Week 5: Tuesday

Question 1

A 2 year old child that has been vomiting and had diarrhea

Answer 1

• How many days ago did this happen?
• Voiding as usual or less?
• How many stools in 3 hours?
• Any change in mental status and energy?

Question 2

Med and nrsg interventions for gastroenteritis

Answer 2

• Hist of present illness
• Obtain current weight
• calculate % weight loss
• Treat dehydration:
• If severe with hospital admission, IV solutions, normal saline or lactated ringers, may be ordered
• If treated at home, oral rehydration solution (ORS) such as pedialyte is recommended.

Question 3

Medical and nursing interventions for gastroenteritis

Answer 3

• In hospital: Monitor vitals, Monitor input
• Do not over-hydrate
• Symptoms: Bulging fontanelles in babies, intracellular edema leading to headache, blurred vision, “wet lungs”, and increased vomiting unrelated to the illness

Question 4

Feeding recommendations - Is bowel rest (NPO) recommended during the acute phase of illness?

Answer 4

• No, but some providers recommend holding fluids for 2 - 3 hours
• Fluid replacement by mouth is appropriate if child is not actively vomiting
• BRAT diet not recommended after the acute phase
• Complex carbs (fruit), yogurt, whole wheat bread is recommended instead

Question 5

Gastroenteritis key points

Answer 5

• an inflammation of the lining of the stomach and intestines
• Gastroenteritis is usually not serious. but it can sometimes cause dehydration or cause severe symptoms
• Dehydration is likely if diarrhea is severe or prolonged.

Question 6

Symptoms of gastroenteritis

Answer 6

• Diarrhea
• Pain or cramping in your abdomen (belly)
• Nausea
• Vomiting
• Sometimes fever

Question 7

Gastroenteritis etiology and treatment

Answer 7

• Gastro E. is a common cause of diarrhea, a common pediatric concern that is generally viral (Rotavirus)
• Testing is rarely necessary in children with acute diarrheal illnesses
• Antidiarrheal drugs are not recommended for infants and young children

Question 8

Diarrhea - non bloody diarrhea, no fever

Answer 8

• Reassuring, likely viral etiology

Question 9

Diarrhea - Bloody diarrhea with no fever

Answer 9

Reassuring, probably still viral etiology

Question 10

Diarrhea - Bloody diarrhea with a fever

Answer 10

Slightly reassuring, could be bacterial etiology

Question 11

Diarrhea - bloody diarrhea with no fever

Answer 11

Possible serious etiology

Question 12

Diarrhea

Answer 12

treating dehydration is the cornerstone

Question 13

(diarrhea) Nursing assessments should focus on

Answer 13

• Character, amount, frequency of diarrhea
• skin integrity
• Intake and output
• Signs and symptoms of dehydration
• Thirst
• Dry mucous membranes
• Lethargy (Alkalosis)

Question 14

Specific assessments for dehydration

Answer 14

Can assess for tenting

Question 15

Red flags during dehydration/diarrhea

Answer 15

• Tachycardia, hypotension, lethargy
• Bloody stools
• Bilious vomiting
  -Dark green (bile) which could indicate intestinal blockage. Requires urgent surgical referral
• Extreme abdominal tenderness and/or distention
• Petechiae and/or pallor

Question 16

TX for dehydration

Answer 16

• For mild to