PPT 1

• Gastroenteritis


  An inflammation of the stomach and intestinal tract that primarily affects the small bowel
• Risk factors for GI disease

  • Pathogens that cause GI disease
• "Food poisoning"


  GI infections are often referred to as this because food is frequently the vehicle for transmission of actively growing microbes or their toxins
• Common bacterial sources of contaminated foods

  • Eggs (Salmonella)
  • Raw or undercooked meat (Escherichia coli)
  • Raw or undercooked poultry (Campylobacter)
• Outbreaks of food-borne viral infections

  • Fecal-contaminated shellfish
• Other sources of food-borne infections

  • Unpasteurized milk
  • Apple juice
  • Ice cream
• Other causative organisms


  • Vibrio cholera (cholera)
  • Shigella bacilli (dysentery)
  • Staphylococcus aureus
• Clostridium difficile (CDI)


  Caused by an anaerobic, spore-forming bacteria pathogen producing toxins that affect bowel mucosa, the major cause of nosocomial diarrhea in clients receiving antibiotic therapy, transmitted by the fecal-oral route
• Management of CDI


  1. Flagyl as first-line antibiotic treatment

  2. Vancomycin for severe cases

  3. Implement contact precautions when caring for the client
• Complications of CDI


  • Toxic megacolon
  • Bowel perforation
  • Sepsis
• Vancomycin-resistant enterococcus (VRE)


  Gram-positive bacteria normally residing in the GI tract, a frequent cause of nosocomial diarrhea, can lead to complications in the innermost layer of the heart, associated with urinary tract infections, bloodstream infections, and wound infections, highly resistant to other antimicrobial therapies
• Treatment of severe VRE infections

  1. Linezolid

  2. Daptomycin
• Shigellosis


  A type of gastroenteritis caused by Shigella dysenteriae, a gram-negative bacilli, also called bacillary dysentery, transmitted by the fecal-oral route
• Management of shigellosis


  1. Diagnosed through stool exam

  2. Ciprofloxacin is the recommended treatment for uncomplicated shigellosis in adults

  3. Azithromycin may be used in children or in cases of resistance

  4. Implement contact precautions when caring for the client
• Complications of shigellosis


  • Reiter's syndrome (reactive arthritis characterized by arthritis, urethritis, and conjunctivitis)
• Botulism


  A serious paralytic illness caused by a nerve toxin produced by the bacterium Clostridium botulinum, spore found in soil and can spread through air, food, or contaminated wound, cannot be spread person-to-person
• Clinical manifestations of botulism

  • Abdominal cramps
  • Diarrhea
  • Nausea and vomiting
  • Double vision
  • Blurred vision
  • Drooping eyelids
  • Difficulty swallowing or speaking
  • Dry mouth
  • Muscle weakness
• Collaborative management for botulism

  1. Antitoxin

  2. Induction of vomiting

  3. Enemas

  4. Penicillin
• Toxin can be inactivated by heating food or drink to 212°F (100°C) for at least 10 mins
• Diagnostic tests for gastroenteritis


  • Fecal examination positive for leukocytes, mucus, or blood
  • Routine stool culture on selective and differential media
  • Culture of rectal swabs especially for Shigella and Salmonella
• Clinical manifestations of gastroenteritis

  • Diarrhea
  • Abdominal pain and cramping
  • Nausea and vomiting
  • Fever
  • Anorexia
  • Abdominal distension
  • Tenesmus (straining on defecation)
  • Borborygmi (hyperactive bowel sounds)
• Health promotion for avoiding gastroenteritis


  • Good handwashing technique after defecation and before handling food
  • Obtaining available vaccinations against bacterial and viral gastroenteritis
  • Encouraging cleanliness and sanitation as well as proper food handling, preparation and storage techniques
  • Advising clients to avoid the use of antibiotics over a long period of time
  • Teaching travelers going to developing countries about safe food practices
• Collaborative management for viral, bacterial and parasitic infections

  1. Rest the bowel with NPO until vomiting has stopped

  2. Decrease diarrhea with anti-infective agents chosen based on organism identified

  3. Restore fluids and electrolytes with clear liquids and electrolyte replacement beverages or IV fluids
• Carefully note a description of diarrhea (onset, number, color, and consistency of stools, and accompanying manifestations such as nausea and vomiting)
• Ask the client about recent foreign travel, eating habits, and antibiotic use
• Assess the client's abdomen for hyperactive bowel sounds, distention, and tenderness
• Assess for signs and symptoms of dehydration, hypokalemia, and metabolic acidosis
• Carefully examine all stools for blood and mucus and record intake and output
• Examine the client's anus for irritation and apply a protective moisture barrier product after cleaning the area
• Health maintenance activities


  • Assessment of clients receiving high or continued doses of antibiotics for C. difficile infection and other manifestations of GI infection secondary to antibiotic use
  • Instruct client to follow their medication regimen and call their health care provider if manifestations continue for several days, they might be dehydrated, or body temperature is high
  • Promote bowel rest and replacement of fluid and electrolytes as needed