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

5. Causative organism Protozoa : Gardia lambila, crypto sporidum

6. Bacteria : salmonella,shigella, escherichia, campylobacter

7. pathophysiology Invasion of pathogens into intestinal mucosal Multiplication of pathogens & secretions of enterotoxins Inflammation of the intestinal mucosa Enterotoxins causes fluid and electrolytes changes Increase secretion of fluid into intestines & lower absorption of nutrients MASSIVE DIARRHEA AND VOMITING

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

9. 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

10. 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.

11. 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

12. 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

13. 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. REHYDRATION

14. 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

15. 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

16. 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 NURSING MANAGEMENT

17. 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

18. 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.

19. 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.

20. LAST BUT NOT LEAST

21. 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.

22. 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

23. THE END