Assessment

HISTORY. Diarrhea is the cardinal symptom of gastroenteritis, but the severity varies with the causative organism. Determine the frequency, color, consistency, and amount of bowel movements. The epidemic viral diarrhea lasts only 24 to 48 hours, whereas rotaviral infection may last up to 7 days. Campylobacter enteritis results in 20 to 30 foul-smelling stools per day for as long as a week. E. coli may cause blood and mucus in the stool, with a duration of 7 to 10 days. Diarrhea from shigellosis is greenish in color, may last from 2 to 20 days, and also contains blood and mucus. Nausea and vomiting are usually confined to the first 48 hours of illness. Ask if cramping, pain, nausea, or vomiting has accompanied the diarrhea.

Fever often occurs with bacterial intestinal infections. Flu symptoms (malaise, headache, myalgia [muscle achiness]) are associated with the epidemic viral gastroenteritis. Determine if other family members or coworkers have the same symptoms. It is important to determine if the gastroenteritis is communicable from contaminated food or water so that the community health department can be notified. Inquire about recent travel and food intake. Investigate what and where the patient has eaten in the last 2 days.

PHYSICAL EXAMINATION. The patient generally appears acutely ill, with dry skin and poor skin turgor. Inspect the mouth and note that the mucous membranes are usually dry, the tongue is furrowed, and salivation is decreased. Other signs include flattened neck veins, redness of the perianal area, and a decreased urine volume (<20 mL/hr or 480 mL in 24 hours) and

366 Gastroenteritis increased urine concentration (a dark, concentrated color). When you perform auscultation, check for hyperactive bowel sounds. The patient may have abdominal distension with diarrheal stools that are liquid, green, foul-smelling, and bloody or mucus-filled.

PSYCHOSOCIAL. Identify the patient's perception of the threat of the symptoms. Assess for behaviors that may indicate anxiety, such as restlessness, irritability, and difficulty sleeping. Identify coping skills the patient is using, such as problem solving, anger, and daydreaming.

Diagnostic Highlights

Test Normal Result

Abnormality with Condition

Explanation

Stool culture and Negative for Gram stain pathogens; normal stool flora

Presence of enteric pathogens; enterotoxigenic Escherichia coli; pus cells, white blood cells and shigella; white blood cells, red blood cells, and campylobacter

Demonstrate presence of pathogens or the effect of pathogens

Other Tests: Blood chemistries to identify dehydration, complete blood count, electron microscopy and immunoassay for epidemic viral or rotavirus gastroenteritis.

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