Acute Gastroenteritis

Question 1

The assessment of acute gastroenteritis

Answer 1

• History of possible exposure to infection, contaminated foods or other causative agents
• History of allergies
• Recent travel (especially to developing countries)
• Child’s dietary habits

Question 2

What are the clinical manifestations of acute gastroenteritis

Answer 2

Diarrhoea, vomiting, fever, abdominal cramps, dehydration, electrolyte imbalance, URTI
• Mild: Few loose stools without other symptoms
• Moderate: Several loose or watery stools, elevated temperature, vomiting and irritability,
weight loss
• Severe: Numerous stools, signs of moderate or severe dehydration, drawn appearance,
weak cry, irritability, purposeless movements

Question 3

What are the laboratory and diagnostic study findings?

Answer 3

• Electrolytes, urea, creatinine, acid base
• Stool culture and urine analysis
• Septic workup if patient is toxic looking

Question 4

Differential diagnosis

Answer 4

• Surgical causes: Pyloric stenosis, intussusception, appendicitis, intestinal obstruction
• Medical causes: Urinary tract infection, URTI
• Food intolerance
• Drugs

Question 5

What is dehydration?

Answer 5

Common disturbance in infants and children whenever total fluid output exceeds
total fluid intake

Question 6

What are the types of dehydration?

Answer 6

1. Isotonic
2. Hypertonic
3. Hypotonic

Question 7

Isotonic

Answer 7

Electrolytes and water
deficits
accounts for 70% and is
link to diarrhea in
infants

Question 8

Hypertonic

Answer 8

Water loss exceeding
electrolytes loss
accounts for 20% and
usually related to
severe diarrhea in
infants

Question 9

Hypotonic

Answer 9

Electrolyte loss exceeding
water loss
accounts for 70% and is
link to diarrhea in infants

Question 10

Nursing problems of acute gastroenteritis

Answer 10

• Deficient fluid volume - diarrhea loss, inadequate intake
• Imbalanced nutrition - inadequate intake
• Risk of infection – microorganisms invading GIT
• Impaired perinium skin integrity – irritation cause by frequent loose stools (acidic)

Question 11

What are nursing goals of acute gastreoenteritis?

Answer 11

• Signs of rehydration
• Consume adequate nourishment
• Child does not exhibit signs of infection and does not transmit infection to others
• Skin remain intact

Question 12

What is the nursing management of acute gastroenteritis?

Answer 12

Reinstate adequate hydration
• Oral rehydration therapy (ORT) for moderate and severe diarrhea and dehydration
• Administered IV fluids as prescribed
• Monitor fluid intake and output and daily weight.
Ensure adequate nourishment
• Tolerance of feeds
• Reintroduce nutrients according to daily requirement needs
Prevent Infection
• Hand hygiene
• Food and bottle hygiene
Skin Care
• Change diaper frequently
• Apply barrier cream as prescribed

Question 13

What is oral rehydration therapy ( ORT )

Answer 13

Enteral rehydration using oral rehydration therapy (ORT) is the preferred
management for mild to moderate dehydration
• Glucose-electrolyte solution with sodium concentration of 45-50mmol/L
and osmolality <250 mmol/L (eg. Pedialyte)

Question 14

What is oral rehydration salt ( ORS ) ?

Answer 14

Administer in small amount initially and gradually increase especially if
child is vomiting
• Has no effect on stool volume or duration of diarrhoea
• Flavours make solution more palatable
• Freeze solution into ice-popsicle form

Question 15

What are the total fluid body expressed as a % of body weight ( BW )?

Answer 15

Infants - 80%
By age of 3 years - 65%
By age of 15 years - 60%

Question 16

< 10kg

Answer 16

100ml/kg/day

or 4ml/kg/hr

Question 17

10-20kg

Answer 17

1000ml + 50ml/kg/day for each kg over 10kg

or 40ml/hr + 2ml/kg/hr for each kg over 10kg

Question 18

> 20kg

Answer 18

1500ml + 20ml/kg/day for each kg over kg over 20kg

or

60ml/hr + 1ml/kg/hr for each over 20kg