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.