Gastroenteritis: Diagnosis and Management (Nursing)

by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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    00:01 So now let's talk about how we're going to diagnose gastroenteritis.

    00:07 So we are going to take a very thorough patient history and we're really going to ask the patients and caregivers about their recent sick contacts.

    00:16 Have they tried any new foods? What foods have they eaten recently? Are there any that could have possibly been improperly stored or improperly prepared? Have they traveled anywhere recently that was different? Have they come in contact with any animals that could be carrying bacteria that could cause the gastroenteritis? And then have they use any new medications recently? We also want to talk about their symptoms.

    00:45 We want to know how often and how much a patient is vomiting or having diarrhea? And then we need to perform a thorough physical exam.

    00:55 While we're doing that we want to pay close attention to a patient's mental status, their pulses and perfusion, and looking for signs of dehydration.

    01:03 To see how sick this patient might actually be.

    01:08 Sometimes when we're diagnosing gastroenteritis, we use stool studies to rule out bacterial or parasitic causes of gastroenteritis.

    01:20 But these are usually only indicated if the symptoms have lasted for a long time.

    01:26 Remember, we said that viral gastroenteritis can last up to two weeks.

    01:30 So if that diarrhea or vomiting has gone past that two week mark, So if that diarrhea or vomiting has gone past that two week mark, So if that diarrhea or vomiting has gone past that two week mark, that's when we would probably investigate it with more stool cities.

    01:39 So how can we prevent gastroenteritis? The best prevention is frequent effective hand washing, particularly in those crowded settings such as schools and childcare centers.

    01:51 We want to make sure we're storing food properly, and avoiding contaminated water, particularly in places where there are known to be microbes.

    01:58 particularly in places where there are known to be microbes.

    02:00 And then we want to make sure kids are getting immunizations as recommended, both in the country and then if they're going somewhere else, if they need an immunization before they go to prevent gastroenteritis.

    02:12 So now let's talk about the treatment of this disease.

    02:16 So the most important part of this is replacement of fluid and electrolytes.

    02:22 We always prefer oral rehydration, and small frequent sips of oral rehydration solutions are the best way to accomplish this.

    02:31 We want to avoid giving kids juice, soft drinks like soda, and sports drinks like Gatorade because they don't have the right balance of sugar and electrolytes.

    02:45 Usually, it's mostly just sugar in those drinks, which can actually make diarrhea worse.

    02:50 If a kid is very sick, they may need intravenous therapy with IV fluids, and this would need to be done in a hospital setting.

    03:00 Finally, if a bacterial or parasitic infection is suspected, or confirmed antibiotics or other treatments, may be ordered.

    03:09 So last but not least, let's apply all this to the clinical judgment model.

    03:15 As always, we'll look at layers two and three.

    03:18 And we'll start by recognizing our cues, which are all sorts of signs and symptoms.

    03:26 So let's go back through the signs and symptoms or the cues of gastroenteritis.

    03:32 So these are when kids are vomiting, having diarrhea, or both.

    03:37 And they can have fever, abdominal cramps, abdominal pain, and then they may have dehydration.

    03:45 And some signs and symptoms of dehydration include decreased tear production, tacky mucous membranes, or dry mucous membranes.

    03:53 They may have poor skin turgor, since when that we have the tenting when you pull up on some of their skin.

    04:01 and an infancy might have that sunken fontanelle on their head.

    04:07 Now that we have our cues, let's analyze them.

    04:11 And we'll do this by looking for those in our physical exam.

    04:16 And through laboratory studies, particularly with a CBC or a complete blood count, and serum electrolytes.

    04:25 And then by calculating the patient's fluid balance.

    04:28 We want to compare everything that's going into the patient, whether that's something they're eating or drinking or with IV fluids.

    04:37 Compare that to what they're putting out whether that's vomiting, diarrhea, or urine, and see if the ins are more than the outs, or opposite.

    04:48 If the outs are more than the ins.

    04:49 And if the outs are bigger than the ins, they're probably dehydrated.

    04:53 Now we can prioritize the hypotheses.

    04:57 So we want to figure out what's causing the gastroenteritis? Is it a virus to this just start? Did they have a fever? Or might it be a parasite? Have they been having diarrhea for a long time, and they're starting to lose weight and be more fatigued? And then why are they dehydrated? As we saw when we are calculating our fluid balance, are they putting out a lot more than they're taking in? So now we can take action based on those hypotheses.

    05:29 We will give the patient rehydration.

    05:32 Hopefully oral but maybe IV.

    05:35 And then any antiemetic or anti-nausea medicines as ordered.

    05:40 And then we'll use our nursing interventions for comfort.

    05:43 So what can we do as nurses to make these patients feel better? Let's give them a favorite toys and TV shows.

    05:51 Maybe make sure there's someone with them to spend time with them and help them find positions of comfort in their bed.

    05:57 Lastly, let's evaluate the outcomes of our actions.

    06:01 So we're going to repeat our physical exam.

    06:04 We want to see that those signs of gastroenteritis have resolved.

    06:10 So are they still vomiting or having diarrhea? Has their abdominal pain gotten better? Has their fever gotten better? Has their mental status gotten better? And then we want to look at their repeat laboratory study.

    06:22 So have their electrolytes gone back to normal? Has their CBC gone back to normal? And then lastly, we're going to recalculate that fluid balance.

    06:30 So we want to make sure that the amount that patient is receiving or taking in is at least equal to and hopefully more than what they're putting out.

    06:40 That's the end of the judgment model.

    06:42 And that's the end of the lecture.

    06:43 So thanks for learning about gastroenteritis, and we'll see you next time.

    About the Lecture

    The lecture Gastroenteritis: Diagnosis and Management (Nursing) by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN is from the course Gastrointestinal Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. “I just need you to provide a stool sample so we can figure out what is causing your symptoms.”
    2. “I will conduct a physical assessment to ensure you’re not dehydrated.”
    3. “How many times do you have diarrhea in a day?”
    4. “Can you tell me what medications you are currently taking?”
    1. Ensure your child is up to date with vaccinations.
    2. Encourage your child to wash their hands frequently.
    3. Gastroenteritis can be caused by improper food storage.
    4. Gastroenteritis is primarily a food-borne illness.
    5. Gastroenteritis cannot be contracted through water.
    1. "Bring your child to the doctor or the hospital if their oral intake decreases or dehydration is suspected."
    2. "Offer your child frequent sips of fruit juice and sports drinks with added electrolytes."
    3. "Avoid giving your child anything by mouth until their diarrhea has passed."
    4. "Assess your child for signs of dehydration like a bulging fontanel."

    Author of lecture Gastroenteritis: Diagnosis and Management (Nursing)

     Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

    Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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