Acute Gastroenteritis(Diarrhea) pediatrics.pptx

This ppt will provide a detailed information about Diarrhea and dehydration in children and other gastrointestinal disorders. It emphasis on nursing management of children with acute Gastroenteritis.

1. COLLEGE OF NURSING NEIGRIHMS CHILD HEALTH NURSING SEMINAR PRESENTED BY- SNEHA PAUL ROLL NO. – 38 3 RD YEAR BSC. NURSING

2. TOPIC - ACUTE GASTROENTERITIS

3. INTRODUCTION

4. DEFINITION Gastroenteritis is an inflammation of the lining of the stomach, small and large intestine, mostly caused by viral or bacterial infections, but also protozoa, E g - giardia . ACUTE GASTROENTERITIS Diarrheal disease of rapid onset, with or without accompanying symptoms, signs as nausea, vomiting, fever or abdominal pain DIARRHOEA DYSENTRY

5. INCIDENCE GLOBALLY (According to WHO) Each year diarrhoea kills around 443,832 children under 5 and an additional of 50,851 children aged 5 to 9 years of age. Globally, there are nearly 1.7billion cases of childhood diarrhoeal disease every year.

6. INCIDENCE INDIA ( According to National Library of Medicine) Rotavirus causes an estimated 11.37 million episodes of acute gastroenteritis(AGE) in children under 5 in India. Diarrhoea is also the third leading cause of childhood mortality in India and is responsible for 13% of all deaths/year in children under 5 years of age. It kills around 300,000 children in India each year.

7. RELATED ANATOMY AND PHYSIOLOGY

8. PATHOPHYSIOLOGY INGESTION OF VIRUS BACTERIA PARASITE PREDISPOSING FACTOR Age, impaired health and environment WEAKENED OR NON-EXPOSED IMMUNE SYSTEM ABDOMINAL PAIN VOMITING

9. DIARRHEA DEHYDRATION GASTROENTERITIS NO TREATMENT TREATMENT SEVERE DEHYDRATION ELECTROLYTE IMBALANCE SHOCK ORS IV REHYDRATION THERAPY CONSEQUENCES Electrolyte imbalance Metabolic acidosis Symptoms Mild- thirsty, restlessness Moderate – lethargic, irritable Severe – limp, drowsy

10. ACUTE GASTROENTERITIS TYPES Common types of Acute Gastroenteritis are: Diarrhea and Dehydration Dysentry Malabsorption Syndrome Celiac Disease Lactose Intolerance

11. 1 . DIARRHOEA AND DEHYDRATION Diarrhea is the second leading cause of mortality after pneumonia in children under 5 years. 1.5 million deaths each year mostly in developing countries. Of all the child deaths from Diarrhea, 78% deaths are from the African and South-Asian Regions. Each child under 5 years of age experiences an average of three episodes of acute diarrhea each year.

12. DEFINITION Diarrhea is the passage of loose or watery stool at least 3 times in a 24 hour period. The consistency of the stool rather than the frequency is most important. The main forms acute childhood diarrhea are as follows: Acute watery Diarrhea Dysentry or bloody Diarrhea Persistent Diarrhea

13. ETIOLOGY

14. PATHOPHYSIOLOGY Diarrhea may occur due to the following mechanisms :

15. CLINICAL FEATURES

16. MANAGEMENT ASSESSMENT OF DEHYDRATION: Dehydration is because of excess loss of fluids as compared to fluid intake. It can occur due to: Excessive fluid loss Inadequate Fluid intake Other: Polyuria , Diabetes Mellitus or insipidus , fistula, cystic fibrosis, burn injury.

17. DEGREE OF DEHYDRATION

18. SUNKEN ANTERIOR FONTANEL

19. MANAGEMENT OF DIARRHEA AND DEHYDRATION PLAN A CHILD WITH NO DEHYDRATION RULE 1 : Give the child more fluids than usual to prevent dehydration. Breast feeding If the Child is exclusively breastfeed, give ORS or clean water along with breast milk. Food based fluids (such as soup, rice water and yogurt drinks) or clean water.

20. MANAGEMENT OF DIARRHEA AND DEHYDRATION PLAN A CHILD WITH NO DEHYDRATION RULE 1 : Give the child more fluids than usual to prevent dehydration. Fluid Intake Upto 2 Years of age : 50-100ml after each loose stool and in between them 2years or more : 100-200ml after each loose stool in between them.

21. RULE 2 : GIVE ZINC SUPPLEMENTS AMOUNT: Upto 6 months- ½ tablet per day for 14 days 6 months or more- 1 tablet per day for 14 days. Infants: Dissolve the tablet in expressed breast milk, ORS or clean water in a small cup or spoon.

22. RULE 3 : CONTINUE FEEDING Upto 6 months of age: Breastfeed atleast 8 times in 24 hours. 6 months to 1 year: Breastfeed and 3 meals per day, if not breastfeed 5 meals per day. 1 – 2 years : Breastfeed + 5 meals per day Above 2 years: Family foods 3 meals per day with 2 times nutritious foods between meals.

23. RULE 4: RETURN TO HEALTH WORKER Advise to take the child to a healthcare worker if he/she doesn’t get better in 3 days or develops any of the following: Many watery stools, fever, poor eating or drinking, marked thirst, repeated vomiting and blood in the stools.

24. PLAN B CHILD WITH SOME DEHYDRATION 1. Give ORS in the health center untill the skin pinch is normal, the thirst is over, the child is calm. 2. Observe the child closely and help give the ORS. 3. After 4 hours , Reassess the child and select Plan A, B or C to continue treatment. 4. If the mother wants to leave before completing the treatment, teach her how to prepare ORS solution and how to continue with the rest of 4 hours treatment at home. 6. Explain the 4 rules in Plan A for treating her child at home.

25. PLAN C CHILD WITH SEVERE DEHYDRATION A. If IV fluids can be given start immediately. Give 100ml/kg Ringer’s lactate solution (or, if not available, normal saline) as follows: INFANTS(under 12 months): First give 30ml/kg in 1 hour and give rest 70ml/kg in 5 hours. CHILDREN (12 months upto 5 years): First give 30ml/kg in 30min and give rest 70ml/kg in next 2 and 1/2 hours.

26. PLAN C CHILD WITH SEVERE DEHYDRATION Also give ORS (about 5ml/kg/hr as soon as the child can drink, usually after 3-4 hours (infants) or 1-2 hours (children). Reassess an infant after 6 hours and a child after 3 hours and choose appropriate plan ( A, B or C).

27. B. If IV treatment available nearby (within 30 minutes) Refer urgently to hospital for IV treatment. If the child can drink provide ORS Solution by giving frequent sips. If IV therapy is not possible immediately insert nasogastric tube and start rehydration by nasogastric tube or by mouth with ORS. ( Give 20ml/kg/hr for 6 hours, reassess the child) After 6 hours, reassess the child and continue with plan (A, B or C) to continue treatment.

28. TREATMENT OF CHILD WITH BLOOD IN STOOL Administer prescribed antibiotics effective against shigella . Provide Zinc supplements. DRUG THERAPY ANTIMOTILITY: Eg - Imodium ANTISECRETARY agents : Eg - Raececadotril PROBIOTICS : Eg -Lactobacillus

29. ORAL REHYDRATION THERAPY

30. COMPOSITION GRAM/L IONS/OSMOLE Mmol /L Sodium Chloride 2.6 Sodium 75 Glucose, anhydrous 13.5 Chloride 65 Potassium Chloride 1.5 Glucose, Anhydrous 75 Trisodium Citrate 2.9 Potassium 20 Trisodium Citrate 10 Total Osmolarity 245 Traditional formula Low osmolarity formula COMPOSITION OF ORT

31. Use of normal physiologic mechanisms Early re-feeding Effective for all types of dehydration No need for laboratory test. Cost effective No infections, metabolic or electrolyte complications. Shock Neonates Paralytic ileus Painful oral conditions like thrush Frequent or persistent vomiting Severe breathing difficulty ADVANTAGES CONTRAINDICATIONS

32. NURSING MANAGEMENT

33. NURSING ASSESSMENT Assess for frequency and consistency and signs of dehydration Monitor Urine Output Check vital signs

34. NURSING DIAGNOSIS Deficient fluid volume related to excessive GI losses in stool or vomiting. GOAL The child will exhibit signs of adequate fluid volume. INTERVENTION Weigh the child Document child’s fluid intake daily Weigh the diaper after each stool ( 1gm of diaper= 1g of fluid output) Give ORS Continue breastfeeding

35. 2 . Imbalanced nutrition less than body requirements related to inadequate intake and diarrheal losses. GOAL The child will maintain adequate nutrition INTERVENTION Provide energy dense soft diet. Add oil to these foods to make them energy rich Provide fresh fruit juices and banana. Avoid high fibre and bulky foods with a lot of sugar.

36. 3. Risk for infection related to contamination during episodes of diarrhea. GOAL The child will exhibit no signs of infection INTERVENTION Hand Washing Maintain personal and environmental hygiene Apply diaper properly to prevent fecal leakage and spread. Maintain aseptic technique during IV infusion or nasogastric feeding.

37. 4. Impaired skin integrity related to skin irritation caused by frequent stool. GOAL The skin will have no signs of skin breakdown. INTERVENTION Provide meticulous skin care Change the diaper frequently to keep the skin dry. Apply a medicated cream or ointment as prescribed. Expose the reddened skin slightly to air to promote healing. Turn the child every 2 hours to avoid pressure on the skin.

38. 5. Impaired oral mucosa membrane related to effects of dehydration. GOAL The child will exhibit moist and intact oral mucous membrane. INTERVENTION Provide meticulous oral care and assess mucous membrane. Provide extra fluids orally. Administer ORS to recover dehydration. Avoid acidic juice as the patient has impaired oral membrane integrity.

39. 6. Anxiety related to unfamiliar environment and parental separation. GOAL The child will show reduced anxiety. INTERVENTION Need for proper personal and environmental hygiene should be provided daily Educate the parents about the prevention of communicable diseases by immunization. Importance of breastfeeding for 2 years and introduction of complimentary feeding by the fourth month with proper hygiene.

40. DYSENTERY Common bacteria that can cause dysentery are Shigella , Campylobacter and salmonella. Especially, treatment is with fluilds and proper antibiotics which may need a stool culture to isolate organisms for sensitivity. eg – Clotrimoxazole .

41. DYSENTERY Common protozoal dysentery is due to amoeba and giardia . Metronidazole 30mg/kg per day x 10days for amoebiasis . Metronidazole 15mg/kg per day x 5 days for giardiasis .

42. MALABSORPTION SYNDROME Malabsorption syndrome refers to a number of clinical disorders in which the intestine’s ability to absorb certain nutrients into the bloodstream is negatively affected that results in chronic diarrhea, abdominal distention and failure.

43. MALABSORPTION SYNDROME MALABSORPTION OF CARBOHYDRATE Congenital- cystic fibrosis Acquired- Lactose Intolerance MALABSORPTION OF PROTEIN Congenital- Cystic Fibrosis, Shwachman -Diamond syndrome Acquired- Celiac Disease MALABSORPTION OF FATS Eg - severe steatorrhea

44. LACTOSE INTOLERANCE Lactose intolerance is the most common carbohydrate malabsorbtion problem. It is a inability to digest lactose found in diary products due to deficiency of lactose enzyme. S/S- Abdominal Pain, Diarrhea, Nausea, Flatulence ( after ingestion of lactose or lactose-containing products )

45. CELIAC DISEASE Celiac disease is defined as an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible children. Genetic marker HLA, a human leukocyte antigen marker is often associated with these disease. TREATMENT Lifelong gluten free diet and replacement with corn and rice. Iron, vitamins and folate supplementation.

46. PREVENTION This involves intervention in two levels: PRIMARY PREVENTION ( To reduce disease transmission) Rota Virus and Measles vaccines Hand washing with soap Providing adequate and safe dinking water Environmental Sanitation 1 and half months 2 and half months 3 and half months ROTA-1 ROTA-2 ROTA-3

47. SECONDARY PREVENTION ( To reduce disease severity) Promote Breast feeding Vitamin A Supplementation Treatment of episodes of acute Diarrhea with Zinc.

48. HEALTH EDUCATION Help the parents to identify the signs of acute gastroenteritis Advice what, when and how to feed the child. Demonstrate the preparation and administration of ORS Advise to increase the fluid intake and continue breastfeeding during illness.

49. HEALTH EDUCATION v. Monitor daily intake output and weight vi. Inform about the symptoms, which needs immediate return to health centre. vii. Advise for routine follow-ups after illness. viii. Educate measures to prevent diarrhea & other acute gastroenteritis in children.

50. RESEARCH ARTICLE: Prevalence of diarrhoea among under five children in India and its contextual determinants: A geospatial analysis. Koustav Ghosh Atreyee Sinha Chakraborty , Mithun Mog Clinical Epidemiology and Global Health Volume12, October-December 2021, 100813 This study attempts to identify the spatial prevalence and clustering of diarrhea in India based on NFHS -4, 2015-16 using a spatial analysis software. The study finds a total of 71 districts belong to hot spot area are mostly from central and eastern costal part of India. This study recommends to target hot-spot districts with high prevalence of diarrhoea and policy intervention like improved sanitation to reduce the risk of childhood diarrhoea .

51. SUMMARY & CONCLUSION

52. BIBLIOGRAPHY Textbook of Pediatric Nursing for Nursing Students, Panchali Pal, 2 nd edition, CBS Publisher & Distributions Pvt. Ltd. Page No. – 262-267, 269-270. Concise Textbook of Pediatric Nursing, Assuma Beevi T.M., 2 nd Edition, Publisher- ELSEVIER, Page No. – 297-306 Marlow’s Textbook Of Pediatric Nursing, Dorothy R Marlow, Barbara A Redding, South Asian Edition, Publisher- ELSEVIER, Page No.- 498-502 Textbook of Pediatric Nursing, Panchali Pal, 1 st Edition, Publisher- Paras Medical Publisher, Page No.-274-280, 281-283. Pediatric Nursing, Parul Dutta , 1 st Edition, Publisher- Jaypee Brothers Medical Publishers Essential of Pediatric Nursing, Marilyn J Hockenberry , David Wilson, 8 th Edition, Page No.-815-822

53. THANK YOU!