Pediatric Vomiting (Nursing)

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

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

    00:03 And today we're going to talk about pediatric vomiting.

    00:06 This is what we're going to cover in our lecture, which is the definition, causes, signs and symptoms, diagnosis and management of the condition.

    00:17 First, how is vomiting defined? I'm sure as you probably all experienced vomiting is the forceful injection of gastric contents out of the mouth.

    00:28 It's not dribbling or drooling.

    00:31 It's not slow, it's usually very fast.

    00:34 And it's definitely something that the patient can't control.

    00:37 So now that we talked about what it is, what can cause it? There are a number of things, the first of which is infection.

    00:46 And this can either be caused by a virus or a bacteria.

    00:51 It can be caused by high intracranial pressure Gastrointestinal or GI obstruction is another cause.

    00:59 And that can be anywhere from the stomach, to the small intestine, to the large intestine.

    01:06 Gastrointestinal reflux. You might have heard it, sometimes people say GERD is where the stomach contents reflux up out of the stomach into the esophagus.

    01:18 And if that happens often enough, or forcefully enough, it can present as vomiting.

    01:23 There's Pyloric stenosis, which is a malformation or thickening of the pyloric muscle or sphincter that exits out of the stomach that allows food to pass through.

    01:35 So when that's too big, it doesn't allow food to move through, and then it backs up as vomit.

    01:41 There's in this intussusception, where you have two parts of the small intestine that are next to each other that slide over one another, that can cause a blockage, which leads to the same thing.

    01:55 Food can't get through, it backs up and then the patient vomits.

    01:59 And the same thing happens with foreign body.

    02:01 So a child may swallow something that's not digestible, such as a toy, or a coin, or a battery.

    02:09 And it gets stuck in the intestine, and that it doesn't allow food to pass through.

    02:14 Its the same thing. Gets blocked. The food backs up and they vomit.

    02:19 So what are the signs and symptoms of vomiting? One thing that we look at, and it's important are the fluid imbalances with this.

    02:27 And the first question that we ask either a patient or the caregivers of that patient, is how much are they vomiting? And how often are they vomiting? Because that's going to make a big difference in how we think about this patient.

    02:40 So if they're vomiting, one time over the course of an entire day, or are they vomiting every five minutes for an hour, or for 24 hours for that often, they could be either just a little bit sick, or they could end up being really sick.

    03:00 So how often they're vomiting and how much they're vomiting, contributes to their fluid status.

    03:06 So as a nurse, it's very important to think about your ins and outs for your patients, which is something you've probably heard about before, but we can talk about it again now.

    03:15 So your ins, are how much is a patient taking in or getting in? So how much are they drinking? How much are they eating? And then if they're in the hospital, how much IV fluids are they getting? And then their outs are, how much are they putting out? And that can be, how much of the vomiting? But then in that calculation, you also need to add in how much are they making urine and how much stool are they making? And then you compare the two.

    03:44 So if the ins are much greater than the outs, the patient probably isn't dehydrated, they're probably in a pretty good state of health.

    03:52 But if the outs are much, much bigger than the ins, then the patient is probably be dehydrated, and may have some electrolyte balances that we need to be concerned about.

    04:05 Some of those electrolyte balances and we measure these with laboratory tests like with the blood are sodium, potassium, and bicarbonate.

    04:15 And these are lab tests that are ordered by providers that the nurses will draw.

    04:20 But even though that you're not ordering them, it's important for you to know these numbers and to know if your patient's electrolytes are high, low, or normal.

    04:29 One condition that is affected or can be affected by a patient's electrolytes or results from a patient's electrolytes is called metabolic alkalosis.

    04:39 And if we think back to chemistry, you remember things that are alkalotic are higher than a pH of 7.4.

    04:46 And when a patient is vomiting, they're losing certain electrolytes, particularly chloride.

    04:49 And if they lose too much of this, that makes them more alkalotic, so their pH rises above 7.4.

    04:59 Signs of metabolic alkalosis. We'll cover those in a second.

    05:01 Are lethargy, neuromuscular irritability, tetany, which is like a rigidity of your muscles where you can't relax your muscles.

    05:12 And sometimes you think of tetany is related to tetanus, but you always think you might have heard of locked jaw with that, where patients literally can't open their mouth.

    05:21 And the picture of the hand here is also similar where your hand is so rigid, you can't relax it.

    05:27 And that's because of these electrolyte imbalances in this alkalosis.

    05:31 And then lastly, this can even result in seizures because of this pH disturbance.

    05:38 Another dangerous side effect, or consequence of pediatric vomiting is aspiration.

    05:45 And aspiration occurs when a patient is vomiting, or can even occur when they're trying to swallow it can happen in both situations, and the contents that should either be coming out of their stomach with vomiting, or going into their stomach while eating, or going into their lungs instead.

    06:07 Some ways that you as the nurse can assess for this is by listening to the patient's breath sounds.

    06:14 You can observe them swallowing.

    06:16 So if you notice that they have a very uncoordinated swallow, or they might seem like you can hear the formula, or the food not leaving their mouth correctly, it sounds very wet, when they're either talking or breathing outside of eating, that might be a sign.

    06:35 They may have foul smelling breath because of that They may have green sputum for the same reason for that same food that sitting in there is They may have shortness of breath, which goes back to the fact that they have things in their lungs, stuff in their lungs that they shouldn't.

    06:49 And it's making it harder for them to breathe normally.

    06:52 So they may be breathing too quickly.

    06:54 They may be not being able to take deep breaths.

    06:59 They may have frequent chest infections.

    07:02 There's a lot of bacteria in your mouth and in your stomach that doesn't belong in your lungs.

    07:08 And if patients are swallowing that, and it's getting into the lungs instead, it can cause pneumonias.

    07:16 And then lastly, a symptom of aspiration can be cyanosis.

    07:21 And cyanosis is a symptom, or a sign of having a decreased oxygen level in your blood.

    07:31 So if a patient's lungs aren't working properly, because they have stomach contents in them, they're not performing blood exchange correctly, so their blood oxygen levels not normal.

    07:44 They're not getting as much oxygen to their tissues as they should.

    07:49 And where you can see this is you may see blue tips of their fingers or blue tips of their toes or especially in younger kids, you can see what called perioral cyanosis, where it's around their lips and mouth can be blue, or gray, or even purple depending on the patient's skin color.

    About the Lecture

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

    Included Quiz Questions

    1. Gastrointestinal obstruction
    2. Infection
    3. Pyloric stenosis
    4. Decreased intracranial pressure
    5. Decreased stomach acid
    1. Ask the client’s caregivers how much and how often they are vomiting.
    2. Obtain blood work from the client.
    3. Initiate intravenous access.
    4. Give the client 25 mg dimenhydrinate orally.
    1. Auscultate the child’s lungs.
    2. Start the client on 2L O2 via nasal prongs.
    3. Swab the client’s mouth to obtain a sputum culture.
    4. Have the client rinse their mouth out with a sterile saline solution.
    1. Metabolic alkalosis
    2. Metabolic acidosis
    3. Respiratory acidosis
    4. Respiratory alkalosis

    Author of lecture Pediatric Vomiting (Nursing)

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

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

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