Know: Condition, signs/symptoms, exam findings, diagnostics, treatment, patient
education.
There are at least 10 questions on statistics regarding STDs
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Week 5
Readings (Burns):
Chapter 40: Gastrointestinal Disorders
Chapter 41: Genitourinary Disorders
Chapter 45: Endocrine and Metabolic Disorders, pp. 952–964
Gastrointestinal
Dehydration
Dehydration
A common problem, increase risk of diarrhea
Infants and young children are at highest risk
Body fluids make up 75% of an infant’s body weight
Infants/toddlers’ high ratio of surface area to weight equals more body loss
through evaporation
Diarrhea
Acute diarrhea is typically caused by viruses, like rotavirus, bacteria, and
parasites
Rotavirus is common in infants between 3 and 15 months of age
Chronic diarrhea can be caused by antibiotic treatment of another condition, poor
absorption of starches and sugars, food allergies, laxative abuse in eating
disorders, hyperthyroidism, or irritable bowel syndrome
In acute cases, treatment is supportive and includes fluid and electrolyte
replacement and/or antidiarrheals based on age; in chronic cases, treatment is
specific to the underlying conditions
Assessing dehydration
History of present illness (HPI): quantity and frequency of fluid intake, vomiting,
and/or diarrhea, urine output or number of wet diapers in 24 hours, duration or
degree of fever, types of medications, underlying diseases
Weight is the most essential measure in calculating body fluid loss
Physical exam (PE): vital signs, color, capillary refill, skin turgor, dryness of lips
and mucous membranes, lack of tears, sunken fontanelles, output, and mental
status
Treatment of mild to moderate dehydration (Centers for Disease Control and Prevention
[CDC], n.d.c.); Hay et al., 2020)
Commercially available oral hydration solutions (ORS)
Continue breastfeeding with ORS supplementation
Offer young children 20 ml/kg per hour
Offer older children 100 mL of ORS every 5 minutes
Combine with IV therapy as needed
Reassess after 4 hours; repeat if needed
Avoid juice, soft drinks, and sports drinks
Treatment of severe dehydration (CDC, n.d.c.; Hay et al., 2020)
Evidence of compromised perfusion and severe dehydration
IV therapy of Ringer's lactate or normal saline if Ringers not available
o under 1 year, 30 ml/kg over the first hour, 70 ml/kg for the following 6
hours, and 100 ml/kg from 6 to 24 hours.
o over 1 year, 30 ml/kg over the first 30 minutes and 70 ml/kg for the
following 3 hours.
o reassess every 15 to 30 minutes
(Dehydration – info from book)
Classifications:
Mild (<3% weight loss when compared with recent current weight in older children and
5% in infants)
Moderate (6% in older children and 10% in infants)
Severe (9% or greater in older children and 15% or greater in infants)
Symptoms Stages of Dehydration
Minimal or none
(<3%)
Mild to Moderate (3-
9%)
Severe (>9%)
Mental Status Well, alert Normal, fatigued or
restless, irritable
Apathetic, lethargic,
unconscious
Thirst Drinks normally,
might refuse liquids
Thirsty, eager to drink Drinks poorly, unable
to drink
Heart Rate Normal Normal to increased Tachycardic, brady in
severe cases
Quality of pulses Normal Normal to decreased Weak, thready, or
impalpable
Breathing Normal Normal, fast Deep
Eyes Normal Slightly sunken Deeply sunken
Tears Present Decreased Absent
Mouth and tongue Moist Dry Parched
Skinfold Instant recoil Recoil in <2s Recoil in >2s
Capillary refill Normal Prolonged Prolonged, minimal
Extremities Warm Cool Cold, mottled,
cyanotic
Urine output Normal to decreased Decreased Minimal
Most often due to infectious process, usually viral, that causes diarrhea.
Types:
isonatremic (isotonic)
o When dehydration is caused by simple diarrhea, homeostatic mechanisms can
usually maintain sodium concentrations in the serum, resulting in isonatremia.
hypernatremic (hypertonic)
o When vomiting occurs with diarrhea and water intake is less, there is greater
water loss than salt loss, potentially resulting in hypernatremic dehydration.
hyponatremic (hypotonic)
o When there is massive stool loss of water and salt and only water is ingested,
there is a large salt loss, potentially resulting in hyponatremia.
S/S:
Vomiting early in the morning is indicative of increased intracranial pressure.
Exam:
Growth parameters and vitals
Neuro: nuchal rigidity, decreased LOC, behavioral changes.
o Sensorium remains intact until there is greater than 6% weight loss d/t
dehydration [Show Less]