gastrointestinal disorder in children Flashcards
diarrhea
mild to severe, and acute or chronic. It can result in mild to severe dehydration.
what is diarrhea secondary to
an infectious agent in the GI tract, upper respiratory infection, urinary tract infection, antibiotic use, or laxative use. self‑resolution occurs in less than 14 days if dehydration does not occur.
what its caused from
Acute infectious diarrhea is caused by a variety of viral, bacterial, or parasitic pathogens.
chronic diarrhea
an increase in frequency and change of consistency of stools for more than 14 days.
dehydration
a body fluid disturbance when the output exceeds intake. It results from causes such as fluid losses through the skin, or respiratory, urinary, or GI tract.
rotavirus
transmission
incubation
- Most common cause of diarrhea in children younger than 5 years
- Affects children of all ages
- Fever
- Onset of foul-smelling, watery stools
- Diarrhea for 5 to 7 days
- Vomiting for approximately 2 days
- Transmission: fecal-oral
- INCUBATION PERIOD: 48 hr
bacterial infectious causing diarrhea
Yersinia enterocolitis Escherichia coli Salmonella nontyphoidal groups Clostridium difficile Clostridium botulinum Shigella groups: Shigellosis Norwalk-like organisms: Caliciviruses Staphylococcus Enterobius vermicularis (pinworm) Giardia lamblia: parasitic pathogen
rotavirus diagonosis
- CBC with differential to determine anemia and/or infection.
- Hct, Hgb, BUN, creatinine, and urine-specific gravity levels are usually elevated with dehydration.
- Stool test for occult blood.
- Perform a urinalysis.
- Tape test: Performed to check for Enterobius vermicularis.
diagnosis of certain virus
- Rotavirus: (stool sample)
- E.coli: (stool sample)
- Salmonella: Gram-stained stool culture
- C. difficile: Stool culture
- C. botulinum: Blood and stool culture
- Staphylococcus: stool, blood, food, or aspirate
- G. lamblia: (stool sample)
- Shigellosis: Blood and stool culture
- Caliciviruses: (stool sample)
Y- ersinia enterocolitis: stool, blood, oral secretions, urine, or bile
nursing care for diarrhea
- Obtain baseline height and weight.
- Obtain daily weights at the same time each day.
- Avoid taking a rectal temperature.
- Assess and monitor I&O (urine and stool).
- Initiate IV fluids as ordered.
- Administer antibiotic as prescribed (Shigella, C. difficile, and G. lamblia).
advoid antibiotics for
(C. botulinum, E. coli, Salmonella).
avoid antimotility for
E. coli, Salmonella, Shigella
start oral replacement solution (ORS)
75 to 90 sodium mEq/L at 40 to 50 mL/kg over 4 hr.
maintenance of therapy ors
40 to 60 sodium mEq/L and limit to 150 mL/kg/day.
ors
- Give ORS alternately with appropriate intake.
- Give infants water, breast milk, or lactose-free formula if supplementary fluid is needed.
- Older children may resume their regular diets for additional intake.
- Replace each diarrheal stool with 10 mL/kg of ORS for ongoing diarrhea.
meds for C. difficile and G. lamblia
Metronidazole and tinidazole
flagile
antibiotic
- good for bacteria in gut
meds for enterobius vermicularis
Mebendazole, albendazole, and pyrantel pamoate
- Administer in a single dose that can need to be repeated in 2 weeks.
- for children older than 2 years of age.
- Entire family should be treated at the same time.
foods to avoid
- Fruit juices, carbonated sodas, and gelatin, which all have high carbohydrate content, low electrolyte content, and a high osmolality
- Caffeine, due to its mild diuretic effect
- Chicken or beef broth, which has too much sodium and not enough carbohydrates
foods to eat
Bananas, rice, applesauce, and toast (BRAT diet, which has low nutritional value, high carbohydrate content, and low electrolytes)
education
- Have the parents inform the child’s school or day care of the infection/infestation.
- Provide frequent skin care to prevent skin breakdown. (zink products, o2 blown, cleanse frequently)
- Change bed linens and underwear daily for several days.
- Cleanse toys and child care areas thoroughly to prevent further spread or reinfestation.
clean education
- Shower frequently.
- Avoid undercooked or under-refrigerated food.
- Perform proper hand hygiene after toileting and after changing diapers.
- Do not share dishes and utensils. Wash them in hot, soapy water or in the dishwasher.
- Clip nails and discourage nail biting and thumb sucking.
- Clean toilet areas.
istonic
- Hypovolemic shock can result.
- Serum sodium is within normal limits (130 to 150 mEq/L).
hypotonic
- Electrolyte loss is greater than water loss.
- Physical manifestations are more severe with smaller fluid loss. - Shock is likely.
- Serum sodium is less than 130 mEq/L.
hypertonic
- Water loss is greater than electrolyte loss.
- Fluid shifts from intracellular to extracellular.
- Shock is less likely.
- Neurologic changes (change in level of consciousness, irritability, hyperreflexia) can occur.
- Serum sodium concentration is greater than 150 mEq/L.
mild weightloss in infants
3-5%
mild weight loss in children
3-4%
mild weight loss s/s
- Capillary refill greater than 2 seconds
- Possible slight thirst
moderate weight loss infants
-6-9%
moderate weight loss children
6-8%
moderate weight loss s/s
- Capillary refill between 2 and 4 seconds
- Possible thirst and irritability
- Pulse slightly increased with normal to orthostatic blood pressure
- Dry mucous membranes and decreased tears and skin turgor
- Slight tachypnea
- Normal to sunken anterior fontanel on infants
severe weight loss infants
greater than 10%
severe weight loss children
10 %`
severe weight loss s/s
- Capillary refill greater than 4 seconds
T- achycardia present, and orthostatic blood pressure can progress to shock - Extreme thirst
- Very dry mucous membranes and tented skin
- Hyperpnea
- No tearing with sunken eyeballs
- Sunken anterior fontanel
- Oliguria or anuria
nursing care for dehydration
- Oral rehydration is attempted first for mild and moderate cases of dehydration.
- Administer parenteral fluid therapy as prescribed.
- Initiate when a child is unable to drink enough oral fluids to correct fluid losses, and those with severe dehydration or continued vomiting.
- Isotonic solution at 20 mL/kg IV bolus with possible repeat for isotonic and hypotonic dehydration.
- Hypertonic dehydration rapid fluid replacement is contradicted because of the risk of cerebral edema.
assessment
- Avoid potassium replacement until kidney function is verified.
- Assess capillary refill.
- Assess vital signs.
- Monitor weight.
- Maintain accurate I&O.
- Encourage oral fluids.
- Resume normal diet as soon as possible.
- Monitor how many times the child voids.
