Dysentery and Diarrhea Quiz

Nursing Management of Gastro-intestinal Disorders

• Acute watery diarrhea is the second leading cause of mortality in children aged 0-59 months worldwide.

Diarrheal Disorders Definition

• Diarrhea is an increase in frequency, fluidity, and volume of stools, relative to the usual habits of the child.

Importance of Diarrhea

• Diarrhea increases mortality rates, with 25-30% of infants and preschoolers dying as a result.
• Diarrhea is a leading cause of illness in developing countries, increasing morbidity.
• Diarrhea spreads through the fecal-oral route.

Types of Diarrhea

• Acute Watery Diarrhea (80% of cases):
  • Starts acutely, lasts 3-4 days, then improves over 4-5 days.
  • Usually self-limiting, lasting less than 14 days.
  • May include fever and vomiting.
  • Watery or loose stools, no visible blood.
• Dysentery (5-10% of cases):
  • Loose stools with visible blood.
• Persistent Diarrhea (10% of cases):
  • Post-infectious diarrhea, starting acutely as watery stool or dysentery.
  • Lasts at least 14 days.
  • Main sequelae include dehydration, weight loss, and malnutrition.

Causes of Diarrhea

• Infectious Diarrhea:
  • Intestinal infection caused by viruses, bacteria, and protozoa. (Specific agents are listed in the image, but can't be reliably extracted).
• Non-Infectious Diarrhea:
  • Dietary factors: Overfeeding, food allergies, and formula that is too concentrated, or unsuitable for the child's age.
  • Malabsorption: Conditions like cystic fibrosis.
  • Other conditions: Irritable colon, ulcerative colitis, heavy metal poisoning, Hirschsprung's disease.
  • Misconception: Teething is not a cause of diarrhea.

Consequences of Diarrhea

• Dehydration: Due to loss of water and salts.
• Electrolyte disturbances.
• Metabolic acidosis: Due to reduced sodium bicarbonate.
• Malnutrition:

Dehydration

• Caused by loss of water and electrolytes in liquid stool and vomit.
• Fever can increase water loss.
• Dehydration can lead to hypovolemia (decreased blood volume) and death if untreated.

Degree of Dehydration

• Signs and symptoms appear with a 5% loss in body weight.
  • Mild dehydration occurs with less than 5% loss in body weight.
  • Moderate dehydration occurs with a 5-10% loss in body weight (average 7.5%).
  • Severe dehydration occurs with more than a 10% loss in body weight.

Types of Dehydration

• Isotonic: Most common type, water loss proportionate to sodium loss.
• Hypertonic: Less common (10-15%), more common in young infants, water loss greater than sodium loss.
• Hypotonic: Less common (5-10%), water loss less than sodium loss.

Clinical Assessment of Diarrheal Disorders

• History: Gather information about the diarrhea's duration, stool characteristics, presence of fever, vomiting, convulsions, other problems, medications, and vaccinations (especially measles)
• Assessment of Dehydration:
  • Two or more signs indicating severe dehydration in column C in the assessment criteria
  • Two or more signs in column B indicate moderate dehydration.
  • Column A indicates no signs of dehydration (mild).

Assessment Criteria for Dehydration

• Symptoms:
  • General condition (Alert, lethargic, etc.).
  • Eyes (Normal, sunken).
  • Thirst (Normally drinks, unable to).
  • Skin pinch (Quick/Slow). -Other assessments listed include the condition of the anterior fontanel (normal, sunken), moisture levels of the mouth/tongue (moist, dry, very dry), presence of tears, extremities (cool skin with cyanosed nails), pulse characteristics (weaker/more rapid), and signs of oliguria or anuria (urine output decreased).
• Further assessment

Therapeutic Management of Diarrhea (Dehydration)

• Treatment Focus:

  • Prevent dehydration (if not already present) through fluid therapy.
  • Treat dehydration with fluids (hydration).
  • Ensure continued feeding during and after diarrhea.
  • Maintain good hygiene, especially hygiene around the buttocks and neck/ears in the case of diarrhea and vomiting.

• Management based on the degree of dehydration.

  • Three treatment plans (Plan A, Plan B, Plan C).

Management Plans

• Plan A: Treatment at home.
• Plan B: Treatment at the Out-Patient Department.
• Plan C: Treatment at the Hospital.

Management of Dehydration: Fluids

• Plan A: Give more fluids (ORS, water, home-made fluids, breast milk).
• Plan B: Give more fluids (ORS).
• Plan C: Give intravenous fluids (Pansol, Ringer's lactate, normal saline, polyelectrolytes).

How much fluid, per plan

• Plan A: Give fluids after each loose stool (dosage for infants and toddlers).
• Plan B: 75 ml/kg of body weight within 4 hours. Specific dosage guidelines for the first hour and subsequent period are provided.
• Plan C: 100 ml/kg of body weight within 3-6 hours, with 30 ml/kg during the first 1½ hours, followed by 70 ml/kg over a 2.5 - 5 hour period
• Longer time for infants less than 1 yr of age.

How to administer fluids

• Plan A, B, and C:
  • Administration methods include cup and spoon, dropper, and syringe.
  • Plan C may include a nasogastric tube to administer fluids.

Feeding

• Breastfeeding: Continue breastfeeding.
• Milk or Formula: Administer milk or formula after rehydration.
• Weaned Children: Provide food after rehydration.
• Dietary Restrictions: Avoid hyperosmolar foods (high sugar) and foods with high fiber.

Further Assessment/Referral

• Reasons to return for further assessment: Frequent large stools, increased thirst, repeated vomiting, blood in stool, and lack of improvement (with fever also listed as a reason).

Oral Rehydration Solution (ORS)

• ORS is a balanced mixture of glucose and electrolytes used to prevent or treat dehydration.