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Gastroenteritis inflammation of GI (s/s (diarrhea (2 to 20 per day,…
Gastroenteritis inflammation of GI
risk factor
young age
ECF is proportionately larger
relatively smaller nutritional reserves
premorbidity & comorbidity
malnurished
hot climate
higher multiplication of organism
environment
overcrowding
poor sanitation
improper food sotrage
cause
bacteria
E .Coli
Salmonella
shigella
campylobacter jejuni
cholera
clostriduim difficile
normal flora in become pathogenic after antibiotic
virus
norwalk/ norovirus
rotavirus, during winter
fngal
candida enteritis
s/s
low grade fever 37.8
vomitting
anorexia
diarrhea
2 to 20 per day
greenish, yellow green watery stool
may have mucus, blood
forceful explsion
may preceded by pain
dehydration
moderate s/s
dry mucous membrane
cracked lip
poor skin turgor
sunken eye & fontanelles
severe
hypovlemic shcok
tachycardia
BP/P
capillary refill > 2sec
palllor
tachypnoea
oliguria, anuria
excorated buttock and perineum
hematuria
loss of sc fat
petechaie with bacterial infection
mental
wekaness
flaccidity
stupor and convulsion
nursing assessment
nature & frequency of stool, types, onset, length
color & of vomitus
assess weight loss
assess hydration status
FTOCC
DETERMINE POSSIBLE IMMUNOSUPPRESION
Diagnostic studies
Stool & rectal swab specimen
C&ST, Ova & cyst for parasite
renal function test
acid - base balance
CBC
:arrow_up: ESR show inflammation adn infection
rotazyme
blood culture to rule out septicemia
serologic studies to detect viral pathogens
RX
if pt is imunosupression/ bacteremia/ C. difficle
metronidazole
vancomycin IV for Resistant C. difficle
dehydration
moderate dehydration
oral rehydration
additional fluid after liquid bowel movement
severe dehydration >10%
IV fluid & electrolyte replaement 20ml/Kg over 2 days
prevent hypotonic hypervolemia (water intoxication)
I/O monitor
MEDS
to slow down colonic transit time
opiates
iperamide (Imodium)
Diphenoxylate with atropine (Lomotil)
codeine
Alpha 2 adrenergic agonist
clonidine
sandostatin analog
Octreotide
esp effective in pt with AIDS and cancer
absorbent
Kaolin and pectin mixture (Kaopectate)
IF NPO, then provide frequent mouth care
Nursing diagnoses
Anxiety and fear related to hospitalization
acknowledge the fear
explore concerns
for chidlren
hold and comfort child after procedures
use age appropriate language
encourage family to stay & parti
address knowledge deficits
deficient fluid volume related to diarrhea and ECF loss
continue oral feeding unless vomit is severe
diluted fruit juices & soft drink wil aggravaates diarrhea by osmotic effect
small & frequent meals with simple carbohydrates like toast
prevent cold, diary, spicy, greasy, gi irritating food : Caffeine
prevent dehydration or fluid overload in old and young ptt
prevent circulatory overload
must use volume-control infusion device / pump for pediatric patient
s/s
edema
bouding pulse, :arrow_up: BP
labor respiration & crackle in lung field
strict I/O
body wieght QD
Detect any septic shock
Correlate parameters with s/s to determine progression
electrolyte balance
Na
Hypernatremia
associate with fluid loss
Hyponatremia
associate with fluid overload
135-145 mEq/L
Cl
95-106 mEq/L
risk for impaired skin integrity related to irritation by frequent stools
perineal care
mild soap & water for cleansing
protective barrier cream
zinc oxide cream
pat dry, don;t rub
may not need to be removed as it could denude skin
for infants
avoid baby wipes that have alcohol
if skin is excorated
expose the diaper area to air & light as possible
Imbalanced nutrition malabsorption
after rehydration, gradual liquid diet to full diet
for infants
progress with increasing strength milk
chronic diarrhea, bloody diarrhea, secretory diarrhea
avoid milk that have lactose
for older children
offer rice creal / non lactose carbohydrate rich food
risk for infection and transmission to other s
contact precaution & sinage posted
proper hand washing
eduacte pt to have good hygiene
send stool specimen before start of antibiotic therapy
universal precaution when collect specimen
risk for complication: septicemia, abscess formation & endocarditis
community nursing intervention
asess sanitation practice in home / day care center
isolate patient from such venue until recovered
perform stool cultures, if 2 cultures from 2 different stool are negative
educate
explain oral-fecal mode of transmission
explain early symptoms of diarrheal and dehydration
discourage over coutner antiemetics & antidiarrheal meds on infants and chidlren
little effect
may cause toxicity
could mask s/s for more serious illness