Pediatric Gastrointestinal Dysfunction – Diarrhea
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Outline
Overview
- Defined as
- Stool volume > 10 g/kg/day in younger children
- >200 g/day in older children
- 9% of hospitalization in the US for children under 5 years of age
- May lead to dehydration, hypokalemia, metabolic acidosis, and death
Nursing Points
General
- Classified as Acute vs Chronic
- Acute
- Infectious
- Rotavirus
- Infectious
- Chronic
- Malabsorption or Inflammation
- Inflammatory Bowel Disease
- Food allergies
- Malabsorption or Inflammation
- Acute
Assessment
- Identify cause
- Recent travel
- Dietary changes
- Assess bowel characteristics
- Frequency
- Blood
- Mucous
- Assess for dehydration and fluid and electrolyte imbalances
- Hypokalemia is common
- Assess for signs of metabolic acidosis (↓pH ↓HCO3)
- Tachypnea
- Lethargy
- Seizures
- Poor perfusion
- Assess for malnutrition
- Weight loss
- Growth restriction
- Delayed puberty
- Decreased energy
- Pallor
Therapeutic Management
- Acute Diarrhea
- Rehydrate
- Oral Rehydration Solution
- IV Fluids
- Treat electrolyte imbalances
- Diet
- BRAT diet no longer recommended
- Slowly resume usual diet
- Instruct on hand hygiene
- Antimotility drugs
- Are not recommended
- Rehydrate
- Chronic Diarrhea
- Identify and treat cause
- Monitor Weight
- Monitor Growth
- Monitor Nutritional Status
Nursing Concepts
- Gastrointestinal/Liver Metabolism
- Fluid & Electrolyte Balance
- Elimination
Patient Education
- Rehydrate and promote return to regular diet as tolerated
- Notify provider if any signs of severe dehydration
- Notify provider if any bleeding in diarrhea
- Notify provider if any signs of metabolic acidosis
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References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
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ADPIE Related Lessons
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Transcript
Hey guys. In this lesson we are going to be talking about diarrhea in the pediatric patient. I know you’re already know a lot about this symptom and how it affects a patient’s fluid and electrolytes so I’m just going to highlight things that are different and noteworthy.
So, diarrhea is a really common cause of admission for pediatric patients, and the reason for this is because kids are at increased risk for dehydration and therefore they often end up needing to come into hospital for IV fluids and monitoring.
So the most common causes of the diarrhea that we see in kids and can be divided into 2 different categories. They are acute causes and chronic causes of diarrhea. The acute causes are almost always going to be infectious and an example of this is a virus called Rotavirus. Rotavirus used to be the a huge cause of admission but there’s actually a vaccine for it now so we are seeing a lot less admissions for this now! Which is great! Other infectious causes may be bacterial like salmonella from food poisoning.
Chronic causes of diarrhea are usually due to problems with absorption or because there’s inflammation in the bowel. Examples of this are Crohn’s Disease and food allergies.
Next you want to know more about the characteristics of the bowel movements. It’s really important to find out how often the child is having diarrhea and then what that stool actually looks like. You can see the photo to the left, is the Bristol stool chart which is a really helpful tool to use when you’re talking to families about what is actually happening when the child goes to the bathroom. A couple of things to pay really close attention to are frequency and if there is blood or mucus in the stool. Blood in the stool tends to be associated with infectious causes of diarrhea or can also occur in inflammatory bowel disease. Mucous and really foul smelling stools usually mean an issue with malabsorption. It’s probably a good idea to get a stool sample as well so it can be tested for specific causes!
Along with all of this you’ve got to pay really close attention to the kids fluid and electrolyte status. Like I said problems with dehydration and electrolytes are a really common cause of admission so you’ve got to be on the lookout for for these issues. The most likely issues will be dehydration and shock, low potassium levels and metabolic acidosis. We have a full lesson dedicated to talking about dehydration in kids so take a look at it for more information on this.
Our management of a patient with diarrhea is going to vary depending on what’s causing it. But generally, If we are treating acute diarrhea our primary objective is going to to be to make sure that patient is hydrated. Then we have to pay really close attention to the electrolyte and treat any imbalances that we see.
Now there’s a lot of talk about what we should do for a child’s diet when they have diarrhea or just gastroenteritis in general. Used to be recommended that kids be on this diet, called a Brat diet and this is a really just eating bland, carbohydrate based food- Bananas, Rice, Applesauce, Toast. Well, this diet is no longer recommended because it does have enough nutrients and proteins to actually help the child. Wo what we recommend now is just that they go back to eating their regular diet in small amounts until they feel normal.
In cases of acute diarrhea and gastroenteritis, antimotility drugs should not be used in children because of potential side effects.
It’s super important to educate parents on hand hygiene because viruses like rotavirus can be spread really easily.
Your priority nursing concepts for a pediatric patient with diarrhea are gastrointestinal/liver metabolism, fluid and electrolyte balance and elimination.
Ok so let’s just recap and go over your major take away points for this lesson! Really your starting point when thinking about diarrhea in a pediatric patients is knowing there are two categories. You have acute diarrhea and chronic cases of diarrhea. Acute diarrhea is what you’re going to see most often and it’s usually caused by a viral infection like something like the rotavirus And because of this a hand hygiene and contact precautions are really important. Chronic diarrhea is usually a problem of absorption or inflammation. And because of The Chronic problem we really have to pay close attention to the nutritional status and weight of these children.
Our top 2 issues for patients with diarrhea are dehydration and electrolyte imbalances. So most of our management is about treating these two issues. When were re-hydrating patients were either going to do this with Oral rehydration solutions or they may be so dehydrated they need IV fluids. The electrolyte imbalances that were going to be most likely to see are hypokalemia and metabolic alkalosis. If you want to know more about these specific issues take a look at the course on fluid and electrolytes
That’s it for our lesson on diarrhea in pediatric patients. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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NCLEX PARENT CHILD NURSING
Concepts Covered:
- Gastrointestinal Disorders
- Respiratory Disorders
- EENT Disorders
- Infectious Disease Disorders
- Lower GI Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Medication Administration
- Hematologic Disorders
- Integumentary Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Renal and Urinary Disorders
- Urinary System
- Studying
- Oncologic Disorders
- Central Nervous System Disorders – Brain
- Renal Disorders
- Infectious Respiratory Disorder
- Noninfectious Respiratory Disorder
- Urinary Disorders
- Sexually Transmitted Infections
- EENT Disorders
- Gastrointestinal
- Newborn Complications
- Pregnancy Risks
- Labor Complications
- Fetal Development
- Terminology
- Prenatal Concepts
- Newborn Care
- Labor and Delivery
- Postpartum Care
- Postpartum Complications
- Communication