Overview/pathophysiology

Gastroenteritis, one of the most common infectious diseases seen in children, is an inflammation of the stomach and intestines that accompanies numerous gastrointestinal (GI) disorders. It is one of the main causes of dehydration and can cause life-threatening complications. Acute infectious gastroenteritis is caused by a variety of bacterial, viral, and parasitic pathogens. Rotavirus infection is the most common cause of severe gastroenteritis/diarrhea in infants and young children worldwide. Before the rotavirus vaccine program started in 2006, about 80% of children in the United States had rotavirus gastroenteritis by age 5 yr. In the 1990s and early 2000s, rotavirus caused approximately 410,000 physician visits, 205,000-272,000 emergency department visits, and 55,000-70,000 hospitalizations of U.S. infants and children each year. There were about 20-60 deaths each year in children younger than 5 yr (Cortese & Parashar, MMWR, 2009). The rotavirus season is starting later, is shorter, and has significantly fewer positive test results according to 2007-2008 and 2008-2009 data (Centers for Disease Control and Prevention, MMWR, Oct. 23, 2009).

Other common causes of infectious gastroenteritis include Escherichia coli, Salmonella, Shigella, and Campylobacter as the most common bacterial pathogens and Giardia and Cryptosporidium as the most common parasites. Clostridium difficile is the most common nosocomial source, and it occurs after antibiotic use.

Health care setting

Primary care, with possible hospitalization depending on severity of illness

Assessment

History is very important, as is physical examination. Signs and symptoms vary widely depending on illness severity. Age, general health, and environment are factors that predispose children to gastroenteritis.

Diagnostic tests

History is important in determining source of gastroenteritis and if there is a need for any tests. In general, laboratory tests are not performed unless the child exhibits moderate-to-severe dehydration, appears toxic, and has abdominal pain or bloody stools.

Serum electrolytes:

Determine severity of electrolyte imbalance and type of fluid replacement necessary.

Complete blood count:

Hematocrit is often elevated in dehydration. The differential will determine whether viral or bacterial infection is present. In a bacterial infection, the white blood cell (WBC) count is elevated with increased polymorphonuclear leukocytes or neutrophils. In a viral infection, the WBC count is slightly elevated with increased lymphocytes.

Blood urea nitrogen:

Elevated with dehydration but should return to normal with rehydration.

Blood culture:

Obtained if child is acutely ill to help determine cause of illness.

Stool specimen:

Examined if diarrhea lasts more than a few days to help determine cause.

Rotazyme:

Rapid test to see if rotavirus is present in stool. Positive test negates need for stool culture.

Stool culture:

Obtained if blood or mucus is present in stool, when symptoms are severe, or if there is history of travel to a developing country.

Stool for ova and parasites:

May be used instead of culture because it is less expensive and often more reliable. A specimen is obtained 3 days in a row.

Nursing diagnosis:

Deficient fluid volume

related to fluid loss occurring with fever, vomiting, diarrhea

Desired Outcome: Within 4 hr following intervention/treatment (for mild-moderate dehydration), the infant/child exhibits adequate hydration as evidenced by alertness and responsiveness, anterior fontanel soft and not sunken (in children younger than 2 yr), moist oral mucous membranes, elastic abdominal skin turgor, capillary refill less than 2 sec, and age-appropriate UO (e.g., infant 2-3 mL/kg/hr, toddler and preschooler 2 mL/kg/hr, school-age child 1-2 mL/kg/hr, and adolescent 0.5-1 mL/kg/hr).

ASSESSMENT/INTERVENTIONS	RATIONALES
Assess weight of child on admission and daily on the same scale, at same time of day, and wearing same amount of clothing (infants are weighed without any clothing). Notify health care provider if child is losing weight.	Consistency with weight measurements helps ensure more accurate results. Weight is a useful indicator of fluid balance. Weight loss indicates that child is not receiving adequate fluid replacement and adjustments need to be made.
Assess vital signs q4h or more often if outside normal parameters. Report abnormalities to health care provider.	HR is elevated and blood pressure (BP) is normal in compensated shock and low in uncompensated shock. Dehydration can quickly lead to shock in infants and young children in whom a falling BP is a late sign of shock.
Do not measure temperatures rectally.	Rectal temperature measurements stimulate stooling, which can lead to dehydration.
Administer oral rehydration solution (ORS), for example, Pedialyte, Infalyte, Rice-Lyte, Rehydralyte.	ORS replaces fluid volume in children with minimal-to-moderate dehydration. – To make it more palatable for child, may add 1 tsp presweetened sugar-free Kool-Aid to chilled 1-liter bottle of ORS or try flavored brands of these solutions. – Small amounts are given frequently, especially if child is vomiting (5 mL q5min with a gradual increase in amount consumed). This is from the 2003 guideline issued by CDC to improve health outcomes by replacing fluid and electrolytes, as well as glucose, with oral rehydration therapy (ORT). ORT includes rehydration with ORS and maintenance phase, including fluid and adequate dietary intake.
Do not give clear liquids such as apple juice, soda, gelatin, or sports drinks.	Liquids with a large amount of simple sugars can exacerbate osmotic effects associated with diarrhea and vomiting.
Do not give tea or soda with caffeine.	Caffeine is a mild diuretic and can increase dehydration as a result of loss of fluid and electrolytes.
Do not give chicken or beef broth.	Broths are high in salt and low in carbohydrates.
Administer and monitor nasogastric tube (NGT) fluid replacement (for mild-moderate dehydration and vomiting) or intravenous (IV) fluids as prescribed for moderate-severe dehydration and vomiting.	If the child is unable to take sufficient ORS orally, use of NGT with ORS might help initial rehydration and speed up tolerance to refeeding. IV fluid and electrolyte replacement likely will be necessary if this is not successful or if the child is severely dehydrated.
Assess hydration status q4h.	Although the child may be receiving maintenance fluids, he or she may still be dehydrated because of diarrhea, vomiting, and/or insensible water losses. A dehydrated child is likely to exhibit decreasing level of consciousness, sunken anterior fontanel (if younger than 2 yr), dry or sticky oral mucous membrane, tented abdominal skin, capillary refill greater than 2 sec, and decreasing UO.
Ensure that child has at least minimal UO but that output is not more than intake.	This is an indicator of adequate hydration.
After child is rehydrated, calculate maintenance fluids based on child’s weight.	The smaller the child, the greater the percentage of body weight is water. To meet minimal fluid requirements, the necessary volume is calculated in the following way: Up to 10 kg: 100 mL/kg/24 hr =______________ < div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Psychosocial support Care of the renal transplant recipient Polycythemia Hyperglycemic hyperosmolar syndrome Stay updated, free articles. Join our Telegram channel Join Tags: All-In-One Care Planning Resource Jul 18, 2016 | Posted by admin in NURSING | Comments Off on Gastroenteritis Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access