Nursing
Nursing
Title: respond to post
Assignment Instructions: I have not encountered this situation at my clinical site thus far. However, I had children presenting with vomiting, in fact there was one today. The child came in with vomiting x 3 days off and on and was exposed to other children at school per mother. Shane et al. (2021) mentioned that infants in daycare settings are especially at risk due to the high likelihood of exposure to viral pathogens like rotavirus and norovirus.
The physical assessment priority for patients presenting with diarrhea and/or vomiting is to evaluate their hydration status. Dehydration is a common and potentially serious complication of acute viral gastroenteritis in infants and children. The assessment includes checking their vital signs to check for tachycardia, hypotension, and fever. Checking their general appearance to assess for signs of dehydration, such as poor skin turgor or dry mucous membranes. In infants. I would check for sunken fontanelle and check weight to assess for any weight loss.
Differential diagnoses:
1. Acute Viral Gastroenteritis: This is the most likely diagnosis given the symptoms of watery diarrhea, vomiting, and fever, along with the history of exposure at the daycare. Viral gastroenteritis is highly contagious and is common in infants in group care settings (Shane et al., 2021).
2. Bacterial Gastroenteritis: Bacterial infections such as those caused by Salmonella or Shigella can present with similar symptoms, including diarrhea and fever.
3. Urinary Tract Infection (UTI): UTIs in infants can present with fever and vomiting. The patient in this case study had fever and vomiting which could be due to UTI.
The primary diagnosis for this patient would be Acute Viral Gastroenteritis. This diagnosis is supported by the history of watery diarrhea, vomiting, fever, and recent exposure at the daycare center.
Treatment Plan:
The main treatment for this patient is to ensure adequate hydration. Oral rehydration therapy (ORT) with an appropriate solution (e.g., Pedialyte) would be initiated to replace lost fluids and electrolytes. I would encourage continued breastfeeding or formula feeding and avoid sugary drinks and fruit juices as they can worsen diarrhea (Shane et al., 2021). Apply a barrier cream such as zinc oxide to the buttocks to prevent further irritation and excoriation due to frequent diarrhea.
Referral:
If the infant shows signs of severe dehydration, such as lethargy, sunken eyes, or inability to retain fluids, I would send her to the emergency department for intravenous (IV) fluids and further management.
Follow-Up Care:
Follow up in 24-48 hours to reassess hydration status and ensure that symptoms are improving. Will educate the mother to monitor for signs of dehydration and worsening symptoms.
Yes, infants attending daycare are at higher risk of viral gastroenteritis due to close contact with other children. Additionally, infants under one year of age are more susceptible to dehydration due to a higher fluid turnover rate and less mature kidney function. Socioeconomic factors, such as access to clean water, proper sanitation, and healthcare resources, can also influence the severity and management of illness (Riddle et al., 2019).
If the parents are experiencing financial hardship, I would provide information on local or state assistance programs, such as WIC or Medicaid, that may cover the cost of oral rehydration solutions or other necessary supplies. I would recommend affordable, over-the-counter oral rehydration solutions that are readily available at most pharmacies or supermarkets. If commercial ORT solutions are not an option, I would instruct the parents on how to make a homemade oral rehydration solution using sugar, salt, and clean water. I will refer the family to community resources such as food banks, charitable organizations, or local clinics that may provide additional support. I will also offer them medication samples if available in the office.
The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend evidence-based guidelines for the care of acute viral gastroenteritis in children. these include the following:
ORT is the first-line treatment for dehydration in children with acute viral gastroenteritis. It is recommended over IV fluids for mild to moderate dehydration as discussed by Freedman et al. (2022).
It is important to continue breastfeeding or formula feeding during the illness. Early refeeding after rehydration can improve outcomes (Shane et al., 2021).
According to Freedman et al. (2022), the use of probiotics to reduce the duration of diarrhea, particularly in cases of rotavirus infection.
Antibiotics are not recommended for viral gastroenteritis and should be reserved for cases where bacterial infection is confirmed or suspected (Riddle et al., 2019).
Emphasize the importance of hand hygiene, especially in daycare settings, to prevent the spread of viral gastroenteritis. Rotavirus vaccination is also recommended as a preventive measure (Shane et al., 2021).
References:
Freedman, S. B., Xie, J., Neufeld, M. S., Hamilton, W. L., Hartling, L., & Tarr, P. I. (2022). Management of acute gastroenteritis in children: A systematic review of clinical practice guidelines and comparison with recommendations from the IFEMC international consensus meeting on pediatric emergency medicine. Pediatric Emergency Care, 38(9), e1294-e1300. https://doi.org/10.1097/PEC.0000000000002580
Riddle, M. S., DuPont, H. L., & Connor, B. A. (2019). ACG clinical guideline: Diagnosis, treatment, and prevention of acute diarrheal infections in adults. American Journal of Gastroenterology, 114(5), 698-712. https://doi.org/10.14309/ajg.0000000000000180
Shane, A. L., Mody, R. K., Crump, J. A., & Tarr, P. I. (2021). Global burden of acute gastroenteritis and implications for practitioners. Pediatrics, 147(1), e20203488. https://doi.org/10.1542/peds.2020-0348
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