MUHIMBILI UNIVERSITY HEALTH AND ALLIED SCIENCESCHOOL OF NURSINGPAEDETRIC NURSINGPRESENTATION: DIARRHEADWASI MASUNGA(2009-04-01524)
INTRODUCTIONDEFINATION OF DIARRHOEA DIARRHOEA Is the passage of unusually loose or watery stools ,usually at least three times in 24hours period .Frequent passing of formed stools is not diarrhea ,nor is the passing of loose, pasty stools by breastfed babies
cont• Diarrhoea is usually a symptom of an infection in the intestinal infection which is caused by variety of bacteria,viral,parasitic organism. Infection is spread through contaminated food or drinking –water or from person –to- person as a result of a result of poor hygiene• Diarrhoea disease is a leading cause of child mortality and morbidity .Diarrhoea disease kills 1.5 million children every year . Globally, there are 2million cases disease every year. Diarrhoea is leading cause of malnutrition in children under five year five years old
• Loss of fluid and electrolytes via stools is net result of imbalance between secretory and absorptive processes in small & large intestine. Electrolytes have a critical role in the regulation of water absorption and secretion across the intestine
CLINICAL TYPES OF DIARRHOEAL DISEASES Four clinical types of diarrhoea can be recognize each reflecting the basic underlying pathology and altered pathology ACUTE WATERY DIARRHOEA(Including cholera) :which lasts several hours or day : the main danger is dehydration and malnutrion if feeding is not continued. COMMON CAUSES ARE: -Rotavirus, -Enterotoxigenic E.coli (ETEC), -Shigella, -Salmonella, -Vibrio cholerae
BLOOD DIARRHOEA BLOOD DIARRHOEA which is called Dysentery, the main dangers are damage of intestinal mucosa,sepsi, and malnutrion. Other complication including dehydration may also occur MAIN CAUSE OF ACUTE DYSENTERY – SHIGELLA, CAMPLYLOBACTER JEJUNI, Enteroinvasive E.coli (EIEC), SALMONELLA
cont PERSISTENT DIARRHOEA: last for 14 days or longer ,the main danger is malnutrion and serious non-intestinal infections, dehydration may also occur DIRRHOEA AND SEVERE MANUTRITION(marasmus and kwashiorkor) : The main danger are severe systemic infection ,dehydration, heart failure, vitamin and mineral deficiency
CONT• NOTE: most common cause of diarrhea in children is ROTA virus(70%),the remaining is bacteria e.g:E.coli,Salmonella,Shigella
Nursing diagnosis• Fluid volume deficit related to active loss from gastro intestinal tract• Altered nutrition less than body requirement related to poor assimilation of nutritions• Family anxiety related to changes in child health status• Acute pain related to hiperperistaltik, irritation perirektal fissure
Management diarrhoeaManagement of diarrhoea in children.Over 90% of deaths from diarrhoea in under- fives would be prevented by:• Continuing breast feeding and other feeding throughout the attack of diarrhoea(prevent malnutrition);• Making sure mothers know when to take the child to a health facility;• Correct assessment, treatment and continued feeding at the health facility level
cont• Treatment of invasive diarrhoea (bloody stool) with antibiotics;• Treating or prevent dehydration and electrolyte imbalance with ORS ( New osmolarityORS)• Reduce the duration and severity of diarrhoea and occurrence of future episodes bygiving supplemental Zinc• investigation and treatment for severe malnutrition andpersistent diarrhoea (lasting>14 days
Nursing management• Observation of complication by checking vital signs, behavior and consciousness• Monitor fluid input and fluid out to know body fluid balance• Weighing the child on admission.• Isolation• Maintain hydration by:- a-Increase oral feeding. b-giving fluid. c-check intake and out put.
CONT• Assess progress of hydration (weighing the child daily).• The nurse is responsible for collecting stool sample for laboratory examination. NOTE: avoid rectal thermometer because it stimulate the bowel.
Medical treatmentZincThe use of Zinc during diarrhoea has been shown to reduce frequency, stool volume and recurrence of diarrhoea episode. All children with diarrhoea should be given Zinc, 10-20mg every day for 10-14 days. Zinc treatment should be continued even after diarrhoea has stopped
cont• Low osmolarity ORS (245mmol/lt) has been observed to be more effective than the Standard ORS in especially preventing dehydration
cont• Use antimicrobial effective for Shigela. At the moment it is Co- trimoxazole, Ciprofloxacin
Treatment plans A, B and C• Plan A: Treat Diarrhoea at Home• Counsel the mother on the 3 Rules of Home Treatment..• Give Extra Fluid, Continue Feeding (including Breast feeding), When to Return• 1. GIVE EXTRA FLUID (As much as the child will take)• TELL THE MOTHER:• Breastfeed frequently and longer.
cont• If the child is exclusively breastfed give ORS or clean water in addition to breast• milk.• If the child is not exclusively breastfed give one or more of the following: ORS• solution, food-based fl uids (such as soup. plain porridge, .fresh fruit juice, green• coconut juice and yoghurt drinks), or clean water
cont• TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER• 2 PACKETS OF ORS TO USE AT HOME,• SHOW THE MOTHER HOW MUCH FLUI D TO GIVE IN ADDITION TO• THE USUAL FUID INTAKE:• Up to 2 years 50 to 100 ml after each loose stool• 2 years or more 100 to 200 ml after each loose stool
PLAN B• Give in clinic recommended amount of ORS over 4-hour period• For infants under 6 months who are not breastfed, also give 100-200 ml clean water during this period• Give Zinc, 10-20mg every day for 10-14 days. Zinc treatment should be continued even after the diarrhoea has stopped
Plan C: Treat severe dehydration quickly• Start with IV fluid immediately. If the child can drink, give ORS by mouth while the drip is set up. Give 100 ml/kg Ringer’s Lactate Solution (or, if not available, normal saline• Infants (under 12 months) First give30 ml/kg in hour Then give 70 ml/kg in: 5 hours
REFERENCE• Hockenberry M.J,Wilson D. Winkelstein M. L, Kline N.E. nursing care of infant and children• Standard treatment guideline and then national medicine list for mainland Tanzania