infantile diarrhea
Diarrhea in children is a common disease in exams.
infantile diarrhea
I. Concept
Diarrhea in children, or diarrhea, is a group of clinical syndromes caused by many reasons, which is characterized by the increase of stool frequency and the change of stool characteristics. In severe cases, dehydration and electrolyte disorder can be caused. This disease is a common disease in infancy and one of the "four diseases" that children's health care in China focuses on. The onset age is mostly from 6 months to 2 years old.
I. Reasons
Vulnerable factors
1. Digestive system features: children have few digestive enzymes, low activity and poor digestive function, while infancy is the fastest growth period after birth, with more nutrients and heavy burden on the digestive system.
2. Poor body defense function
3. Artificial feeding
(2) Infection factors
1. The main pathogens of intestinal infection are rotavirus and Escherichia coli.
2. Parenteral infection
(3) Non-infectious factors
1. Dietary factors
2. Climate factors
Third, the pathogenesis
1. Noninfectious diarrhea
2. Infectious diarrhea
Viral enteritis: intestinal mucosal injury and disaccharidase deficiency.
Bacterial hepatitis: the toxin of secretory diarrhea
Invasion of intestinal mucosa, leading to inflammation.
Fourth, clinical manifestations.
(1) Clinical manifestations of various diarrhea.
1. Mild diarrhea, vomiting and diarrhea, no symptoms of dehydration and systemic poisoning.
2. Severe diarrhea
(1) Severe gastrointestinal symptoms
(2) Symptoms of systemic poisoning
(3) imbalance of water, electrolyte and acid-base.
(2) Clinical characteristics of enteritis caused by different causes.
1. Rotavirus enteritis, also known as autumn diarrhea, mostly occurs in autumn and winter. It is common in children from 6 months to 2 years old. Acute onset, often accompanied by fever and upper respiratory tract infection symptoms. The stool is yellow or yellow-green, without fishy smell, and water and electrolyte disorders often occur. Fecal microscopy occasionally shows a small amount of white blood cells.
2. E.coli enteritis mostly occurs in the high temperature season from May to August, mainly manifested as fever, vomiting, diarrhea and loose stool. In severe cases, dehydration, acidosis and electrolyte disorder may occur.
3. Fungal enteritis is mainly caused by Candida albicans infection, which is related to low immunity or long-term use of antibiotics. The main symptoms are thin yellow stool, more foam and mucus, sometimes tofu residue-like blocks (colonies), occasional bloody stools, fungal spores and pseudohyphae, positive fungal culture, often accompanied by thrush and yellow-white pseudomembrane around anus.
(3) Persistent diarrhea and chronic diarrhea
(4) Non-pathological diarrhea
1. "Physiological" diarrhea is more common in infants born within 6 months, with edema and eczema. Good growth of spirit, appetite and weight does not affect growth and development.
2. Children with hunger diarrhea are hungry and often cry because of hunger. The stool is characterized by a small amount of water. As long as you gradually increase your diet, your stool can turn normal.
Fourth, the auxiliary inspection
(1) Blood routine
(2) stool examination
(3) Blood biochemical examination
Verb (abbreviation of verb) therapeutic principle
1. Adjust diet and emphasize continuing to eat to meet physiological needs. However, it should be adjusted reasonably according to the special pathophysiological condition of the disease, individual digestion and absorption function and usual eating habits.
2. Control infection For 70% of children, watery diarrhea caused by viruses and non-invasive bacteria is generally not needed, and microecological agents and intestinal mucosal protective agents are used to avoid using antidiarrheal drugs. Antibiotics can be used for invasive bacterial enteritis, newborns, infants and immunocompromised people.
3. Correct water and electrolyte disorders
4. The symptomatic treatment of abdominal distension can be subcutaneous or acupoint injection of neostigmine or anal exhaust, and those with low potassium should be supplemented with potassium in time. Severe vomiting can be treated by acupuncture at Neiguan point or intramuscular injection of chlorpromazine. People with high fever are given physical cooling or antipyretic drugs.
5. The treatment of persistent and chronic diarrhea is based on the etiology.
Sixth, nursing evaluation
1. Health history
2. Symptoms and signs
3. Laboratory inspection
4. Social and psychological factors
Seven, nursing diagnosis/problems
1. Insufficient body fluid is related to excessive loss of body fluid and insufficient intake.
2. Malnutrition: Less than the body's requirement is related to diarrhea, vomiting, excessive loss of body fluids and insufficient intake.
3. Hyperthermia is related to intestinal infection.
4. The risk of skin integrity damage is related to the increase of defecation times, irritation of buttocks skin and improper use of diapers.
5. Lack of knowledge (parents) lack of reasonable feeding knowledge, health knowledge, diarrhea prevention and nursing knowledge.
6. Potential complications: acidosis, hypokalemia and hypocalcemia.
Eight, nursing goals and nursing evaluation
1. The frequency of diarrhea and vomiting gradually decreased to stop, and the stool characteristics were normal.
2. The dehydration and electrolyte disorder were corrected, the body weight returned to normal, and the urine volume was normal.
3. The child's temperature drops to normal.
4. The child's skin is intact.
Parents of children can take care of their children correctly under the guidance of medical staff.
Nine, nursing measures
1. Adjust diet
2. Monitor body temperature and control infection.
3. Observe the condition closely.
4. Pay attention to defecation.
5. Replenish liquid to correct water-electrolyte disorder and acid-base balance.
6. Hip care
X. Health education
1. Reasonable nutrition
2. Develop good hygiene habits
3. Guide parents to accurately configure and use ORS solutions.
strengthen body physique