Pediatric Diarrhea: Diagnosis and Managment (Nursing)

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

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    00:01 Hi, I'm Dr. Jackie Calhoun.

    00:02 And today we're going to talk about how to diagnose pediatric diarrhea with laboratory studies and imaging.

    00:10 So in this lecture, we're going to cover the diagnosis and then the treatment.

    00:15 And this is the follow up to the previous lecture, where we covered the definition, causes, and signs and symptoms.

    00:23 So let's start with how do we make a diagnosis of pediatric diarrhea.

    00:27 Most of these cases are diagnosed based on the history and physical exam alone.

    00:33 Like your patient will come in, and their parents will be like, "Oh, they've been pooping 14 times today." And like, oh, that sounds like they're probably having diarrhea.

    00:42 But sometimes we need to investigate more.

    00:45 And if we're concerned, they may have an infection, we might use stool cultures.

    00:50 And then, if they've been having diarrhea for a long time, we might check serum electrolytes to see how those look we might check serum electrolytes to see how those look in comparison to normal or blood gases.

    01:01 And both of these can help check the severity of the disease.

    01:03 And both of these can help check the severity of the disease.

    01:05 The more abnormal these values are, The more abnormal these values are, the more likely those patients are to be sick.

    01:12 So how do you treat pediatric diarrhea? Rehydration is the most important treatment.

    01:20 And this may also include replacement of electrolytes as well, depending on how abnormal those electrolytes are when you check them.

    01:31 We always want to try to replace the fluids orally first so have the patient drink what they need to before we move to IV therapy.

    01:41 But if the kid is very sick that might be required.

    01:45 Antibiotics might be indicated in some bacterial infections.

    01:50 But it's always important to remember that antibiotics can also cause diarrhea.

    01:55 So if we're giving them unnecessarily, we actually might be making the problem worse.

    02:00 It is important to note that we rarely give antidiarrheal medications to kids because children can easily develop constipation.

    02:11 Most types of diarrhea in kids are self limiting.

    02:14 So they're going to go away on their own, especially if it's caused by a virus or a certain food.

    02:21 And if we give them medication, to dry up that diarrhea, the kids are going to be constipated, and will have actually more problems.

    02:32 So let's work through this checklist, which are things we need to look for nursing interventios that we should do.

    02:41 So first, we need to obtain a thorough history about the patient.

    02:47 We want to include questions about their dietary intake.

    02:51 Do they go to school or daycare? Are they around a lot of other kids that could be giving them viruses that are causing diarrhea? What kind of play activities are they doing? Do they play things with other kids where they're sharing a lot of toys, which can be a way that they can transmit diseases more easily? We want to talk about the frequency or how often how much.

    03:15 What does the stool like? Is it thick or thin? And then how does it smell? We want to know all those things about the kids diarrhea.

    03:27 We need to accurately monitor the patient's fluid balance.

    03:32 and hydration level.

    03:35 So we are going to, as we're providing that oral or IV rehydration therapy as ordered, we're going to make sure we know exactly how much we're giving them.

    03:46 And we also want to know how that compares to how much they need based on their size.

    03:52 Additionally, we also want to know how much they're putting out.

    03:56 So it's important to measure that as well.

    03:59 We're going to calculate the patient's weight loss percentage.

    04:03 So basically, we're going to take their healthy weight or the way they were before they started having diarrhea, and compare that to the weight they are now.

    04:13 And that's going to give us a pretty good guess as to how much weight they've lost, and then how much fluid they lost.

    04:20 And one of the ways we do this is by obtaining a patient weight daily We want to make sure that we are advancing children to a regular diet or what they normally eat.

    04:35 Once they're tolerating that oral rehydration, because this is gonna reset their body's digestion and start getting them back to health.

    04:43 We want to notice if this diarrhea is causing them to have changes in their eating patterns, and eating behavior.

    04:51 And then, if they're on tube feeds, or even just regular formula feeds with a bottle, we want to make sure that it's been mixed properly.

    05:01 So, if it's too concentrated, especially in infants, So, if it's too concentrated, especially in infants, this can be a big cause of diarrhea.

    05:07 We want to make sure that patients are tolerating foods properly.

    05:13 We want to make sure that patients are tolerating foods properly.

    05:13 So especially with milk and other dairy foods that can cause diarrhea in patients.

    05:19 So we want to see if they're drinking a lot of milk, and having a lot of diarrhea, they may be lactose intolerant.

    05:26 We want to rule out other food intolerances as well.

    05:30 And then we want to look at methods of food preparation.

    05:33 So remember, bacteria can be a cause of diarrhea.

    05:36 And many bacteria that patients acquire that cause diarrhea comes from undercooked or raw foods.

    05:45 So if patients are being served a lot of raw meat, raw eggs, contaminated shellfish, that might be what's causing them to have these symptoms.

    05:56 Stress levels can speed up the digestion.

    05:59 So if a patient is under has a lot of stress or anxiety, that could be causing them to have diarrhea, and then fecal impaction.

    06:08 So, this is always a funny one, because you would think of someone is technically constipated, like, how can they be having diarrhea.

    06:15 But it's actually if there is stool that's lodged in the colon somewhere, you can actually have watery stool, be able to be moved around that.

    06:28 And so you can see the watery diarrhea come out.

    06:30 But there's actually stool lodged in there as well.

    06:33 So if you rule out all other causes, this could be part of it too.

    06:38 We're going to assess the patients for signs of dehydration.

    06:41 And the signs includes low or no urine output, which makes sense.

    06:46 So if the patients are dehydrated, they don't have enough fluid in their body to make urine with.

    06:52 They may all have poor skin turgor.

    06:55 And this is where you where you pinch a part of the patient's body.

    06:57 So it can be their abdomen, it can be up by their shoulder, can be even on their hands.

    07:02 And if that skin doesn't spring back to normal quickly, if it's tenty is what we often call it, that can be a sign of dehydration.

    07:13 They may not be making adequate tears.

    07:16 So if they're crying and there's no tears coming out, that's a problem.

    07:20 They may have tacky or dry mucous membranes, that could be an absence of saliva.

    07:26 And then in infants that they have a sunken fontanelle.

    07:28 So in the front of their head, this right here is a little open space where the sutures have been closed in their skull.

    07:36 And you can feel it's usually flat and flush with the bone.

    07:40 But if a patient if a baby is dehydrated, that's actually going to be lower down than the rest of the skull is.

    07:47 And then, lastly, we want to look at all the labs that we've drawn on these patients, particularly the electrolytes and the blood gases.

    07:55 Okay, so now let's put it all into the clinical judgment model.

    07:59 We'll look at layers two, and three.

    08:02 And we'll start by recognizing the cues or the signs and symptoms of pediatric diarrhea.

    08:09 So the signs and symptoms of diarrhea include the abdominal cramps, maybe abdominal pain.

    08:16 We're going to have that increase intestinal activity.

    08:17 We're going to have that increase intestinal activity.

    08:19 so we're going to hear more active bowel sounds than normal.

    08:24 We might actually, you know, see their intestines moving a little bit under their skin.

    08:28 They're going to have urgency.

    08:29 They're going to have to go to the bathroom quickly.

    08:32 And then signs of dehydration include those things we just talked about.

    08:35 Where we have absence of tears and tacky mucous membranes, Where we have absence of tears and tacky mucous membranes, and poor skin turgor or the tenting of the skin.

    08:40 and poor skin turgor or the tenting of the skin.

    08:42 And then, in infants, we have the sunken fontanelle.

    08:47 We're gonna, let's analyze those cues now.

    08:49 So we want to pay close attention and looking for those things on our physical exam with our patients.

    08:56 We want to pay close attention to their laboratory studies, particularly those electrolytes and blood gases to see how close to normal they are.

    09:05 And then we want to calculate a very accurate fluid balance.

    09:10 So we want to make sure we calculate all of the ins that a patient is taking in both IV, and what they're eating and drinking.

    09:17 And then what they're putting out through diarrhea, urine, and then sometimes vomiting as well.

    09:26 And we want to compare that and see if the ins are much higher than the outs or vice versa, and that can be a sign of dehydration, and then how severe the diarrhea is.

    09:37 So now, we need to prioritize those hypotheses that we developed.

    09:42 So we want to know what is causing this patient to have diarrhea? So we want to know what is causing this patient to have diarrhea? Do we think this is a virus or a bacteria? Do we think that it's caused by a certain food that they're eating? Are they having a lot of stress? And all of that we're going to talk to those patients and families to get a really good history, to see, you know, what could be causing this? And then why are they dehydrated? Are they not drinking anything but having a lot of diarrhea? Are they vomiting in addition to having diarrhea? Are they not making much urine either.

    10:16 So this is all goes into, like, why they are dehydrated and figuring out how to how to fix that problem.

    10:22 So now we can develop our action plan, and that includes giving rehydration, particularly, we want that oral rehydration, and then IV if the patient needs to have it.

    10:35 And then at night, any antiemetic medication is ordered.

    10:38 So if the patient is throwing up or vomiting, in addition to having diarrhea, we may give medicine to help suppress that nausea and vomiting.

    10:46 But remember, we're never going to give an antidiarrheal medication to kids.

    10:51 And now we're going to use our nursing interventions for comforting these patients.

    10:55 So what can we do as nurses to help make these patients feel better? So give them their favorite toy. Give them their favorite show.

    11:02 Make sure they're comfortable in bed.

    11:05 Make sure there's people with them to spend time with them.

    11:09 And then lastly, let's evaluate the outcomes of our actions.

    11:14 So we're going to repeat our physical exam.

    11:16 Let's make sure that their bowel sounds have returned to normal, that they look hydrated again.

    11:22 So are they making tears? Are their mucous membranes look good? Are they making urine again? And then let's look at our repeat our lab studies one more time.

    11:29 So let's make sure those are electrolytes are on normal again, those blood gases are normal.

    11:34 And then lastly, we're going to recalculate our fluid balance again so that we can compare those ins and outs and they should match up, or even the ins should be a little more than the outs at this point.

    11:42 or even the ins should be a little more than the outs at this point.

    11:45 And that's the end of our judgment model.

    11:47 So thank you for listening.

    11:48 And I hope you learned something. And see you next time.

    About the Lecture

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

    Included Quiz Questions

    1. Based on history and symptom presentation.
    2. Based on stool culture results.
    3. Based on electrolyte levels.
    4. Based on blood culture results.
    1. Oral or intravenous rehydration.
    2. Antibiotic therapy.
    3. Antidiarrheal medications.
    4. Obtaining stool cultures.
    1. “We recently switched my child from dairy-free formula to cow’s milk.”
    2. “I always make sure to add the amount of water it says on the formula package.”
    3. “My child has a gluten intolerance, so I make sure everything they eat is gluten-free.”
    4. “I always sterilize my child’s bottles between uses.”
    1. Weighing the client daily.
    2. Assessing for dehydration.
    3. Monitoring urine and fecal output.
    4. Encouraging adherence to a clear liquid diet.
    5. Obtaining daily complete blood counts.

    Author of lecture Pediatric Diarrhea: Diagnosis and Managment (Nursing)

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

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

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