Stephen, age 45 was admitted in ER for food poisoning. Food poisoning cases are due to the consumption of contaminated food. The patient consumed some confectionery and undercooked meat. After the period of 2-3 hours he vomited with abdominal pain and cramps. In the next half-an-hour he had diarrhea with fever. When he was admitted in the ER he was feeling very weak, pale, with strong headache, tired and dehydrated. He was given flagyl and nasograstric (NG) tube was inserted. When I was assigned as a student nurse in the ER for taking care of this patient there was no other nurse present at that time.
Initial Nursing Assessment:
- Alert/Oriented x 3.
- Complaining of right rib pain 10/10 scale
- T=39.5,
- P=64 weak and irregular
- R=24pm/regular
- BP=100/58 mmHg
- In lungs – coarse crackles to the Right upper lobes and decrease breath sound to the bases, oxygen saturation 90% on room air
- Reduced flow of urine
- Inconsistency in bowels
- Complaining of difficulty sleeping due to pain
- Bowel sounds present x4.
- Abdominal cramps and pain
- Last BM was 5 days ago.
- Poor skin turgor turgid indicates dehydration
- Oral thrush noted on inside of cheeks and under his tongue
I did not give him solid food because he was still feeling nauseous. It is important to check his signs and symptoms closely in order to evaluate his further treatment. Because he was dehydrated I gave him plenty of liquid and regular slips clear liquid. I avoided giving him drinks with excess sugar excessive consumption of sugar can only worsen the situation.
Antiemitic drugs For Nausea and Vomiting I gave him:
- Promethazine
- Diphenoxylate
- Antidiahrrheal drugs For diahrrea
- Loperamide (one brand name: Imodium)
- Bismuth subsalicylate (brand names: Kaopectate, Pepto-Bismol).
- He was already taking Flagyl
I monitored all the complications after every 20-30 minutes. As the patient was excessively dehydrated I inserted peripheral LV. Catheters with large bore to administer liquid with 0.9% Nacl. In addition, potassium chloride was also administered as his potassium levels were also declining. The fluid was kept warm to maintain his body temperature. He needed at least 75ml/kg of fluid per hour in order to increase urine output and balance the depletion of water in the body.
I monitored his body temperature, pulse, BP, urine flow and skin turgor. In addition, his blood sample was obtained to know the red blood cell count, white blood cell count, blood glucose and electrolytes. I also sent his stool sample for examination to check for any other infections. E.coli 0157.H7 was suspected, hence he was given large volume of fluids to release toxins from urine.
I continued treatment for E.Coli food poisoning as there was a possibility for hemorrhagic colitis. I kept his hands washing before consumption of food. He bed and clothings were also kept clean.
The patient was made to wash hands:
- After using the washroom
- After sneezing, blowing nose or coughing
- Prior to dining, lunch or eating anything
- Prior to handling food
- After touching/handling raw meat
- After picking or handling trash
- After changing a diaper
- After handling paper, currency or money
- After being with a pet and playing with them or holding them. including, dogs, cats, reptiles, turtles, fish etc.
- Avoid touching mouth, eyes or ear when is not washed
As Stated by the physician, the patient needs a complete nursing care. An appropriately made care plan for the patient suffering from food poisoning needs to have complete assessment, diagnosis, drug administration, intervention and evaluation.
Dehydration can be minimized by increasing water intake and dietary fiber. His constipation is evaluated by regularly observing the frequency of bowel movements, checking for daily salt-formed stools, abdominal distention, rectal fullness, pressure, straining and pain at the time of defecation. The causes of constipation are mostly associated with lack of water in the body due to excessive diarrhea. Pain is relieved by use of medication prescribed by the physician. Other side effects like nausea and vomiting are eliminated by use of anemeitic drugs.
