Pediatric Community Education - Assignment Example

Pediatric Community Education Author’s Name: Instructor’s Name: Course Details: Institutional Affiliation: Date of Submission: Introduction Gastroenteritis is a condition that affects a large proportion of the pediatric population. Gastroenteritis is one of the diarrheal diseases that contribute up to one third of mortality among the pediatrics world wide. The condition is associated with a lot of mortality in children due to the high surface area to body ration and their high metabolic rates. Gastroenteritis affects the gastrointestinal tract system. The condition is arises from the causative microorganisms gaining entry into the gastrointestinal tract. The microorganism thus brings about the inflammation of the gastrointestinal tract. The areas affected by the condition include the stomach and the small intestines. The inflammation triggers the occurrence dehydration to set in as fluids and electrolytes are lost from the various body compartments. The dehydration occurs due to episodes of vomiting and diarrhoea (Armon and Elliott, 2004). Various microorganisms are associated with the causation of gastroenteritis. The leading microorganisms that cause gastroenteritis are the viruses. Some of the most notable viruses that cause gastroenteritis include the norovirus, rotaviruses and adenovirus. Other microorganisms that cause gastroenteritis comprise of the bacterial species and parasites. The bacterial species that cause gastroenteritis consist of campylobacter, Escherichia coli, salmonella and Shigella. On the other hand, parasites that cause gastroenteritis include those from the protozoan species such as gardia lamblia (Field, 2003). Gastroenteritis can easily be passed on from one person to another. The most common means through which the transmission of gastroenteritis takes place is through contact. Establishment of close contact with individuals who are infected by the gastroenteritis predisposes one to getting infected. Other means through which gastroenteritis can be acquired include the consumption of contaminated water and food (Acute Gastroenteritis Guideline Team, 2005). Pathophysiology The invasion of gastrointestinal tract by the causative microorganisms results in the inflammation and cell lysis. The inflammation decreases the absorptive capabilities of the villi within the gastrointestinal tract. This stimulates the secretion of water and electrolytes from the body compartments. As a result, fluids are lost from the intravascular and extracellular compartments. The patients lose fluids and electrolytes from the intravascular compartment though vomiting and diarhoea. The volume of fluids being depleted exceeds the rate of intake within the fluid compartments in the body. The loss fluids and electrolytes losses make the patient to become dehydrated. The body tries to compensate the on going fluids and electrolytes. For instance, the renal output of the patients will be limited. Less fluid will thus be lost through micturation. This reduces the effects of dehydration since when one is dehydrated a significant amount of fluids is sucked from the various body compartments to sustain some functions such as circulation and renal flow (Field, 2003). The sucking of fluids from various body compartments is what leads to the dryness of the mucous membranes being experienced. Patients will thus exhibit the loss of tears, sunken eyes and decreased skin turgor. The patient’s level of hydration will steadily diminish with the ongoing loss of electrolytes and fluids. If no interventions are put in place on time to limit the amount of fluid and electrolytes being lost, the patients will experience vascular compromised. Compromising of the vascular system results in limited perfusion of vital organs such the heart, lungs, kidney and brain. Limited perfusion leads to detrimental effects such as shock. Continuous loss of fluids and electrolytes then results in circulatory collapse. The body will thus rely on acidotic respiration. The acidotic respiration aims at eliminating the acidic products what continues to accumulate as a result of the respiratory system being compromised. Compromising of circulation finally leads to death since most organs will become ischemic (Field, 2003). Clinical Presentation Patients with gastroenteritis exhibit some or all the signs and symptoms. The symptoms start to take toll with intervals of 12-72 hours after having acquired the infection. The clinical features that are exhibited by the patients with gastroenteritis include vomiting, diarhoea, nausea, fever, loss of appetite, abdominal pains and general body weakness. Most of the clinical signs and symptoms that will be exhibited by the patients will mainly include a wide range of features associated with dehydration (Borowitz, 2005). Patients with gastroenteritis exhibit the features of dehydration which include the dryness of the mucous membranes, poor skin turgor, sunken eyes, lack of tears, poor capillary refill and abnormal breathing amount other features. However, the features of dehydration will vary depending on the level of dehydration that the patient is having. Patients who seek medical attention on time will avert the effects of dehydration from taking toll such as acidotic respiration, vascular collapse among others. However, the patients who do not seek medical attention on time develop various complications associated with dehydration with the ultimate result being death (Bellemare, Hartling and Wiebe, 2004). Diagnosis Clinical presentation of patients as well as laboratory examinations offers a platform for making the diagnosis of gastroenteritis. The clinical signs and symptoms patients with gastroenteritis exhibit ought to correspond to those of gastroenteritis. The patient will have gastroenteritis on having its clinical features. Patients who exhibit the characteristic features of diarhoea, vomiting, fever and abdominal cramps are considered to have gastroenteritis. On examination, this patient’s will often have general body weakness and dehydrated. The laboratory examinations provide a basis of establishing the causative microorganism. Stool culture also provides the basis upon which the identification of the causative microorganisms. The presence of microorganisms that are associated with gastroenteritis in the stool is an indicator of the patient having gastroenteritis. The past medical history of the patient is also essential in making the diagnosis since most patients who present with gastroenteritis often have a history of recurrent infections (Glass et al, 2003). Discussion The clinical features that the patient in the case study is having could very well be exhibited in other disease conditions. For instance the patient is said to have episodes of diarhoea and vomiting which could also have presented in other disease conditions which are likely to be features of other diseases. The past medical history suggests that the patient has had recurrent otitis media infections. Otitis media can as well present with the features that the patient is exhibiting such as diarhoea and vomiting episodes which are present in this patient. The patient could thus be having a recurrence of the otitis media which is making the patient to exhibit episodes of vomiting and diarrhoea (Centers for Disease Control and Prevention, 2003). The pediatric patients in the case study, exhibits signs and symptoms of gastroenteritis. Examination of the patient reveals that the signs and symptoms are similar to those exhibited by patients with gastroenteritis. The patients history shows that he has been having repeated episodes of vomiting and diarhoea which are characteristic features of gastroenteritis. In addition, the signs of the patient having dehydration are also visible. The patients is said to have dry and cracked lips. In addition, the tongue of the patient is reported to be coated. The dehydration is characteristic to the symptoms of dehydration since body fluids are lost from the fluid compartments within the body (Dean, 2003). The loss of fluids in this case has resulted from the vomiting diarhoea. Dehydration is further supported by other features of dehydration which include the presence of weak distal pulse and cold extremities as well as pupil sluggishness. The patients past medical history also support the fact that the patient has gastroenteritis since the patient has a history of recurrent otitis media. The patient has temperatures that are slightly above the normal. The elevate temperatures are characteristic of gastroenteritis which the patients normally have elevated temperature readings on examination (Colletti et al, 2010). The patient in the case study has oxygen saturation rates that are low despite the high respiratory rate and air entry that is normal. This can be attributed to the exudates fluids that have high protein and cellular debris that has escaped from the intravascular compartment. The patient is also reported to have cold extremities. This can be attributed to poor perfusion of the peripheries due to depletion of fluids within the intravascular compartment which limits the amount of blood that is supplied to various organs and tissues (Field, 2003). Patient, community and family education will seek to create awareness. Patient education will be done using various approaches. There will be need to use diagrams and charts in illustrating to the patients on the disease condition. In addition, practical demonstrations will also facilitate better understanding by the patients. Patient’s education will allow patients, family and community are also able to make their own contributions or actively participate (Fonseca, Holdgate and Craig, 2004). The education will focus on the making the community, patient and family aware of what gastroenteritis is by definition. Education of the community, patient and/or family will be centered on describing gastroenteritis. The patient, community and families awareness about the disease will be evaluated. The community will be allowed to give their description on how best they understand the disease condition. The correct descriptions will be taken while the descriptions made by the patients, community and family that were wrong will be dismissed in an appropriate way. The community will thus be made to understand what gastroenteritis is with the terms that the patients, community and family can easily understand. The community, family and patients will be made aware that gastroenteritis affects the gastrointestinal system and brings about the inflammation of the gastrointestinal system (Acute Gastroenteritis Guideline Team, 2005). The next agenda on the education of the patients, family and the community will entail informing them on the symptoms and signs that are associated by the gastroenteritis. The community, patients and family will be allowed to give their contribution on the symptoms and signs that are associated with the condition. All the signs and symptoms that are contributed by the patients will be taken noted down. The patients, family and community will be made aware of other signs and symptoms that they did not mention which are associated with the disease (Gracey and Cullinane , 2003). The third step in educating the patients, family and community will entail familiarizing the community on the causative agents which are associated with gastroenteritis. The community, family and patients will be given an opportunity to mention some of the causative agents which they think are associated with gastroenteritis. The community, patients and the family will then be informed of the causative agents that are associated with e disease. The illustration of the causative agents and to the patients, family and community will this require the use of diagrams and charts to illustrate the causative agents. The patients will be informed of the viruses, bacteria’s and parasites which cause the condition (Grunenberg , 2003). The fourth step will entail educating the patients how the infection is acquired. The patients will be given an opportunity to air out their opinion on what they believe makes human beings acquire the infection. The correct contribution given by the patients, community and family will then be emphasized in this fourth step. The patients, family and community will then be made aware of how the condition is acquired. They will be informed that the condition mainly results from coming in contact with contaminated food, water, surfaces and even patients. The patients, family and community will be informed that coming in contact with contaminated food, water and patients having the condition will predispose them to getting infected (Hartling et al, 2006). The fifth step will involve educating the patients on the Pathophysiology of the condition. The patients will be allowed once again to give their account on how they think the condition affects the body and how it is able to manifest itself. The correct sentiments made by the patients, family or the community will be emphasized when informing them of the course of the illness. The patients, family and community will be made aware of how the condition affects the body and the changes that take effect when infected. They will be educated on how the conditions affects the gastrointestinal system and the effects the disease brings such as dehydration and other effects which are associated with eh condition. The course of the illness will be illustrated using charts, diagrams as well as practice demonstration on the effects that the condition will have on the body (Acute Gastroenteritis Guideline Team, 2005). The key factors that the patients, family and the community are made aware of are the various stages of dehydration and the features that are exhibited at each stage. In addition, they will be made aware of how the vomiting and diarhoea contribute to the loss of fluids. Other complications which are associated with the condition such as acidotic respiration and circulatory failure will also be illustrated for the patients, family and community to get the real picture of the course of the illness. Educating the patients on the course of the illness will enable them to effectively pick out the various features that associated with eh condition on time so that medical intervention sought (Heyworth, Baghurst and McCaul, 2003). The sixth step will entail educating the patients on the various preventive measures which can be put into place to avert gastroenteritis. The patients, family and the community will be allowed to make their contributions on the various ways through which the prevention of gastroenteritis can be attained. The correct steps mentioned by the patients, family and the community will be further echoed when informing them on the other ways used to prevent gastroenteritis. For instance the patients, family and community will be made aware that the condition is preventable. The various ways to prevent the infection will then be illustrated. Some of the preventive steps which the patients, family and the community can use will then be put forward. The patients, family and community will be informed that the practicing of high hygiene standards as the key preventive strategy they can employ. For instance, the patients, family and community will be informed on the role of hygiene in the prevention of the condition and the hygiene practices they ought to employ (Acute Gastroenteritis Guideline Team, 2005). The patients, family and the community will be enlightened on the care they ought to give patients while at the same time preventing themselves from infection. A good example of such a hygiene practice will be the disposal of the vomitus and diarhoea from the patients away from the houses and exercising caution while collecting and disposing the vomitus and diarhoea to avoid contamination. This will entail the use of gloves to prevent coming into direct contact with the vomitus, diarhoea as well as the materials and equipment handled by the infected patients. Soiled clothing and linens should also be well disposed and cleaned with disinfectants (Koslap-Petraco, 2006). However, the family and community should also be informed on how to deal with the eventuality of accidentally coming in contact with the vomitus, stool and materials used by the patients. Under such a circumstance, the patients, family and the community will be educated on how to effectively disinfect themselves using antiseptics and disinfectants that are readily available. The patients, family and the community will also be informed on the significance of hygiene in the room in which the patient is being nursed. The patients, family and the community is made aware on how they can maintain hygiene of the room by ensuring that it is cleaned with disinfectants and at the same time have adequate aeration (King et al, 2003). The final step will involve educating the patients, family and the community on how to effectively management the patients condition. The patients, family and the community will be allowed to contribute on the appropriate ways they think they can attend to the patients. The children who were exhibiting similar symptoms and signs ought to be treated before the condition posses its adverse effects. They will then be informed of how they can effectively take care of the patient. The treatment rationale for the patients with gastroenteritis will entail the use of rehydration therapy. The therapy will be geared towards replacing the fluids that have been lost through the vomiting and diarhoea. The amount of fluid that will be used will be based on the level of dehydration of the patient. The hydration therapy will have to be continued until the patient attains the normal hydration levels. For instance, they will be informed and on the role of rehydrating the patients suing fluids. The fluids used will include the oral rehydration solution. They will also be informed on the importance of feeding the patients. They will be encouraged to feed the patients on smaller food rations which can be tolerated. However, if the patient’s dehydration is severe, the patients, family and community will be informed on the role that intravenous therapy has on the outcome of the patient (Acute Gastroenteritis Guideline Team, 2005). The management of gastroenteritis as a paramedic will entail conducting a comprehensive clinical examination which will be followed by the formulation of an elaborate management plan for the patient’s condition. The comprehensive clinical examination will involve the use of the patient’s history of presenting illness as well as physical examinations. The management plan will be based on the clinical examination findings. The patient in the case study has had several episodes of vomiting and diarhoea. The patient has thus become dehydrated. The patient is said to have dry mucous membranes, reduced skin turgor, inability to drink and feed. Based on the clinical examination of the patient in the case study, it is evident that the patient is severely dehydrated (Cincinnati Children's Hospital Medical Center, 2006). Management of gastroenteritis will be aimed at correcting dehydration that has taken place while at the same time preventing further dehydration. If the patient’s intravenous line can be traced, the management of dehydration in this patient will entail the use of intravenous fluids such as ringer’s lactate of normal saline. The fluid therapy will be divided into two phases. The first phase will be the loading dose while the second phase will be the maintenance dose. The loading dose will entail fluids being given at the rate of 30mg/kg/Bwt for the first 30 minutes. The maintenance dose on the other hand will involve the giving of fluids at the rate of 70mg/kg/Bwt for the next 2 1/2 hours. The patient’s condition will be assed from time to time and if found to be improving, the patient will be put on oral rehydration solution. In the eventuality that the intravenous line cannot be traced, the patient will be put on oral rehydration solution which will be given through the nasogastric tube. The oral rehydration solution will be given at the rate of 20mg/kg/Bwt for there hours. The patient will then be reassessed after the three hours. If the patient will be found to have improved, the patient will then be administered oral rehydration solution at the rate of 5ml/kg/Bwt two hourly (Cincinnati Children's Hospital Medical Center, 2006). Medication will be administered to the patient. For instance, there will be need to give anti-microbial therapy to deal with possible infections. In addition, probiotics are given to reduce the duration of diarhoea. Feeding will also be recommended once the patient has attained sufficient rehydration (Freedman, Adler and Seshadri, 2006). Conclusion Patient education will be centered and expanding the knowledge of the patients, family as well as the community on gastroenteritis. The community is impacted with knowledge on the condition in terms of what the condition is, the causative agents, Pathophysiology, clinical features and ways in which they can prevent and manage the disease condition. Patients will thus have the knowhow on the care to be given to those who have Gastroenteritis. References Acute Gastroenteritis Guideline Team (2005). Cincinnati Children's Hospital Medical Center. Evidence-based care guidelines. Gastroenteritis. Reterived on 5th May, 2012 from www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/gastro.htm. Armon K., Elliott EJ., (2004). Acute gastroenteritis. In: Moyer VA, Elliott EJ, Davis RL, eds. Evidence based pediatrics and child health, 2nd ed. London, UK: British Medical Journal Books; 377–392. Bellemare S., Hartling L., Wiebe N., (2004). Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials. BMC Med ;2:11. Borowitz SM., (2005). Are antiemetics helpful in young children suffering from acute viral gastroenteritis? Arch Dis Child.; 90:6468. Centers for Disease Control and Prevention (2003). Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR.;52. Centers for Disease Control and Prevention website. Retrieved on 5th May, 2012 from http://www.cdc.gov/mmwr/pdf/rr/rr5216.pdf. Cincinnati Children's Hospital Medical Center (2006). Acute Gastroenteritis (AGE) In children aged 2 months through 5 years. Evidence-Based Care Guideline for Children with Acute Gastroenteritis (AGE). Retrieved on 9th May from http://www.cincinnatichildrens.org/assets/0/78/1067/2709/2777/2793/9199/32e14f93-09fe-4138-85be-7d86ed145537.pdf. Colletti JE., Brown KM., Sharieff GQ., Barata IA., Ishimine P., (2010). ACEP Pediatric Emergency Medicine Committee. The management of children with gastroenteritis and dehydration in the emergency department. Journal of Emergency Medicine;38(5):686-698. Dean, J., (2003). Gastroenteritis prevention: Improving the health of young indigenous populations. Journal of Rural and Remote Environmental Health 2(1): 6-13. Reterived on 5th may 2012 from http://www.jcu.edu.au/jrtph/vol/v02dean.pdf. Field M., (2003). Intestinal ion transport and the pathophysiology of diarrhea. Jouranl of Clinical Investigations;111:931–43. Fonseca BK., Holdgate A., Craig JC., (2004). Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med;158:483-90. Freedman SB., Adler M., Seshadri R., (2006). Oral ondansetron for gastroenteritis in a pediatric emergency department. New England Journal of Medicine; 354:1698-705. Gracey M., Cullinane J., (2003). Gastroenteritis and environmental health among Aboriginal infants and children in Western Australia. Journal of Paediatric Child Health;39:427–31 Grunenberg N., (2003). Is gradual introduction of feeding better than immediate normal feeding in children with gastroenteritis? Arch Dis Child; 88:4557. Hartling L., Bellemare S., Wiebe N., Russell K., Klassen TP., Craig W., (2006). Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev;(3). Heyworth JS., Baghurst P., McCaul KA., (2003). Prevalence of gastroenteritis among 4-year-old children in South Australia. Jounal of Epidemiology and Infection;130:443–51. King CK., Glass R., Bresee JS., Duggan C., (2003). Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR.; 52(RR16):116. Koslap-Petraco MB., (2006). Homecare issues in rotavirus gastroenteritis. 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