Gastroenteritis Flashcards
Give a simple definition of gastroenteritis
Gastroenteritis is an inflammation of the mucus membranes of the gastrointestinal tract that results in acute vomiting and diarrhoea
List four common symptoms of gastroenteritis
- Low grade fever
- Abdominal cramps and pain
- Nausea and vomiting
- Diarrhoea
List four conditions which can be mistaken for gastroenteritis in children
- Acute appendicitis
- Partial bowel obstruction
- Inflammatory bowel disease
- Strangled hernia
Organisms that cause gastroenteritis can be classified under three headings. List each heading and give an example of an organism under that heading
- Virus, eg. rotavirus
- Bacteria, eg. Salmonella Spp
- Protozoan, eg. giardia lamblia
List six signs and symptoms you may expect to see in an infant that is moderately dehydrated.
- Reduced urine output
- Moderate thirst
- Increased pulse rate and weak
- Respiration is deep and may be rapid
- Normal to low systolic blood pressure
- Sunken fontanelle in infants
What infection control precautions would you follow when caring for a child with gastroenteritis?
- Hand hygiene
- Single room
- Gown and gloves
- Cleaning and disinfecting equipment and environment
- Visitor education
- Inform receiving department if transporting patient
How would you explain gastroenteritis to the parent?
Gastroenteritis is an inflammation of the mucus membranes of the gastrointestinal tract that results in acute vomiting and more importantly diarrhoea
List the presenting symptoms that would lead you to suspect the child has viral gastroenteritis
- Vomiting and diarrhoea: watery and blood free
- Low grade fever
- Anorexia
What symptoms would make you suspicious that the gastroenteritis is caused by bacterium not a virus?
- Bloody diarrhoea
- Shock
- Abdominal cramps
What is the most likely causative organism of viral gastroenteritis?
Rotavirus
List four alternative diagnosis that may be mistaken for gastroenteritis
- Acute appendicitis
- Partial bowel obstruction
- Sepsis
- Inflammatory bowel disease
List four signs and symptoms which may lead you to question the diagnosis of gastroenteritis
- Bile stained vomit
- Fever greater than 39 degrees
- Signs of shock
- Severe abdominal pain with significant tenderness, distension, mass or guarding
What are some of the important questions that you would ask the mother when taking a history to help identify the cause and severity of the illness?
History of recent contact with a person who has gastroenteritis or that the child has recently been overseas.
What is the single most important measure in preventing the spread of viral gastroenteritis?
Good hand hygiene.
Chris, a 2 year old boy, arrives in the emergency department with a history of vomiting for the last 24 hours. He has a low grade fever is lethargic and miserable. on urinalysis his specific gravity is 1.030 and has ketones ++. What does this suggest?
Gastroenteritis.
Specific gravity indicates whether you are dehydrated or not which this SG indicates that he is and an increase in ketones indicates the body fat is being broken down for energy and dehydration.
It is now 48 hours since Chris was admitted to the ward. Chris was diagnosed with a viral gastroenteritis and has been steadily improving. Following a breakfast of toast and a drink of milk he has a large episode of loose diarrhoea. What would you like to do now?
Reduce or eliminate lactose from the diet
Perform a reducing substances test
Encourage fluids
Chris has now been on a low lactose diet and lactose free milk. His diarrhoea has improved. His mother asks when should she start him on his normal diet again. What would you tell her?
Chris may be lactose intolerant so it is important to remain on a low lactose and lactose free milk diet until confirmation for healthy bowel functioning, decreasing discomfort and diarrhoea.
Why are children more prone to dehydration than adults?
Infants experience more severe vomiting and diarrhoea than children and adults and they rely on someone else for their intake.
75-80% of an infants body weight is water
List six signs and symptoms you may expect to see in an infant that is moderately dehydrated
- Reduced urine output
- Moderate thirst
- Increased pulse rate and weak
- Respiration is deep and may be rapid
- Normal to low systolic blood pressure
- Sunken fontanelle in infants
Why is enteral (oral/NG) rehydration favoured over IV rehydration
Enteral rehydration is associated with significantly fewer major adverse events and a shorter hospital stay.
NGT is used for children with moderate dehydration
IV Hydration is used for children with severe dehydration
Why can drinks such as lemonade make diarrhoea worse?
As it has a high solute load which can increase water loss into the lumen of the small intestine.
Why can children with gastroenteritis present with metabolic acidosis?
As it occurs with severe diarrhoea as bicarbonate is lost in the stool
What causes a disaccharide intolerance following gastroenteritis?
May occur secondary to damaged intestinal lumen which decreases or destroys the enzyme lactase
Why can’t children suffering from a monosaccharide intolerance have glucolect?
Monosaccharides are your glucose and fructose.
If you have monosaccharide intolerance you are unable to transport and absorb glucose which is what glucolect is.
Why do children with gastroenteritis need to be weighed before breakfast everyday?
For weight management and improvement
As a staff member what can you do to prevent the spread of gastroenteritis to yourself and other patients?
Good hand hygiene Gloves Gown Parent education Patient isolation Clean equipment effectively
What would be the significance of a positive result for reducing substances detected in a patients bowel action?
Lactose intolerance (disaccharide intolerance)
Nursing care for gastroenteritis
Daily weights strict fluid balance- weigh nappies BGL, K + Na monitoring promote comfort family support antiemetics NGT or IV cares Bowel patterns fluid and electrolytes skin integrity
Normal urine output
Children: 0.5-1mL/Kg/Hour
Infant: 2ml/Kg/Hour
