lOMoARcPSD|62239921
GASTROINTESTINAL
DEHYDRATION
1. Pediatric patients are at a higher risk for dehydration due to:
a. ↑ % body water
b. ↑metabolic rate
c. ↑BSA (body surface area)
2. Causes
a. Fever (insensible loss 7ml/kg/day for each degree)
b. ↓ Fluid intake
c. Vomiting and diarrhea
d. Burn injuries
e. Diabetes/DKA
f. Concentrated formula – body trying to water down the formula
Dehydration Lab values:
● ↑Urine spec. gravity > 1.030
● ↑Hematocrit
● ↑BUN & creatinine
● ↑Serum osmolality
Isotonic dehydration: hypovolemic shock
Hypotonic dehydration: shock & seizures
Hypertonic dehydration: neuro, LOC
Assessment
1. Weight loss (1Kg = 1L)
a. Mild: 3-6%
b. Moderate: 7-10%
c. Severe: >10%
2. Tachycardia
3. Tachypnea (abnormal respiration)
4. Sunken eyes
5. Poor skin turgor (abdomen)
6. Dry mucous membranes
7. Reduced tears
8. Sunken anterior fontanelle
9. ↓ # of wet diapers
10. Don’t forget to check Glucose
a. To identify new onset diabetes or DKA
11. RED FLAGS -> poor perfusion
a. Sleepy to lethargic
b. Not responding to pain
, lOMoARcPSD|62239921
c. Delayed capillary refill (>2 seconds)
d. Hypotension
e. Cyanosis
f. Cool peripheries/mottled
Therapeutic Management
1. Identify and treat cause
2. Monitor child’s weight closely
a. 1 kg = 1 L
3. Fluid replacement is the primary goal
a. Oral replacement for mild to moderate
i. Electrolyte drink (Pedialyte or diluted Gatorade)
ii. 2-5 ml every 2-3 minutes / over 4-6 hours
iii. Contraindications of giving oral fluids:
1. Decreased LOC
2. Tachypnea
b. IV replacement for severe
i. Bolus (NS or LR)
1. 20 mL/kg isotonic fluid over 20-30 minutes
ii. Maintenance fluids: 24hr
1. Weight-based
2. 1-10 kg: 100 ml/kg
3. 11-20 kg: 1000 ml + 50 ml/kg for each kg >10 kg
4. > 20 kg: 1500 + 20 ml/kg for every kg > 20kg
4. Monitor neurological status
5. Monitor cardiovascular status
6. Strict intake and output measurements (weight & diapers)
7. Monitor electrolytes
Increased Fluid Needs:
● Fever ● DKA
● Vomiting/ ↓ intake ● Burns
● pyloric stenosis ● Diarrhea
● Cystic fibrosis ● Shock
● Tonsillitis ● Tachypnea
● Herpes stomatitis ● Radiant warmer
● Diabetes Insipidus ● Phototherapy
● Post-op Bowel repair
Decreased Fluid Needs:
● Congestive heart failure ● With Increased intracranial pressure
● Syndrome of inappropriate ● Mechanical ventilation
antidiuretic hormone (siadh) ● Renal failure
● Fluid overload (post-operatively)
, lOMoARcPSD|62239921
Diarrhea:
● baseline weight/height & daily
● No fruit juice, soda, jello
● Replace K+ (if needed) + urine output
Constipation:
● Probiotics (Yogurt with bifidobacterium) are effective for children w/constipation
Hirschsprung Disease - the Spring is sprung
● congenital absence of ganglion cells (peristalsis) in the colon and / or rectum, resulting in
the patient not able to pass stool creating a backup
● Aganglionosis= absence of ganglion cells = no motility
● S/S:
○ poor feeding, diarrhea, lack of meconium, foul smelling ribbon-like stools, bilious
vomiting, abd. distention, chronic constipation
○ hx of bowel perforation, sepsis, shock
● E. coli infection occurs
● Treatment: surgical removal of aganglionic part of bowel to relieve obstruction & restore
normal bowel function. Re-anastomosis later on
● Labs: CBP, CMP, rectal biopsy
● Measurement tape will be left under the patient to avoid pain
● Temporary colostomy - teach about ostomy care
● Toilet training after age 2
Gastroesophageal Reflux
● gastric into esophagus -> weakness/dysfunction of sphincter
● delay gastric emptying
● Can lead to Aspiration pneumonia
● S/S:
○ Irritability, failure to thrive, freq. spitting up, weight loss
● Nursing Care:
○ sitting up position, smaller frequent meals, burp several times during feeding
(every oz), thicken foods/formula with larger nipple, moms to avoid caffeine,
smoking/alcohol, chocolate, avoid obesity, feeding tube (NG) for severe GERD
● Meds:
GASTROINTESTINAL
DEHYDRATION
1. Pediatric patients are at a higher risk for dehydration due to:
a. ↑ % body water
b. ↑metabolic rate
c. ↑BSA (body surface area)
2. Causes
a. Fever (insensible loss 7ml/kg/day for each degree)
b. ↓ Fluid intake
c. Vomiting and diarrhea
d. Burn injuries
e. Diabetes/DKA
f. Concentrated formula – body trying to water down the formula
Dehydration Lab values:
● ↑Urine spec. gravity > 1.030
● ↑Hematocrit
● ↑BUN & creatinine
● ↑Serum osmolality
Isotonic dehydration: hypovolemic shock
Hypotonic dehydration: shock & seizures
Hypertonic dehydration: neuro, LOC
Assessment
1. Weight loss (1Kg = 1L)
a. Mild: 3-6%
b. Moderate: 7-10%
c. Severe: >10%
2. Tachycardia
3. Tachypnea (abnormal respiration)
4. Sunken eyes
5. Poor skin turgor (abdomen)
6. Dry mucous membranes
7. Reduced tears
8. Sunken anterior fontanelle
9. ↓ # of wet diapers
10. Don’t forget to check Glucose
a. To identify new onset diabetes or DKA
11. RED FLAGS -> poor perfusion
a. Sleepy to lethargic
b. Not responding to pain
, lOMoARcPSD|62239921
c. Delayed capillary refill (>2 seconds)
d. Hypotension
e. Cyanosis
f. Cool peripheries/mottled
Therapeutic Management
1. Identify and treat cause
2. Monitor child’s weight closely
a. 1 kg = 1 L
3. Fluid replacement is the primary goal
a. Oral replacement for mild to moderate
i. Electrolyte drink (Pedialyte or diluted Gatorade)
ii. 2-5 ml every 2-3 minutes / over 4-6 hours
iii. Contraindications of giving oral fluids:
1. Decreased LOC
2. Tachypnea
b. IV replacement for severe
i. Bolus (NS or LR)
1. 20 mL/kg isotonic fluid over 20-30 minutes
ii. Maintenance fluids: 24hr
1. Weight-based
2. 1-10 kg: 100 ml/kg
3. 11-20 kg: 1000 ml + 50 ml/kg for each kg >10 kg
4. > 20 kg: 1500 + 20 ml/kg for every kg > 20kg
4. Monitor neurological status
5. Monitor cardiovascular status
6. Strict intake and output measurements (weight & diapers)
7. Monitor electrolytes
Increased Fluid Needs:
● Fever ● DKA
● Vomiting/ ↓ intake ● Burns
● pyloric stenosis ● Diarrhea
● Cystic fibrosis ● Shock
● Tonsillitis ● Tachypnea
● Herpes stomatitis ● Radiant warmer
● Diabetes Insipidus ● Phototherapy
● Post-op Bowel repair
Decreased Fluid Needs:
● Congestive heart failure ● With Increased intracranial pressure
● Syndrome of inappropriate ● Mechanical ventilation
antidiuretic hormone (siadh) ● Renal failure
● Fluid overload (post-operatively)
, lOMoARcPSD|62239921
Diarrhea:
● baseline weight/height & daily
● No fruit juice, soda, jello
● Replace K+ (if needed) + urine output
Constipation:
● Probiotics (Yogurt with bifidobacterium) are effective for children w/constipation
Hirschsprung Disease - the Spring is sprung
● congenital absence of ganglion cells (peristalsis) in the colon and / or rectum, resulting in
the patient not able to pass stool creating a backup
● Aganglionosis= absence of ganglion cells = no motility
● S/S:
○ poor feeding, diarrhea, lack of meconium, foul smelling ribbon-like stools, bilious
vomiting, abd. distention, chronic constipation
○ hx of bowel perforation, sepsis, shock
● E. coli infection occurs
● Treatment: surgical removal of aganglionic part of bowel to relieve obstruction & restore
normal bowel function. Re-anastomosis later on
● Labs: CBP, CMP, rectal biopsy
● Measurement tape will be left under the patient to avoid pain
● Temporary colostomy - teach about ostomy care
● Toilet training after age 2
Gastroesophageal Reflux
● gastric into esophagus -> weakness/dysfunction of sphincter
● delay gastric emptying
● Can lead to Aspiration pneumonia
● S/S:
○ Irritability, failure to thrive, freq. spitting up, weight loss
● Nursing Care:
○ sitting up position, smaller frequent meals, burp several times during feeding
(every oz), thicken foods/formula with larger nipple, moms to avoid caffeine,
smoking/alcohol, chocolate, avoid obesity, feeding tube (NG) for severe GERD
● Meds:
