section name header

Information

  1. ACUTE GASTROENTERITIS (AGE)
    1. Introduction: In infants and young children, gastroenteritis is a common acute illness that can rapidly progress to dehydration, hypovolemic shock, and severe electrolyte disturbances.
    2. Assessment:
      1. Diarrhea: often watery, green, explosive, contains mucus and blood.
      2. Abdominal cramping and pain, often accompanied by bouts of diarrhea.
      3. Dehydration: see Table 5-16. Signs and Symptoms of Dehydration in Infants and Young Children .
      4. Irritability, restlessness, alterations in level of consciousness.
      5. Electrolyte disturbances: see Chapter 6. Physiological Integrity.
    3. Analysis/nursing diagnosis:
      1. Fluid volume deficit related to vomiting and diarrhea.
      2. Altered nutrition, less than body requirements, related to AGE and its treatment (i.e., dietary restrictions).
      3. Pain related to abdominal cramping, diarrhea.
      4. Impaired skin integrity related to diarrhea.
      5. Altered tissue perfusion related to dehydration and hypovolemia.
      6. Knowledge deficit regarding diagnosis, dietary restrictions, treatment.
    4. Nursing care plan/implementation:
      1. Goal: prevent spread of infection.
        1. Standard precautions to prevent infection.
        2. Enforce strict hand washing.
        3. Institute and maintain enteric precautions—follow policies regarding linens, excretions, specimens ("double-bag, special tag").
        4. Tape diapers snugly; keep hands out of mouth.
        5. pillImageObtain stool culture to identify causative organism; then administer antibiotics as ordered.
        6. Identify family members and others at high risk, obtain cultures.
      2. Goal: restore fluid and electrolyte balance.
        1. pillImage Administer IV fluids and electrolytes as ordered.
        2. Monitor for appropriate response to therapy: decreased specific gravity, good skin turgor, normal vital signs.
        3. foodImageMonitor weight, I&O, specific gravity.
        4. Oral feedings—oral rehydration therapy (ORT) with Pedialyte or comparable solution; resume normal diet as quickly as possible.
        5. bulbImage Ongoing assessment of stools: note Amount, Color, Consistency, Timing (ACCT).
      3. Goal: maintain or restore skin integrity.
        1. Frequent diaper changes.
        2. Keep perineal area clean and dry.
        3. Apply protective ointments (e.g., petroleum jelly, A and D emollient ointment).
        4. If feasible, expose reddened buttocks to air (but not with explosive diarrhea).
      4. Goal: provide discharge teaching to parents.
        1. Careful review of diet to be followed at home.
        2. Review principles of food preparation and storage to prevent infection.
        3. Instruct in disposal of stools at home.
        4. Emphasize importance of good hygiene.
    5. Evaluation/outcome criteria:
      1. No spread of infection noted.
      2. Fluid and electrolyte balance normal.
      3. No skin breakdown noted.
      4. Parents verbalize understanding of home care.