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Acute Gastroenteritis
in pediatric(Diarrhea)
Prepared By /
lamiaa400@yahoo.com
Gastroenteritis
• Gastroenteritis (gastro) is an
inflammation of the lining of the
stomach and small and large
intestines,...
Definitions and Terms:
Acute Gastroenteritis (AGE): diarrheal disease of rapid
onset, with or without accompanying symptom...
Types of diarrhea
 1-Acute diarrhea: in children less than 5
Short in duration (less than 2 weeks 14 days
duration).Often...
Types of diarrhea
 2-Chronic diarrhea:
Diarrhea lasting longer than two weeks but
resolving within a month is known as pe...
Types of diarrhea
 3- Intractable diarrhea of infancy : it is a
syndrome occur in infancy occur in the
first few months o...
Gastroenteritis
• Rotavirus is the most common cause of severe
gastroenteritis , dehydrating diarrhea in young
children). ...
Etiology:
Viral
70-85% in developed countries
• Rotavirus: represent of all pediatric
AGE hospitalizations
Presentaion:
• ...
Etiologies:
Bacterial
Campylobacter, Salmonella, Shigella,
E. coli, Yersinia, Clostridium difficile
Presentation:
High fev...
Etiologies:
Parasitic
Giardia and Cryptosporidium
<10% of cases
Presentation:
• Watery stools
• Low-grade fever
Causes &High risk groups
• Contaminated water& food
• Poor hygiene
• Nutritional deficiency
• Poor sanitation
• Increase f...
Sign & Symptoms
• Nausea & Vomiting
• Diarrhea
• Loss of appetite
• Fever
• Headaches
• Abdominal pain
• Abdominal cramps
...
Complications
• Dehydration
Excessive loss of fluids and minerals (electrolytes)
from the body& Electrolyte deficiency
K...
Physical Examination
 Cool extremities.
 Anterior fontonellae markedly depressed and eyes were
sunken.
 Blood pressure ...
Symptom
Mild (<5% body
weight lost)
Moderate (5-9% body
weight lost)
Severe (>10% body
weight lost)
Mental
status
Normal, ...
Laboratory Investigation
 Careful history(travel, blood in stool, water, contact
with birds, recent antibiotics, fever, v...
Treatment
Aim of treatment:
1.Assessment fluid and
electrolyte imbalance
2.Rehydration
3.Maintenance fluid therapy
4.Reint...
Management
• Symptom management
• Correction of underlying causes If the
cause is found to be a medication,
lactose intole...
Treatment
Fluid Management
Oral rehydration therapy IV fluids in
treatment of mild to moderate dehydration
oral for reabso...
ORS Composition
• Oral rehydration solutions (ORS) have
sugar, salt and water to be easily
absorbed in the gut. Used in ca...
Treatment
-Early feeding reduces illness duration and
improves nutritional outcome.
Cereal, cooked vegetable and meats
For...
Treatment
Antidiarrheals
Antiemetics are recommended
Probiotics (e.g. Lactobacillus) alter the
composition of gut flora an...
Nursing Management
• Goals of treatment
• Maintain adequate hydration
• Maintain appropriate nutrition
• Prevent spread in...
Management
NURSING MANAGEMENT FOR DIARHEA
•1-Fluid volume deficit related to excessive gastrointestinal
loss in stool and ...
Management
• NURSING MANAGEMENT FOR DIARHEA
• 2-Altered nutrition less than body requirments related to
diarrheal losses a...
Nursing Notes
Alert : avoid fruit juice ,carbonated soft
drinks ,gelatin ,chicken have ( low
electrolyte, high osmolarity,...
Management
• NURSING MANAGEMENT FOR DIARHEA
• 3-Imapaird skin integrity related to irritation caused by
frequent loose sto...
Prevention
Wash your hands frequently, especially
after using the toilet, changing diapers.
Before and after preparing fo...
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Acute gastroenteritis in children

gastroenteritis in children include definition,causes ,nursing intervention

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Acute gastroenteritis in children

  1. 1. Acute Gastroenteritis in pediatric(Diarrhea) Prepared By / lamiaa400@yahoo.com
  2. 2. Gastroenteritis • Gastroenteritis (gastro) is an inflammation of the lining of the stomach and small and large intestines, mostly caused by viral or bacterial infections, but also protozoa e.g. giardia.
  3. 3. Definitions and Terms: Acute Gastroenteritis (AGE): diarrheal disease of rapid onset, with or without accompanying symptoms, signs, such as nausea, vomiting, fever, or abdominal pain Diarrhea: the frequent passage of unformed liquid stools (3 or more loose, watery stool per day) OR An increase in the fluidity, volume and frequency of stools Dysentery: blood or mucus in stools
  4. 4. Types of diarrhea  1-Acute diarrhea: in children less than 5 Short in duration (less than 2 weeks 14 days duration).Often caused by URTI or UTI,antibiotic or laxative therapy, subside without treatment if dehydration not occur called( acute infectious diarrhea(infectious gastroenteritis) caused by viral, bacteria ,parasitic. Acute diarrhea is typically self limiting and resolves quickly with no lasting sequelae If :Shigella, Salmonella, Chlamydia, Symptoms of acute inflammatory diarrhea include fever (higher than 38.5C), lethargy, and a stool that contains pus, blood, leukocytes and/or mucus . Rotovirus, low grade fever, malaise, nausea and vomiting as well as diarrhea.
  5. 5. Types of diarrhea  2-Chronic diarrhea: Diarrhea lasting longer than two weeks but resolving within a month is known as persistent diarrhea. Chronic diarrhea can be the result of disease processes, medication, genetic abnormalities, or a variety of other causes. • It usually caused by malabsorption syndrome immune deficiency, infammation of bowl, food allergy lactose intolerance ,inadequate management of acute diarrhea
  6. 6. Types of diarrhea  3- Intractable diarrhea of infancy : it is a syndrome occur in infancy occur in the first few months of life , persistent longer than two weeks with no pathogens and is refractory to treatment The current concept of intractable diarrhea of infancy is that of a heterogeneous syndrome with high mortality
  7. 7. Gastroenteritis • Rotavirus is the most common cause of severe gastroenteritis , dehydrating diarrhea in young children). Rotavirus is highly contagious most common in children from 3M – 2 years • Salmonella,compylobacter organism bacteria(less than 1 year)(colicky pain bloody diarrhea,fever,cerebral manifestation as drowsiness,confusion(life threaten septicemia persist 2-3 weeks
  8. 8. Etiology: Viral 70-85% in developed countries • Rotavirus: represent of all pediatric AGE hospitalizations Presentaion: • Mild or moderate fever • Vomiting followed by watery diarrhea (up to 10-20 bowel movements per day) • Diarrhea persisting for 5-7 days
  9. 9. Etiologies: Bacterial Campylobacter, Salmonella, Shigella, E. coli, Yersinia, Clostridium difficile Presentation: High fevers Shaking chills Bloody bowel movements (dysentery) Abdominal cramping & fecal leukocytes
  10. 10. Etiologies: Parasitic Giardia and Cryptosporidium <10% of cases Presentation: • Watery stools • Low-grade fever
  11. 11. Causes &High risk groups • Contaminated water& food • Poor hygiene • Nutritional deficiency • Poor sanitation • Increase frequency in infancy • Immune deficient individuals • Malnutrition • Travel to endemic areas • Lack of breast feeding • Exposure to unsanitary conditions • Poor maternal education
  12. 12. Sign & Symptoms • Nausea & Vomiting • Diarrhea • Loss of appetite • Fever • Headaches • Abdominal pain • Abdominal cramps • Bloody stools • Fainting and Weakness • Heartburn • Dehydration • Lethargic
  13. 13. Complications • Dehydration Excessive loss of fluids and minerals (electrolytes) from the body& Electrolyte deficiency Kidney failure& • Acid base imbalance with acidosis • Shock occur when dehydration progress to the point circulatory impaired
  14. 14. Physical Examination  Cool extremities.  Anterior fontonellae markedly depressed and eyes were sunken.  Blood pressure 45/30 mm Hg, difficult to obtain.  The pulse 160 beats/min, with weak pulsation.  Temperature 39°C, skin turgor markedly decreased.  The tongue and buccal mucosa were dry.  Respiratory deep. The weight 9 kg.
  15. 15. Symptom Mild (<5% body weight lost) Moderate (5-9% body weight lost) Severe (>10% body weight lost) Mental status Normal, alert Restless or fatigued, irritable Apathetic, lethargic, unconscious Heart rate Normal incrases Tachycardia or bradycardia Eyes Normal Slightly sunken Deep sunken Fontanelle Normal Slightly sunken Deep sunken Tears Normal decreased Absent Degree or Levels of dehydrationDegree or Levels of dehydration  The following table highlights the physical findings seen with different levels of pediatric dehydration.
  16. 16. Laboratory Investigation  Careful history(travel, blood in stool, water, contact with birds, recent antibiotics, fever, vomiting  Stool analysis:  Foul smell stool means malabsorption  Neutrophil in stool indicated bacterial infection  Eosinophil means parasitic infection  gross Blood in stool means shigella and campylobacter  CBC  Electrolyte
  17. 17. Treatment Aim of treatment: 1.Assessment fluid and electrolyte imbalance 2.Rehydration 3.Maintenance fluid therapy 4.Reintroduction adequate diet
  18. 18. Management • Symptom management • Correction of underlying causes If the cause is found to be a medication, lactose intolerance • Oral rehydration, a person with diarrhea needs to continue to eat to maintain adequate caloric intake as well as meeting the needs of increase fluids
  19. 19. Treatment Fluid Management Oral rehydration therapy IV fluids in treatment of mild to moderate dehydration oral for reabsorption of sodium and water
  20. 20. ORS Composition • Oral rehydration solutions (ORS) have sugar, salt and water to be easily absorbed in the gut. Used in case vomiting and dehydration • 5-10 ml every minute by syringe or NGT 10 ml/kg • Composition of ORS  Sodium Chloride  Tri-Sodium Citrate (bicarbonate)  Potassium Chloride  Glucose
  21. 21. Treatment -Early feeding reduces illness duration and improves nutritional outcome. Cereal, cooked vegetable and meats Formula fed infants -Restart feeding once the rehydration phase is complete (ideally in 2-4 h). - Fatty foods and foods high in simple sugars should be avoided. -Lactose-free formulas are unnecessary;
  22. 22. Treatment Antidiarrheals Antiemetics are recommended Probiotics (e.g. Lactobacillus) alter the composition of gut flora and assist in restoring normal gut function Antimicrobials C difficile- & start metronidazole Cholera-tetracycline Giardia-metronidazole Cryptosporidium-metronidazole
  23. 23. Nursing Management • Goals of treatment • Maintain adequate hydration • Maintain appropriate nutrition • Prevent spread infection • Support and education
  24. 24. Management NURSING MANAGEMENT FOR DIARHEA •1-Fluid volume deficit related to excessive gastrointestinal loss in stool and vomiting •Administer ORT-ORS •Monitor urine every 8 hours •Assess V.S Oral Rehydration Solution (ORS): given by spoon, cup, dropper, syringe, naso-gastric tube or IV Monitor dehydration Monitor number of wet diapers, Assess vomiting Intake and output
  25. 25. Management • NURSING MANAGEMENT FOR DIARHEA • 2-Altered nutrition less than body requirments related to diarrheal losses and inadequate intake • Goals consume nourishment adequate to maintain appropriate weiht for age • Avoid BRAT • Assess feeding tolerance • Risk for transmitted infection related to microorganism invading GIT • Standard precaution(disposable of stool,laundrey • Careful hand washing,diasposable diaper • Decrease chance of dermatitis
  26. 26. Nursing Notes Alert : avoid fruit juice ,carbonated soft drinks ,gelatin ,chicken have ( low electrolyte, high osmolarity,high carbohydrate) Avoid BRAT: banana,rice,applesauce and toast or tea low energy ,low protein • Fruit juice has too much sugar that can draw water from the body into the gut, so that child can become even more dehydrated.
  27. 27. Management • NURSING MANAGEMENT FOR DIARHEA • 3-Imapaird skin integrity related to irritation caused by frequent loose stools • Change diaper frequently • Clean buttocks • Apply ointment as zinc- oxide • Avoid using of baby wipes containing alcohol • Apply antifungal medication to treat infection
  28. 28. Prevention Wash your hands frequently, especially after using the toilet, changing diapers. Before and after preparing food. Wash diarrhea-soiled clothing in detergent . Never drink unpasteurized milk or untreated water.

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