Gastroenteritis in Children - Term Paper Example

Student Name: Instructor’s Name: Course: Institution: Date Gastro-enteritis in Children Introduction Gastro-enteritis is an infection of the digestive system. It is characterized by an abrupt onset of diarrhoea which may be accompanied by vomiting in young children. Gastro-enteritis is mainly caused by an enteric virus, though it may also be due to protozoa infections. This disease normally lasts for a few days; but symptoms are uncomfortable and affect the child as well as family or carers. Serious diarrhoea can swiftly cause dehydration that can be life threatening (Levine, et al 2010). In developing countries, children are mostly affected by gastroenteritis with most experiencing two or more episodes every year. Often, parents and carers manage their child’s disease at home, and might not seek medical advice However, most parents and carers look for medical guidance from healthcare professionals in a community setting. Roughly 10% of children below 5 years visit healthcare services suffering from gastroenteritis every year (Fischer Walker, Perin, Aryee, Boschi-Pinto, and Black 2012). Diarrhoeal sickness accounts for 16% of clinical presentations in main paediatric emergency department (Fischer Walker, Perin, Aryee, Boschi-Pinto, and Black 2012). Many children having gastroenteritis do not require hospital admission they can be treated as inpatients. Hospital admission is not often recommended as it exposes other susceptible admitted children to the disease. Gastroenteritis weighs down health service resources. Gastro-enteritis management in children is complex. This paper discusses primary health care strategies that can be applied to children below 5 years who seek medical advice from a healthcare professional in a community setting. It discusses diagnosis, evaluation of dehydration, nutritional management, fluid management and the function of antibiotics as well as other therapies. It gives recommendations on the guidance to be offered to parents and carers as well as considers when care ought to be transferred from home management to hospital admission. Patient-centred care A primary health care nurse should take into consideration the child’s and parents’ or carers’ needs and preferences in the treatment of gastro-enteritis. Parents and carers of children with gastro-enteritis should be allowed to make well-informed decisions as regards their care management, in collaboration with their healthcare professionals. It is essential to have good communication between parents or carers of children with gastro-enteritis and healthcare professionals. It must be supported with evidence-based written information modified to their needs. The advice given to parents or carers of children with gastro-enteritis as well as their care management must be culturally appropriate. Moreover, it must be available to individuals with additional needs like physical and learning disabilities. Parents or carers must be allowed to make decisions as regards their child’s care management. Moreover, they must be provided with the information and support they require (Health Protection Agency, 2011). Diagnosis Abrupt diarrhoea and vomiting ought to arouse suspicion of gastroenteritis. Bacterial infection is characterized by bloody diarrhoea. If the nurse suspects gastroenteritis, he/she enquire about current contact with somebody suffering from acute diarrhoea or nausea and contact with a recognized source of enteric infection, such as infected water or food, and current travel overseas. The nurse should try to look for other likely sings of diagnosis other than gastroenteritis, including temperatures above 38°C in children below 3 months or temperatures above 39°C in children above 3 months, tachypnoea, distorted conscious state, neck rigidity, swollen fontanelle in babies, non-blanching rash, bilious vomit, blood or mucus in stool, severe stomach ache and abdominal swelling or rebound tenderness (Khanna R, Lakhanpaul M, Burman-Roy S, et al, 2009). A primary health care nurse should advice for stool microbiological tests if the child has currently travelled overseas, the child has diarrhoea for more than one week, there is suspicion concerning the diagnosis of gastroenteritis, septicaemia or there is trace of blood or mucus in the stool or if the immune system of the child is compromised (Health Protection Agency, 2009). The nurse should also assess for dehydration and shock. Symptoms for dehydration and shock include sunken eyes, reduced skin turgor, tachycardia, and tachyponea, irritable, lethargic, cold extremities, hypotension, reduced level of consciousness; fragile peripheral pulse, compromised immune system and protracted capillary replenish time. Moreover, the nurse should carry out a blood culture if she/he considers giving antibiotic therapy. The nurse should inform and take action according to the advice of the public health authorities in case you suspect an epidemic of gastroenteritis (National Institute for Health and Clinical Excellence, 2009). Fluid management For children with gastroenteritis but are not dehydrated, a primary health care nurse should advice their parent or carers to continue breastfeeding them as well as giving them other milk feeds, encourage them to give their children plenty of fluids, discourage them from giving their children fruit juices and fizzy drinks, particularly those at high risk of dehydration. They should also give oral rehydration salt (ORS) solution to children at high risk of dehydration (Lo Vecchio, Giannattasio, Duggan, et al. 2011). For children with gastro-enteritis and are dehydrated, a primary health care nurse should give them low-osmolarity ORS solution as an oral rehydration therapy, 50 ml/kg for fluid deficiency replacement more than 4 hours and maintenance fluid and regularly give them ORS solution in small quantities. Moreover, the nurse should consider supplementing their usual fluids with milk feeds or water if the child refuses to drink plenty of ORS solution and do not show signs of severe dehydration and shock. If the child is unable to drink the ORS solution or if he/she vomits persistently, the nurse should consider giving the solution by means of a nasogastric tube. The nurse should regularly assess the reaction to oral rehydration therapy (Freedman, Cho, Boutis, Stephens, Schuh, 2010). For children who shows signs of dehydration and shock and shows medical evidence of weakening even with oral rehydration therapy, a primary health care nurse should give them intravenous fluid therapy. In this case, the nurse should give isotonic solutions like sodium chloride with or without glucose for fluid deficit replacement as well as maintenance. For children with signs of shock requiring initial quick intravenous fluid boluses, include 100ml/kg for fluid deficiency replacement to maintenance fluid needs, and assess the clinical reaction. For children who do not show signs of shock, add 50 ml/kg for fluid deficiency replacement to maintenance fluid needs, and assess the clinical reaction. The nurse should assess plasma sodium, urea, potassium, glucose and creatinine at the onset, monitor frequently, and adjust the fluid composition or else time of administration if needed. Once the level of plasma potassium is known, the nurse should consider giving intravenous potassium supplement (Nager, 2011). Nutritional management During rehydration therapy, the nurse should advice the parents or carers to continue breastfeeding and not to give their children solid foods. For children who are dehydrated and in shock, the nurse should advice tier parents and carers to give them ORS instead of oral fluids. For children who are not dehydrated and refuse to take ORS, the nurse should consider supplementation with the children’s usual fluid, such as milk feeds and water. After rehydration, the nurse should immediately recommend giving undiluted milk, re-introduce the child to solid food and discourage use of fruit juices as well as carbonated drinks until the child stops to diarrhoea (Pieścik-Lech, Shamir, Guarino, Szajewska, 2013). Antibiotic therapy Children with gastro-enteritis should not be regularly given antibiotics. Antibiotics treatment should be given to all children are suffering from septicaemia, extra-intestinal spread of bacterial infection, below 6 months and suffering from salmonella gastroenteritis, malnourished children suffering from salmonella gastroenteritis and finally those suffering from giardiasis, Clostridium difficile-associated pseudomembranous enterocolitis, dysenteric shigellosis, cholera or dysenteric amoebiasis. The nurse should advice parents or carers of children who have currently been out of the country to seek professional advice as regards antibiotic therapy (Pieścik-Lech, Shamir, Guarino, Szajewska, 2013). Other therapies The nurse should recommend zinc supplementation probiotics, oral ondansetron for all children below 5 years with acute gastroenteritis as it reduces the length and severity of diarrhoea and the possibility of recurrence (Cheng, 2011; Chen, Kong, Lai, et al. 2010 and Lazzerini, Ronfani 2012). Transfer of care During remote assessment, the nurse should arrange for emergency transfer to secondary health care for children with signs signifying shock. Also, the nurse should arrange for face-to face assessment for children with signs signifying another severe diagnosis or at increased risk of dehydration as well as children with signs signifying medical shock or whose social situation makes remote assessment undependable. Moreover, the nurse should give a ‘safety net’ to children who do not need referral. The safety net must contain information for parents or carers on how to identify signs of dehydration and shock and how to get instant help from a suitable healthcare professional in case of dehydration or shock. Finally, the nurse should arrange for follow-up at a specific time and place, if needed National Institute for Health and Clinical Excellence, 2009). Educate parents or carers For parents or carers taking care of children with gastro-enteritis at home, the nurse should inform them that many children with gastroenteritis may be safely handled at home, with guidance from a healthcare professional if needed. The nurse should also educate the parents or carers about the signs that indicate dehydration and shock and should advice then to seek medical help immediately these signs are detected. Moreover, the nurse should inform the parents or carers that children who are at high risk of dehydration include children below 1 year, especially those less than 6 months sold, infants who are born underweight, children who have had diarrhoea more than five times in the past 24 hours, children who have experienced vomiting more than two times in the past 24 hours, children who have not been given or have not been able to stomach supplementary fluids prior to presentation, children who are not breastfeed during the disease and lastly children with symptoms of undernourishment. Furthermore, the nurse should inform the parents or carers that the normal period of diarrhoea is 5–7 days and in many children it stops in 2 weeks and the normal period of vomiting is 1-2 days and in many children it stops in 3 days. The nurse should advice the parent or carer to seek medical advice if these signs do not disappear in these timeframes (National Institute for Health and Clinical Excellence, 2009). Preventing Gastro-enteritis Prevention is always better than cure as it save on health service resources. To prevent the spread of gastro-enteritis, a primary health care nurse should advice parents or carers as well as children on the importance of washing their hands using soap in warm running water and carefully drying them, washing their hands after visiting the toilet or after changing nappies (for parents or carer) as well as before cooking, serving and eating food. Also, the parents and carers should be warned against sharing towels used by children with gastro-enteritis (Ejemot, Ehiri, Meremikwu, et al 2008). Moreover, children with gastro-enteritis should not go to school or any other childcare service. Children should only be allowed to go back to their school or any other childcare service after at least 2 days of the last incident of diarrhoea or vomiting. Furthermore, children should only be allowed to swim in swimming pools after 2 weeks of the last incident of diarrhea (Health Protection Agency, 2010). In developing countries, breast feeding should be encouraged for protection against gastroenteritis. Rotavirus vaccines should also be recommended for preventing diarrhea (Tu, Woerdenbag, Kane, et al, 2011). Conclusion Many children with gastroenteritis may and must be managed in the community by a primary health care nurse through fluid management, nutritional management, antibiotic therapy and educational therapy and other therapies. Primary health care nurse should also be able to assess dehydration to identify children at high risk of dehydration and shock. Signs to look for include overall appearance, heart rate, prolonged capillary replenish time, altered responsiveness, pale skin, reduced urine output, dehydrated mucous membranes, sunken eyes, depressed fontanelle, absence of tears, respiratory rate, weak peripheral pulses, tachycardia, tachypnoea, reduced skin turgor as well as blood pressure. References Cheng A. (2011). Emergency department use of oral ondansetron for acute gastroenteritis related vomiting in infants and children. Paediatric Child Health; 16: 177–82. Chen CC, Kong MS, Lai MW, et al. (2010). Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhoea. Paediatric Infect Dis J; 29: 135–8. Ejemot RI, Ehiri JE, Meremikwu MM, et al (2008). Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 23 ;( 1):CD004265. Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. (2012). Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. 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