pain
 Assessment: Ask the patient about the intensity and location of pain, as well as any positions that
relieve or aggravate it.
 Intervention:
 o Encourage the patient to rest in a comfortable position that minimizes abdominal pressure.
o Collaborate with the medical team for appropriate analgesic administration.
o If permitted, apply a warm compress to the abdomen to help ease the pain.
 Evaluation: Ask about pain levels after intervention and note any decrease in intensity.
3. Nutritional Deficit
 Assessment: Assess the patient’s nutritional status by observing their food intake and any signs of
malnutrition, such as weakness and pale skin.
 Intervention:
o Provide easily digestible foods like porridge or clear soups to reduce irritation in the
digestive system.
o Encourage small, frequent meals to help maintain nutritional intake.
o If the patient struggles to eat, discuss potential nutritional supplements with the medical
team.
 Evaluation: Monitor the patient’s nutritional status and food intake after interventions.
4. Hypovolemia
 Assessment: Check for signs of hypovolemia, such as low blood pressure, rapid pulse, and poor skin
turgor.
 Intervention:
o Offer oral fluids as tolerated or administer IV fluids as ordered to replace fluids lost due to
diarrhea.
o Track the patient’s fluid intake and output to evaluate fluid balance.
o Instruct the patient to drink fluids periodically to ensure proper hydration.
 Evaluation: Monitor blood pressure, skin turgor, and fluid intake to ensure hypovolemia signs are
decreasing.
5. Hyperthermia
 Assessment: Take the patient’s temperature regularly to monitor for fever, and ask if they
experience chills or excessive sweating.
 Intervention:
o Apply a warm compress to the forehead and body folds to help reduce fever.
o Encourage the patient to drink more fluids to avoid dehydration due to fever.
o Collaborate with the medical team on administering antipyretics if needed.
 Evaluation: Regularly check the patient’s temperature to ensure that hyperthermia is under control.
 REFERENCE

Ministry of Health of the Republic of Indonesia. (2022). Indonesian Health Profile

2021. In Pusdatin.Kemenkes.Go.Id.

Hariani, H., & Ramlah, R. (2019). Implementation of Diarrhea Control Program

at Matakali Health Center. J-KESMAS: Journal of Public Health, 5(1),
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Novieastari, E. (2020). Nursing Diagnosis. Indonesian Nursing Journal,

7(2), 77–80.https://doi.org/10.7454/jki.v7i2.137

Semarang City Health Office. (2021). Semarang City Health Profile 2021. Health

Office, Central Java. (2021). Central Java 2021.

Azizah, Lely, Erjon, Suryani, Veroneka, Vincencius. Anatomy and Physiology of the
Digestive System. Kota Baru: Yayasan Pendidikan Cendekia Muslim, 2021.
Yulianti, R., & Astari, R. (2020). Health Journal Health Journal. Health Journal, 8(1),
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Muhammad. (2019). 45(45), 95-98. In Nursing Care for Diarrhea.

Mardalena, I. (2018). Nursing Care for Patients with Digestive System Disorders.