September - APNA

More documents

Recommendations

Info

CLINICAL CARE Gastroenteritis in children Each year around 20 000 children suffering dehydration, as a result of gastroenteritis, are admitted to Australian hospitals and over a million more consult a general practitioner 1 . Gastroenteritis in infants and children is a common intestinal infection, which causes vomiting, diarrhoea and fever and can usually be managed at home by encouraging oral rehydration therapy (ORT). Acute gastroenteritis is the most frequent diagnosis in paediatric emergency departments across Australia and New Zealand 2 . Gastrointestinal conditions accounted for the highest number of calls to the Kidsnet helpline service 3 , emphasising that managing vomiting and diarrhoea at home is still a great concern to parents. What is gastro Diagnosis of gastroenteritis evolves from the exclusion of other causes of vomiting and diarrhoea, such as infective, surgical and metabolic. Although it can sometimes be bacterial or parasitic, the majority of cases are viral — the most common of which is rotavirus. Gastroenteritis is seasonal and usually presents in autumn and winter, with rotavirus peaking in spring. As there are no indications for anti motility or anti diarrheal drugs in children, and antiemetics are avoided due to the high risk of Degree of Dehydration Very mild (3%) Mild (5%) Moderate (7-8%) Severe (>10%) Table 1. An overview of the signs and symptoms of dehydration. side effects, the key to managing gastroenteritis is achieving and maintaining adequate hydration 4 . How to determine dehydration Determining if a child is dehydrated and to what extent is difficult, as individual signs of dehydration are imprecise. The following combination of three clinical signs has been shown to be the most accurate for assessing dehydration 5 . 1. Increased capillary refill >2 seconds 2. Abnormal skin turgor 3. Abnormal respiratory patterns (deep acidotic breathing) What next The use of ORT for mild and moderate dehydration can prevent or reduce hospitalisation and aid in a child’s recovery. Oral rehydration therapy has become the therapy of choice as it has been shown to be as effective as intravenous therapy, with fewer adverse effects 6 . As dehydration is a deficiency in both fluids and electrolytes, introducing oral rehydration solutions such as Hydralyte is extremely beneficial as early intervention. Oral rehydration solutions use the principle of glucose Symptoms and Signs Reduced urine output, thirst, no clinical signs Dry mucous membranes Mild tachycardia Lethargy, tachycardia, reduced skin turgor, sunken fontanelle, sunken eyes Above + poor perfusion, shock facilitated sodium transport in the small intestine, to facilitate intestinal water absorption 6 . Drinks with high sugar content have a high osmolarity and therefore may increase diarrhoea and the risk of dehydration. For this reason, sports drinks are unsuitable for rehydration 7 . Breastfed babies should continue with frequent feeds, and may be supplemented with oral rehydration solutions. It is imperative to give small amounts of oral rehydration solutions fluid via syringe, spoon, cup or bottle as the child will tolerate this better than larger volumes at once. Commencing a trial of fluid form (Table 1) when the child and family are seen will simultaneously educate the families in the methods of ORT and give staff a more accurate account of the fluid intake and output of the child with gastroenteritis. Early reintroduction of the child’s normal diet has been shown to improve the child’s weight gain, and reduce the duration of diarrhoea 6,4 . When dealing with children with gastroenteritis it is essential to educate the families on infection control, and the importance of hand washing. Five tips for managing rehydration 1. Early intervention with oral rehydration solutions 2. Offer small frequent sips of oral rehydration solutions, 0.5ml/kg every 5 min or a Hydralyte iceblock. 3. Strict hand washing to prevent spread. 4. Engage parents as partners in the therapeutic process. 5. Utilise trial of fluid form. Introducing ORT with an oral rehydration solution and trial of fluid forms into your practice will ensure early intervention and education of families, leading to more effective and successful ongoing management of gastroenteritis. 18 Primary Times <strong>September</strong> 2010
CLINICAL CARE References 1. Carlin J, Chondros P, Masendycz P, Bugg H, Bishop R, Barnes G. Rotavirus infection and rates of hospitalisation for acute gastroenteritis in young children in Australia, 1993–1996. Med J Aust. 1998;169:252–256. 2. Acworth J, Babl F, Borland M, Ngo P, Kriesser D, Schutz J, et al. Patterns of presentation to the Australian and New Zealand Paediatric Emergency Research Network. Emergency Medicine Australasia 2009;21:59–66. 3. Harris C, Wilkinson F, Mazza D, Turner T. Evidence based guideline for the management of diarrhoea with or without vomiting in children. Special Issue. 2008;37:22–29. 4. Steiner M, DeWalt D, Byerley J. Is this child dehydrated JAMA. 2004;291:2746–2754. 5. NSW Health Department. Infants and children: Acute Management of Gastroenteritis. 3rd Ed. Clinical practice guidelines for the treatment of infants and children with gastroenteritis. 2010. 6. Hanson R, Exley B, Ngo P, Fitzpatrick M, Petering E, Matthews S, et al. Paediatric telephone triage and advice: the demand continues. MJA. 2004;180:333–335. 7. Schultz J, Babl F, Sheriff N, Borland M. Paediatric Research in Emergency Departments International Collective (PREDICT). Journal of Paediatrics and Child Health. 2008;44: 560–563. Resources 1. Paediatric clinical practice guidelines are available on the Clinical Information Access Program website: www.ciap. health.nsw.gov.au 2. The Royal Children’s Hospital Melbourne website has information sheets for health professionals and parents: www.rch.org.au 3. Parent fact sheets are also downloadable on the following websites: - Children’s Hospital at Westmead: www.chw.edu.au - Sydney Children’s Hospital: www.sch.edu.au Peta Dewar, RN, Master of Nursing Paediatrics and Neonates Peta has over 12 years of general and emergency paediatric experience. She worked as the Paediatric Emergency Clinical Nurse Consultant for Northern Sydney Central Coast Area Health Service for six years and is consulting for Hydration Pharmaceuticals. Coming soon Absolute cardiovascular disease risk vodcasts Want to know more about assessing absolute cardiovascular disease risk The National Vascular Disease Prevention Alliance* has collaborated with leading experts in the field to develop five vodcasts on absolute cardiovascular disease risk. These vodcasts are short video interviews that cover: • what absolute risk means in practice • overcoming barriers to using an absolute risk approach • engaging patients to think about absolute risk • assessing absolute risk in Aboriginal and Torres Strait Islander people • assessing absolute risk in younger people. For more information, visit www.heartfoundation.org.au/absoluterisk * The National Vascular Disease Prevention Alliance is a group of four leading and well-known Australian charities: Diabetes Australia, Kidney Health Australia, the National Heart Foundation of Australia and the National Stroke Foundation. It was established in 2000 and aims to reduce cardiovascular disease in Australia.
Page 1 and 2: Supporting nurses in PRIMARY HEALTH
Page 3 and 4: CONTENTS EDITORIAL BOARD APNA NEWS
Page 5 and 6: PROFESSIONAL ISSUES Member question
Page 7 and 8: APNA NATIONAL CONFERENCE 2011 Great
Page 9 and 10: PROFESSIONAL ISSUES All practice nu
Page 11 and 12: Secure your FLUVAX ® 2011 season o
Page 13 and 14: PRACTICE MATTERS standards or guide
Page 16 and 17: CLINICAL CARE Helping patients thro
Page 18 and 19: PRACTICE NURSE PROFILE Practice nur
Page 22 and 23: CLINICAL CARE Identifying common nu
Page 24 and 25: SPECIALIST INTERVENTION Practice nu
Page 26 and 27: FEATURE Nutrition and chronic disea
Page 28 and 29: FEATURE without the nutrients. Pati
Page 30 and 31: NEWS Role of codeine questioned The
Page 32: CoaguChek ® XS systems - the smart

September - APNA

Create successful ePaper yourself

Delete template?

Save as template?