AKSUM UNVERSITYCOLLEGE OF HEALTH SCIENCEDPARTMENT OF

NURSING

POST GRADUATE PROGRAM IN PEDIATRIC AND CHILD HEALTH

NURSING PEDIATRIC NURSING -1
Prepared by 1.Ngsti G/michael 3.T/brhan W/rufael
2.shiwaynesh tilahun 4.Tekle
5 Abrhaley tesfay 6 fiseha abadi
7 kibrom
July 20, 2024 1
 Presentation Outline
• Objective
• Introduction
• Diarrhea
• Causes of diarrhea
• Clinical manifestations
• Complication of diarrhea
• Types of dehydration and management
• Treatment of diarrhea
• reference

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Objective

After completed this presentation the student will be able to

Define Diarrhea
List the clinical types of diarrhoea.
Causes of Diarrhoea
Discuss dehydration and types of dehydration

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 Introduction
• The term gastroenteritis denotes inflammation of the
gastrointestinal tract, most commonly the result of infections
with bacterial, viral, or parasitic pathogens Many of these
infections are foodborne illnesses Several clinical syndromes
are often described because they have different aetiologies,
outcomes, and treatments.

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 Diarrhoea

• Diarrhoea is defined as the passage of three or more loose or

liquid stools per day (or more frequent passage than is normal for
the individual).

Diarrhoeal disease is the second leading cause of death in children

under five years old.

• It is both preventable and treatable.

• Each year diarrhoea kills around 525 000 children under five.

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Cont.….
A significant proportion of diarrhoeal disease can be prevented through
safe drinking-water and adequate sanitation and hygiene.

Globally, there are nearly 1.7 billion cases of childhood diarrhoeal

disease every year.

Diarrhoea is usually short-lived, lasting no more than a few days.

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 Causes

Diarrhoea caused by A variety of bacterial, viral and parasitic organisms. Infection is

spread through contaminated food or drinking-water, or from person-to-person as A result
of poor hygiene .
• Viruses:- adenoviruses, Astro virus, cytomegalovirus and viral hepatitis.
• Rotavirus is a common cause of acute childhood diarrhoea.
• Bacteria and parasites:- E. coli or parasites through contaminated food or water, leads to
diarrhoea.
• Medicines:- anti-cancer drugs and antacids with magnesium.
• Surgery. Partial intestine or gallbladder removal surgeries can sometimes cause diarrhoea.

• July 20, 2024 7

Clinical manifestations

 Loose or watery stools

 pain in the abdomen
 Vomiting
 Head aches

July 20, 2024 8

 Cont.
• There are three clinical types of diarrhoea:
1. acute watery diarrhoea –is an abrupt onset of watery diarrhoea
occurred due to poisoning and infection of virus and bacteria .
lasts several hours or days, and includes cholera; , shigella manifested by
diarrhoea and vomiting, which can also be associated with systemic
features such as abdominal pain and fever
2.acute bloody diarrhoea or dysentery :-The most common causes of
dysentery are shigella bacteria (60% frequent small stools containing
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visible blood, often accompanied by fever, tenesmus, and abdominal pain.
larger volume bloody stools with less systemic illness) because the
aetiologies may differ. Prolonged (lasting 7-13 days) Treat for 5 days
with Cotrimoxazole. In addition, give zinc supplementation for 10 days.
Advice mother when to return immediately.

3.persistent diarrhoea – lasts 14 days or longer.

are important because of their impact on growth and nutrition

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Complication of diarrhea
Dehydration
Metabolic acidosis
Impaired consciousness
 convulsion
Circulatory shock
Pre renal azotemia
Electrolyte imbalance

July 20, 2024 11

 Dehydration

• During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium

and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing.
Dehydration occurs when these losses are not replaced.

• The degree of dehydration is rated on a scale of three.

• Severe dehydration (at least two of the following signs):

• lethargy/unconsciousness

• sunken eyes

• unable to drink or drink poorly

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Management
• If Children Coming With Sever Dehydration Treat With
• Plan C Step 1
• IV Ringer’s Lactate 30mls/Kg Over 30mins If Age > 12m
• OR Over 60mins If Age < 12m
• Plan C Step 2
• IV Ringer’s Lactate 70ml/Kg Over 2.5hrs If Age > 12m OR Over
5hrs If Age < 12m Give ORS At 5mls/Kg/Hr Via NGT.

July 20, 2024 13

Cont.

• Reassess the child every 15–30 min. If hydration status is not

improving, give the IV drip more rapidly. Also watch for over-
hydration.
• Also give ORS (about 5 ml/kg per h) as soon as the child can
drink: usually after 3–4 h (infants) and 1–2 h (children). Reassess
an infant after 6 h and a child after 3 h. Classify dehydration. Then
choose the appropriate plan (A, B or C) to continue treatment.
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 Some dehydration (two or more of the following signs):
• restlessness, irritability
• sunken eyes

• drinks eagerly, thirsty

• Treat Some Dehydration with ORS.

1.Calculate the amount of ORS required in some dehydration: 30-90

ml/kg).

2. Advise the mother to give calculated amount in 4 hrs in small quantities

at a time either with a spoon or in small sips.
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Never give large amounts with a bottle or cup.

This may be vomited out or may stimulate gastro-colic reflex and result in a
large watery stool.

– If the child vomits, wait 10 min, then continue, but more slowly.

Continue breastfeeding whenever the child wants. When you do not know the
weight, use the child’s age.

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3. Replenish ongoing losses by advising the mother to give 50-100 ml
of ORS to a child < 2 yrs and 100-200 ml in children between 2-10 yrs.
after passage of each diarrhoea stool.

.After 4 h: – Reassess the child and classify him or her for dehydration.
4 Select the appropriate plan to continue treatmen

5. Give Zinc supplements When is oral rehydrating therapy

July 20, 2024 17

• No dehydration (not enough signs to classify as some or severe
dehydration).

• Counsel the mother 4 rules of Home treatment

• 1. Give Extra fluid (as much as the child takes)

• 2. Give Zinc supplements

• 3. Continue Feeding

• 4. Advise mother when to return immediately

July 20, 2024 18

Diagnosis

• Blood test – CBC test, electrolyte and kidney function

• Stool test – to see bacteria or parasite

• Upper endoscopy- to examine stomach and uper small intestine

• Hydrogen breath test- to determine lactose intolerance

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 nursing Interventions to prevent diarrhoea ,
use of improved sanitation and hand washing with soap can reduce
disease risk.

Treat with oral rehydration solution (ORS), a solution of clean

water, sugar and salt. In addition, a 10-14 day supplemental
treatment course of dispersible 20 mg zinc tablets shortens diarrhoea
duration and improves outcomes.

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exclusive breastfeeding for the first six months

rotavirus vaccination.

safe drinking-water,

July 20, 2024 21

Medical interventions
Rehydration:

• with oral rehydration salts (ORS) solution ORS is absorbed in the small
intestine and replaces the water and electrolytes lost in the faeces.

Zinc supplements:

zinc supplements reduce the duration of a diarrhoea episode by 25% and are
associated with a 30% reduction in stool volume.

Rehydration:- with intravenous fluids in case of severe dehydration or shock.

July 20, 2024 22
Cont.

• Nutrient-rich foods:

• the vicious circle of malnutrition and diarrhoea can be broken by

continuing to give nutrient-rich foods – including breast milk and by
giving a nutritious diet – including exclusive breastfeeding for the first
six months of life

• Consulting a health professional, in particular for management of

persistent diarrhoea or when there is blood in stool or if there are signs
of dehydration.
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• References
1. Nelson Textbook of pediatrics21th editions
2. Diarrheal disease WHO
3. Basic Pediatrics Protocols.
4. Pub med pediatric gastro enteritis
5. Diarrhea books

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