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.