gastroenteritis in Nursing

3.  Gastroenteritis is inflammation of the
gastrointestinal tract, involving the stomach,
intestines, or both.
 “Stomach flu" or "gastric flu“/bug because
of gastroenteritis is viral (70%), but
influenza viruses (flu viruses) do not cause
gastroenteritis.

4.  Occurs worldwide.
 Feco-oral route.
 Water common reservoir.
 Overcrowding & poor sanitation are risk
factors.
 Animals, insects may be source of infection.

7.  2 billion cases of gastroenteritis that resulted
in 1.3 million deaths globally in 2015 (<5
years)
 In India in 2011, 1.7 billion cases (<5 yr)-
0.7 million deaths.
 In India, one of every 250 children die of
rotavirus diarrhoea each year.
 The prevalence of rotavirus diarrhoea in
India has been found to vary from 5-71 per
cent in hospitalized children <5 yr of age
with acute gastroenteritis.

8.  Food products such as uncooked meat or
seafood.
 Immune-deficiencies (HIV/AIDS or cancer, or
its treatment (e.g. chemotherapy).
 Age (<5 yrs)
 Household members/classmates.
 Travelling to the crowding places.

9.  Viruses (70%)
 Bacteria (20%)
 Parasites (10%)

10. Four categories of viruses:

11.  Rotavirus is highly contagious.
 Feco-oral route (contaminated food and
water).
 The illness in adults is mild.
 Mod- Sev. sign of diarrhoea in young
children.
 Adults may be infected after close contact
with an infected infant.
 Incubation period is 1 to 3 days.

12.  Can infect people of all ages but usually
infects infants and young children.
 Infection is most common in winter.
 Feco-oral route.
 Incubation is 3 to 4 days.

13.  Infections occur year-round, with a slight
increase in summer.
 Children < 2 yr are affected.
 Fecal-oral route.
 Incubation is 3 to 10 days.
 In immunocompromised patients, additional
viruses (eg, cytomegalovirus, enterovirus)
can cause gastroenteritis.

14. The bacteria most commonly implicated are
 Enterotoxin E.coli (RBC/WBC)
 Salmonella (undercooked egg/food/milk)
 Shigella (GNB, Enterobacteriaceae)
 Campylobacter

15. The parasites most commonly implicated are
 Giardia, Entamoeba histolytica, Cryptosporidium
 Found where the water isn't clean.
 Travelers should drink bottled water to avoid
them.
 Children in day care.
 Men who have sex with men.

17.  Drinking contaminated water
 Share personal objects.
 Water quality typically worsens during the
rainy season.
 Common in the winter.
 Bottle-feeding of babies with improperly
sanitized bottles is a significant cause.
 Poor hygiene, (especially among children), in
crowded households and in those with poor
nutritional status.
 Adults who have immunocompromised.

19. The condition is usually of acute onset, normally
lasting 1–6 days
 Diarrhoea (If the stool is bloody, the cause is less
likely to be viral and more likely to be bacterial).
 Dehydration is a common complication of
diarrhoea.
 Vomiting
 Fever (Low-grade)
 Abdominal pain (bacterial infections for several
weeks)
 Muscle pain (viral)
 Lack of energy
 Stunted growth
 Long-term cognitive delays

20.  Anorexia
 Headaches
 Abnormal flatulence
 Abdominal pain
 Abdominal cramps
 Malena
 Fainting and Weakness
 Heartburn

21.  Based on a person's signs and symptoms.
 Dehydration Assesment:

22.  Stool cultures (Viral/Bacterial)
 CBC
 Electrolytes (Na & K)
 KFT (S. Creat)
 Urinary output

23.  Dehydration
 Electrolyte imbalance
 Febrile convulsions (Shigellosis-Ghorashi et al,
2010)
 Haemolytic uremic syndrome
 Sugar intolerance

24. Trounce & Walker, Sugar intolerance
complicating acute gastroenteritis, London,
Sugar intolerance occurred in 31 of 200 children
admitted to hospital with acute gastroenteritis.
In 28 this was transient and settled rapidly, but
in the remaining three it indicated a more
serious and persistent problem. The most
important predisposing factor was viral
infection, in particular with rotavirus.

25.  Lifestyle
 Fresh water and good sanitation practices are
important for reducing rates of infection
 Personal measures (hand washing with soap)
 Alcohol-based gels.
 Breastfeeding is important, especially in places
with poor hygiene.
 Breast milk reduces both the frequency of
infections and their duration.

26.  Rotavirus vaccine be offered to all children
globally.
 The dose of vaccine should be given to
infants between 6,10 and 14 weeks of age.

28.  The preferred treatment in those with mild to
moderate dehydration is oral rehydration
therapy (ORT).
 For children at risk of dehydration from
vomiting, taking a single dose of the anti
vomiting medication metoclopramide or
ondansetron.

29. Mild
Dehydration
Mod.
Dehydration
Sev.
Dehydration
If tolerating ORS IF Shock (reassess
frequently)
Oral Fluids NG Rehydration ABC
ORS IV Rehydration (RL) IV Rehydration
BT

30. (1) Fluoroquinolone:
 ciprofloxacin, 750 mg as OD or 500 mg bid for
3 days
 Levofloxacin, 500 mg OD or 500 mg QID for 3
days
 Norfloxacin, 800 mg OD or 400 mg bid for 3
days.
(2) Azithromycin, 1000 mg OD or 500 mg QID 3
days.
(3) Rifaximin, 200 mg tid or 400 mg bid for 3 days
(not for use in dysentery).
(4) Antimotility agents
Loperamide, Bismuth subsalicylate

31.  A study done by Stenkvist & Kreuger on Clinical features
of acute gastroenteritis associated with rotavirus, enteric
adenoviruses, and bacteria.
 It was a prospective study on children with acute GE
admitted or treated as outpatients, with features of
rotavirus diarrhoea (168 cases) were compared with
enteric adenovirus (32 cases), bacterial (42), mixed (16),
and non-specific (135) infections. The rotavirus disease
was a sudden onset of vomiting, a high frequency of fever
and dehydration duration of diarrhoea of 5-9 days.
 This study showed that the clinical features of
gastroenteritis with rotavirus, enteric adenoviruses, and
bacteria each exhibited patterns that guides for
presumptive diagnosis. Early treatment with antibiotics of
any septic bacterial infections can then be begun, steps
can be taken for prevention of nosocomial and family.

32.  Diarrhoea related to infections as evidenced by
abdominal pain.
 Acute Pain related to bacterial infection.
 Imbalanced Nutrition less than body requirements
related to Nausea and Vomiting as evidenced by
inadequate food intake.
 Deficient Knowledge related to new disorder and
treatment as evidenced by verbalizes misconceptions
or inaccurate information.
 Risk for Fluid Volume Deficit related to Diarrhoea.

33.  Ask the client about a recent history of:
 Drinking contaminated water.
 Eating food inadequately cooked.
 Ingestion of unpasteurized dairy products.
 Assess for abdominal pain, cramping, hyperactive bowel sounds,
frequency, urgency, and loose stools.
 Stool for culture.
 Hand washing before preparing food for others.
 Educate perianal care after each bowel movement
 2.5 liters/24 hour of water intake plus 200 ml for each loose stool
in adults unless contraindicated.
 Restrict the intake of caffeine, milk and dairy products.
 Potassium (banana, spinach, broccoli)
 Administer anti-diarrheal medications as prescribed.

34.  Assess the level, nature and origin of Pain.
 Encourage pain reduction techniques
 Provide adequate rest
 Provide diversional activities like
socialization for client’s comfort and relief
from pain
 Administer analgesics as prescribed.
 Perform deep breathing exercises (DBE) to
reduce pain sensation.

35.  Measure client weight.
 Monitor and record the number of vomiting,
amount and frequency.
 Monitor the client’s food intake.
 Provide a diet according to his needs.
 Provide parenteral fluids, as ordered.

36.  Assess the client’s skin turgor and mucous membranes for signs
of dehydration.
 Assess the volume and frequency of vomiting.
 Assess the consistency and number of bowel movements.
 Assess the colour and amount of urine.
 Assess the client’s TPR and BP.
 Instruct the client to monitor weight daily and consistently with the
same scale, preferably at the same time of the day, and wearing
the same amount of clothing.
 Encourage regular oral hygiene.
 Encourage increase fluid intake of 1.5 to 2.5 liters/24 hour plus
200 ml for each loose stool in adults unless contraindicated.
 Parental fluid administration as ordered.
 Administer antiemetic medications as ordered

37.  http://www.ihatepsm.com/blog/integrat
ed-management-neonatal-and-childhood-
illness-imnci
 https://www.superbabyonline.com/immu
nization-schedule-in-india/
 https://www.ncbi.nlm.nih.gov/pmc/articl
es/PMC1777930/pdf/archdisch00707-
0012.pdf
 https://adc.bmj.com/content/archdischil
d/60/10/986.full.pdf
 https://www.ncbi.nlm.nih.gov/pubmed/2
0718189