Pediatrics, part 65: Gastrointestinal Disorders - Acute Infectious Diarrhea & Dehydration


Cathy discusses acute infectious diarrhea, dehydration, and the prevention and treatment of infectious gastrointestinal disorders. She discusses the common causes of acute infectious diarrhea, including Rotavirus, E. coli, Salmonella, and Giardia. Cathy then discusses the risk factors, signs/symptoms, labs, treatment, and nursing care of a child with acute infectious diarrhea. She goes into detail about the specific signs and symptoms you can expect with mild, moderate, and severe dehydration. Cathy then discusses the prevention and treatment of infectious gastrointestinal disorders. And finally, she provides a quiz at the end to test your understanding of key points she made in the video.

  • 00:00 Introduction
  • 00:42 Common causes of acute infectious diarrhea
  • 1:59 Risk factors, signs/symptoms, labs, treatment, nursing care of acute infectious diarrhea
  • 4:05 Signs/symptoms of dehydration
  • 6:18 Prevention & treatment of infectious gastrointestinal disorders
  • 8:25 QuizTime!

Full Transcript: Pediatrics, part 65: Gastrointestinal Disorders - Acute Infectious Diarrhea & Dehydration

Hi, I'm Cathy with Level Up RN. In this video, we will be talking about acute infectious diarrhea, as well as dehydration and the prevention of infectious gastrointestinal disorders. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN pediatric nursing flashcards, go ahead, and pull out your flashcards so you can follow along with me, and pay close attention to the bold red text on these cards, because those are the things that you are likely to see show up on a nursing school exam.

Acute infectious diarrhea can be caused by a virus, bacteria, or parasite. So there are many different microorganisms that can cause infectious diarrhea. Some of the more common ones that I would be familiar with in nursing school include rotavirus, E. coli, salmonella, and Giardia. Rotavirus is a virus that is transmitted through the fecal-oral route, and it is the most common cause of diarrhea in children under five. Of note, rotavirus is preventable through vaccination. E. coli is a bacteria that is also transmitted through the fecal-oral route, but can also be transmitted through contaminated food. So Shiga toxin producing E. coli, which is a specific strain of E. coli, can cause bloody diarrhea, as well as hemolytic uremic syndrome. Salmonella is a bacteria that is transmitted through contaminated food, such as undercooked meat. And then Giardia is a protozoan infection that is transmitted through contact with infected people or animals or unfiltered water. Risk factors for acute infectious diarrhea include a recent travel history, recent antibiotic use, which can cause diarrhea due to Clostridium difficile, or C. diff. Other risk factors include poor hygiene, crowded living conditions, poor sanitation, lack of clean water, as well as consuming raw, undercooked, or contaminated foods. In addition to loose, watery stools, signs and symptoms of acute infectious diarrhea include cramping, abdominal pain, vomiting, fever, and dehydration. So dehydration is a huge risk for children. So we will definitely be talking about dehydration in a lot more detail in this video.

In terms of diagnostic tests, blood tests and stool cultures may be ordered, and diarrhea can lead to electrolyte imbalances such as hyponatremia and hypokalemia, and lead to metabolic acidosis as well. And then the child's urine-specific gravity will be increased due to fluid loss with diarrhea. Treatment of infectious diarrhea in children includes the administration of oral rehydration solution, or ORS. Severe diarrhea may require the administration of IV fluids and electrolytes, and then antiemetics can be prescribed for nausea and/or vomiting.

So as the nurse caring for a patient with acute infectious diarrhea, it's going to be very important that you monitor your patient's weight, as well as their intake and output. And then you will also want to provide important family teaching regarding the prevention and treatment of infectious diarrhea at home, which we will talk about at the end of this video, but let's first go into more detail about dehydration. Here on the screen, I have a flashcard from our pediatric nursing flashcards that covers important information about the signs and symptoms of dehydration, which you are very likely to get tested on in nursing school. So dehydration can cause decreased skin turgor, dry mucous membranes, sunken fontanelles, hypotension, tachycardia, and an increase in respiratory rate. And then other signs and symptoms will vary depending on if the child has mild, moderate, or severe dehydration.

So in terms of weight loss, you can expect a weight loss between 3 and 5 percent with mild dehydration, a weight loss between 6 and 10 percent with moderate dehydration, and a weight loss over 10% with severe dehydration. And then in terms of level of consciousness, with mild dehydration, the child will be alert and thirsty, with moderate dehydration, the child will be irritable, and then with severe dehydration, the child will be lethargic, or they may be in a coma. And then in terms of capillary refill, this will be equal to or less than two seconds with mild dehydration, between two and four seconds with moderate dehydration, and over four seconds with severe dehydration. And then in terms of urine output, it will be relatively normal with mild dehydration, it will be decreased with moderate dehydration, and then with severe dehydration, the child will be urinating very little or not at all. And then in terms of the appearance of the eyes, they will appear normal with mild dehydration. With moderate dehydration, they will be slightly sunken, and we will have a decrease in tear production. And then with severe dehydration, they will be deeply sunken, and no tears will be produced when the child is crying.

Let's now talk about prevention of infectious diarrhea, which is something you will definitely want to teach your families about. So this teaching should include the importance of hand hygiene, particularly before eating or handling food and after using the restroom. Foods should be properly prepared and stored. So this means cooking meats thoroughly and using separate equipment for raw meats as opposed to cooked foods. And then it's also important to refrigerate perishable items within two hours of purchasing or cooking.

Only properly treated water should be consumed, so unsafe water, such as water from lakes or rivers, should be avoided. Super absorbent diapers should be used to help prevent leaking and contamination, and then gloves should be worn when handling the diapers or stool of an infected child. And then sandboxes need to be covered when not in use to prevent animals from using them like a litter box. When a child has acute infectious diarrhea, the caregiver should provide oral rehydration solution in small, frequent intervals. Fruit juices, caffeine, soda, gelatin, and broth should be avoided. And then a BRAT diet, which includes bananas, rice, applesauce, and toast, was recommended for decades during episodes of diarrhea, but is no longer recommended by the American Academy for Pediatrics because it is lacking in key nutrients and can actually increase the duration of diarrhea. And then finally, the best way to monitor hydration in infants and young children is to count the number of wet diapers per day. So most babies have between six and eight wet diapers per day.

All right. It's quiz time, and I've got five questions for you this time because we went over a lot of important information.

Question number one. What is the most common cause of acute infectious diarrhea in children under five years old?

The answer is rotavirus.

Question number two. What type of liquid should be provided to a child with acute infectious diarrhea?

The answer is an oral rehydration solution.

Question number three. What acid-base imbalance may be caused by diarrhea?

The answer is metabolic acidosis.

Question number four. A BRAT diet is recommended for a child with acute infectious diarrhea. True or false?

The answer is false. A BRAT diet is lacking in nutrients and may actually prolong the child's diarrhea.

Question number five. What is the best way to monitor the hydration status of an infant?

The answer is you want to count the number of wet diapers per day.

All right. That is it for this video. I hope you found it to be helpful. Take care and good luck with studying.

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