Gastric Flashcards
Why do infants and children have increased risk of dehydration?
They have increased extracellular fluid percentage and relative increase in body water compared to adults.
Increased basal metabolic
Increased ratio of BSA to body mass
Immature renal function
Increased insensible fluid loss through temperature elevation
What happens if you leave dehydration unchecked?
shock.
important to act quickly ro prevent hypovolemic shock.
Therapeutic Management: Dehydration
restore appropriate fluid balance and prevent complications
Risk Factors: Dehydration
Diarrhea Vomiting Decreased oral intake sustained fever Diabetic ketoacidosis Extensive burns
Nursing Alert** Dehydration
nurse must be able to assess a child’s hydration status accurately and intervene quickly.
Children > risk for hypovolemic shock. Dehydrated children deteriorate quickly and experience shock.
Mild: Dehydration
Alert, normal, extremities prink, brisk capillary refill, UO: may be slightly decreased
Moderate Dehydration
listless fontanels: sunken oral musocsa: mildly sunken Skin turgor: decreased HR: may be increased CR: delayed UO: < 1 ml/kg/hr
Severe Dehydration s/s
Alert- comatose fontanels: sunken eyes: deeply sunken orbits Oral mucosa: dry ST: tenting HR: Increased progressing to bradycardia BP: normal > hypotension Extremities: big capillary refill, cool, mottled, dusky UO: significantly < 1ml
Teaching: Dehydration (Mild-Moderate)
ORS should contain 75 mmol and 13.5 g glusecose
Tap water, milk, undilated fruit juice, and broth are NOT appropriate for oral rehydration
Children with mild to moderate dehydration require 50–100 mL/kg of ORS over 4 hours. After reevaluation, oral rehydration may need to be continued if the child is still dehydrated. When rehydrated, the child can resume a regular diet.
Risk Factors: dehydration
diarrhea vomiting decreased UO Diabetic ketoacidosis extensive burns high fever
Nursing Management: dehyrdation
restore appropriate fluid balance and to prevent complications (hypovolemia)
provide oral hydration to children for mild-moderate
Teaching: Severe dehydration
receive IV fluids, initially 20ml/ normal saline then reassess hydration status
-maintenence may be ordered.
0evauluate hydration status and appropriateness of IV fluid orders
Etiology: Vomiting
forceful explosion of gastric contents through the mouth. Three phases: prodromal: n/c, signs of autonomic system stimulation
Retching
Vomiting
Therapeutic Management: Vomiting
slow oral rehydration and it may require adminitration of antiseptics
Nursing Management: Vomitting
promote fluid and electrolyte balance.
Oral rehydration is accomplished successfully for most.
Teach caregivers about oral rehydration
Nursing Management Vomiting: mild moderate dehydration
withhold oral dfeeding for 1-2 hours after emesis, after which oral rehydration can begin. Give the infant or child 0.5 -2 of ORS every 15 minutes depending on child’s age and size. As improve, larger amounts tolerated
What happens if oral rehydration doesn’t work?
Iv fluids will be ordered.
Antiemetics may be used to help control vomiting and ondansetron Is preferred over promethazine b/c < side effects. Educate family about voting and use of antiemitc therapy
Nursing Alert** Vomitting
Ginger capsules, ginger tea, and candied ginger are generally useful for reducing nausea and safe for children over 2, w/ no side effects
Diarrhea: Patho
most commonly caused by viruses bu may be related to bacterial or parasitic enteropathogens. May be blood or non bloody.
Often occur with antibiotic use.
Risk factors:
ingestion of undercooked meats, foreign travel, day care attendance, well water use
Theraputic Management: Diarrhea
supportive (maintaining fluid balance & nutrition) Probiotic supplementation may be useful.
Labs: Diarrhea
Stool culture: may indicate presence of bacteria
Stool for ova and parasites (O&P): may indicate the presence of parasites
Stool viral panel or culture: to determine the presence of rotavirus or other viruses
Stool for occult blood: may be positive if inflammation or ulceration is present in the GI tract
Stool for leukocytes: may be positive in cases of inflammation or infection
Stool pH/reducing substances: to see if the diarrhea is caused by carbohydrate intolerance
Electrolyte panel: may indicate dehydration
Abdominal radiographs (KUB): presence of stool in colon may indicate constipation or fecal impaction
Causes Chronic Diarrhea: Infants
Intractable diarrhea of infancy
Milk and soy protein intolerance
Infectious enteritis Hirschsprung disease Nutrient malabsorption
Causes Chronic Diarrhea Toddlers
Chronic nonspecific diarrhea Viral enteritis Giardia Tumors (secretory diarrhea) Ulcerative colitis Celiac disease
Causes Chronic Diarrhea School age
Inflammatory bowel disease Appendiceal abscess Lactase deficiency Constipation with encopresis
Nursing Management: Diarrhea
restoring fluid balance and providing family education
Restoring fluid and electrolyte balance:D
Continue child’s regular diet. Intial is focused on restoring balance and then help encourage the child to consume a regular diet to maintain energy and growth
Nursing Alert** Diarrhea
avoid foods high in glucose, may worsen diarrhea
Providing family education: D
Teach about oral rehydration therapy
finish all prescribed antibiotic therapy
how to prevent occurrences
hand washing techniques and transmission route.
cause= excessive intake of water or fruit juice, teach appropriate fluid intake
What is Nephrotic Syndrome?
increased glomerular basement membrane permeability, which allows abnormal loss of protein in the urine. Nephrotic syndrome generally occurs in three forms—congenital, idiopathic, and secondary.
- Finnish descent
- prognosis; poor; rate