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GASTROENTERITIS)

GASTROENTERITIS). Paediatric Nursing Dk.Norasmah phi 23 rd Intake. Definition. Acute infection of bowel which cause diarrhea and vomiting Most common disorder in childhood. Incidence. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year

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GASTROENTERITIS)

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  1. GASTROENTERITIS) Paediatric Nursing Dk.Norasmah phi 23rd Intake

  2. Definition • Acute infection of bowel which cause diarrhea and vomiting • Most common disorder in childhood

  3. Incidence • Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year • leading cause of death among infants and children under 5

  4. Causative organism Protozoa : Gardia lambila, crypto sporidum

  5. Bacteria : salmonella,shigella, escherichia, campylobacter

  6. pathophysiology

  7. Signs & symptoms • Diarrhea • Vomiting • Abdominal pain • Fever • Dehydration • Tenesmus(feeling of incomplete defecation) • Reduce appetite

  8. Diagnostic investigation Blood test: • FBC – increase WBC = infection • Urea & Creatinine – to rule out hypnatraemia or hypokalemia(mineral imbalance • Culture & Sensitivity – to evaluate infection Stool • Ova & Cyst • ME & CS – check frequency,characteristics (amount, consistency,colour,watery,semisolid,odor) & presence of mucous or blood

  9. Nursing assessment • Assess hydration status • Input output chart • Assess stool(nature, consistency & frequency) • h/o travel to other country • Ask if child is on antibiotics, the food eaten recently & contact with contaminated person.

  10. PRINCIPLES IN THE MANAGEMENT OF GE • Correction & maintenance of hydration • Prevention of further nutritional loss • Provide health teaching to patients and parents • Prevention of spread of infections

  11. REHYDRATION • Rehydration is the replenishment of  water and  electrolytes lost through  dehydration. • It can be performed by mouth (oral rehydration) or by adding fluid and electrolytes directly into the blood stream (intravenous rehydration). • As oral rehydration is less painful, less invasive, less expensive, and easier to provide, it is the treatment of choice for mild  dehydration from infectious  gastroenteritis. • Because severe dehydration can rapidly cause permanent injury or even death, intravenous rehydration is the initial treatment of choice for that condition

  12. REHYDRATION • Oral rehydration can be accomplished by drinking frequent small amounts of an oral rehydration salt solution. • One standard remedy is the WHO/UNICEF glucose-based Oral Rehydration Salts (ORS) solution, which contains Sodium , glucose, chloride, potassium, citrate. • Sugar improve absorption of electrolytes and water, but if too much is present in ORS solutions,   diarrhea can be worsened. • ORS does not stop diarrhea, but keeps the body hydrated and healthy until the diarrhea passes. • When vomiting occurs, rest the stomach for ten minutes and then offer small amounts of ORS solution. Start with a teaspoonful every five minutes in children and a tablespoonful every five minutes in older children and adults.

  13. NURSING MANAGEMENT DEHYDRATION • Monitor strict IO chart, weight & dehydration status • Replace fluid & electrolytes loss(ORS,NG Feeding, IV FLUID) • IV 5% dextrose with 0 45% saline,IV KCL added depending on potassium levels. • Rehydrate until symptoms of dehydration subsides • Continue breast feeding • ½ strength milk as tolerated. Give ORS until diarrhea & vomiting subsides • For older children – give ORS, avoid spicy food, give dry foods eg biscuits, drink diluted juice and bland food as tolerated

  14. Symptoms of dehydration • sunken eyes & fontanelles • Dry mucous membrane • Loss of skin turgor • Weight loss • Reduce urine output • Change in mental status ie confusion, delirium • Sign of shock eg low BP and tachycardia

  15. NURSING MANAGEMENT ANXIETY DUE TO DISCOMFORT • Administer analgesic & antibiotics as prescribed. • If diarrhea is severe, anti diarrheal eg Imodium(Loperamide) is administered but not recommended for children below 6 years • Antiemetic for nausea & vomiting but not recommended for children below 6 years

  16. NURSING MANAGEMENT SKIN CARE • Use barrier cream(eg Drapolene for nappy rash care for infant.) INFECTION CONTROL • Proper hand washing • Practice barrier nursing • Placed patient in isolation room

  17. HEALTH EDUCATION • Encourage hand washing before and after every meals and snacks • During red tides outbreak, avoid eating shellfish • Wash all raw food properly • Avoid cross contamination and maintain hygiene during food preparation eg cutting board • Drink boiled water • Don’t drink from unfamiliar places such as parks, lakes and river.

  18. HEALTH EDUCATION • If the child still needs ORS after 24 hours, make a fresh solution. • ORS does not stop diarrhea. It prevents the body from drying up. The diarrhea will stop by itself. • If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop. • If diarrhea increases and /or vomiting persists, take child over to a health clinic. 

  19. LAST BUT NOT LEAST

  20. Case Scenario • Baby Darwina is 9 months old is still breast feeding and has started weaning since 4 months old. She was brought to the clinic by the parents due to diarrhea and vomiting since the previous day. She is crying and seems very irritable. On examination, her temperature is 38.9 c, pulse 125 beats and respiration of 30.She is also moderately dehydrated. She is diagnosed with Gastroenteritis.

  21. Nursing problems • Altered fluid volume related to severe diarrhea and vomiting • Pain related to abdominal cramping • Risk for altered skin integrity due to skin contact to faeces & frequent cleansing • Risk of infection due to exposure of family members and others to infection pathogens • Parents’ lack of knowledge related to disease process & its management

  22. THE END

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