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Title: Disorders of Digestive System


1
Disorders of Digestive System
Prepared by Dr / Magda Abd-El-Aziz
2
INTRODUCTION
  • Focuses on most common gastrointestinal disorders
    such as foreign bodies in G .I .T system,thrush
    stomatitis ,vomiting, colic, constipation,diarrhea
    and dehydration,major nursing diagnostic and
    nursing intervention related to recognition and
    management of the child.

3
Objectives
General
General
  • By the end of this lecture the student will be
    able to discuss Disorders of Digestive System

4
Specific objectives
  • By the end of this lecture the student nurse will
    be able to
  • Define the common gastrointestinal disorders
    (ingestion of foreign bodies, stomatitis,
    vomiting, colic, constipation, diarrhea and
    dehydration).
  • Mention the etiology and causative organisms of
    these disorders.
  • Apply the nursing process to different
    gastrointestinal disorders.
  • Provide health education to parents regarding the
    management and prevention of common
    gastrointestinal disorders.

5
Out line-
  • Introduction.
  • Foreign body in G.I.T.
  • Stomatitis.
  • Vomiting.
  • Colic.
  • Constipation.
  • Diarrhea.
  • Dehydration.
  • Nursing intervention.
  • Prevention of diarrhea.

6
Disorders of Digestive System
  • A- Foreign bodies in G.I.T
  • Etiology
  • The infant during the oral phase of development
    enjoys putting objects into his mouth, as he
    sucks upon a small object lie may swallow it.
    Objects may lodge at any part in the stomach or
    pass through the intestinal tract or it may
    perforate the intestine.
  • Assessment
  • Observation for sign of perforation, which are
    nausea vomiting, blood in stools, tenderness of
    the abdomen, evidence of pain.

7
  • Nursing diagnosis
  • High risk for intestinal perforation related to
    swallowing of foreign bodies.
  • Goal
  • The infant/child will experience no signs of
    perforation.

8
Intervention and treatment
  • No specific nursing care other than close
    observation of the child's stools and signs of
    perforation. Stool must be placed in a fine
    mashed sieve and water run with force upon it
    until the fecal matter disintegrates and object
    if present is clearly seen.
  • Outcome criteria
  • The infant/child will experience normal bowel
    movement.

9
B- Stomatitis
  • Definition
  • Inflammation of the mucous membrane of the mouth.
    It may be due to local lesion in the mouth or a
    feature of a systemic disease e.g. measles.

10
Causes of stomatitis
  • Infection
  • Viruses measles, primary herpes simplex,
    coxsackie A.
  • Bacteria streptococcus, diphtheria.
  • Fungus monilia coral thrush.
  • Eruption stomatitis associated with eruption of
    teeth.
  • Traumatic cheek biters.
  • Local reactions due to sensitivity to contact
    substances from toys and foods.
  • Immunological impairment in leukemias.
  • Drugs and poisons phenytoin, salicylates,
    corrosives.

11
Types of Stomatitis
  • Catarrhal stomatitis.
  • Herpetic stomatitis.
  • Thrush stomatitis.

12
Thrush stomatitis
  • Definition
  • It is a "fungus infection" of the skin and mucous
    membrane of the mouth characterized by white
    patches, resembling milk curds.
  • Etiology
  • Candida albicans infection is due to inadequate
    sterilization of teats and bottles or from
    mother's breast of the attendant's hand. Newborns
    are infected during passage in birth canal.

13
  • Assessment
  • Mouth contains white patches, which resembles
    milk curds (it is difficult to remove and if
    removed bleeding occurs). Also there discomfort
    during feeding.
  • Nursing diagnosis
  • Altered oral mucous membrane related to mouth
    infection.
  • Goal
  • Prevent and reduce the effects of oral ulceration.

14
Nursing management
15
  • Absolute cleanliness of all articles which enter
    infants mouth-such as mothers nipple, rubber
    nipple, pacifiers, teats, or his toys.
  • Applicators used must be sterile.
  • Infants must have their own feeding equipment to
    prevent spread of infection.
  • Medicine dropper may be used, if nipple irritates
    the child.
  • Give infant some sterile water after each feeding
    to wash the mouth.

16
  • Expected outcome
  • Mouth membrane remains intact.
  • Ulcers show evidence of healing.
  • Nursing diagnosis
  • Altered nutrition less than body requirements
    related to loss of appetite. Also discomfort and
    interference with feeding.
  • Goal
  • Appetite stimulation.

17
Nursing management
  • Encourage parents to relax pressure placed on
    eating.
  • Allow infant any tolerated food plan to improve
    quality of food selection when appetite
    increases.
  • Take advantage of any hungry period, serve
    small snacks.
  • Allow child to be involved in food preparation
    selection.
  • Outcome criteria
  • The nutritional intake is adequate.

18
Medical treatment
  • Treatment should be continued for one week after
    recovery prevent recurrence.
  • Cleanliness and sterilization of the feeding
    bottles and teats.
  • The infant's mouth is gently painted three times
    daily with 1 aqueous solution of gentian violet.
  • This may be combined with nystatine, 100.000
    units by month, 3 4 times daily.
  • Mother's nipple and areola painted with nystatine
    ointment between meals.
  • Prognosis
  • Generally very good, recovery occurs after (3
    5) days.

19
C Vomiting
  • Complete or partial emptying of the stomach
    especially when it occurs sometimes after feeding
    i.e. bringing up an appreciable amount of the
    swallowed food.
  • Vomiting results from a coordinated sequence of
    abdominal muscle contractions and reverse
    esophageal peristalsis. It is usually associated
    with nausea except when projectile.

20
Vomiting is classified as follows
  • Mechanical secondary at an obstructive lesion.
  • Reflexive due to gastrointestinal tract stimuli
    (e.g. infection, allergy).
  • Central
  • Central nervous system involvement (e.g.
    neoplasms, meningitis).
  • Caused by other than primary central nervous
    system involvement (e.g., abnormal metabolites,
    sepsis, psychogenic vomiting).

21
Regurgitations
  • Means to express "spill out" of "spill over"
    a small amount of formula. a during or
    small amount of swallowed food Also spitting up
    from stomach shortly after eating. Or non
    forceful expulsion of food and secretions from
    esophagus or stomach through the mouth.

22
Differences between regurgitation and vomiting
  • Regurgitation is not accompanied by nausea.
  • No forceful contraction of abdominal muscle.
  • Occurs in early weeks of life.
  • A short time after feed babies regurgitate small
    amounts (1-2 mouthfuls) of milk.
  • Weight gain is normal.
  • Doesn't need any treatment.

23
Rumination
  • Means voluntary or habitual regurgitation
    of formula into the mouth after it has been
    swallowed i.e. returning of food from stomach and
    chewing it again . Vomiting is one of the most
    common symptoms in infancy and may be associated
    with a wide variety of disturbances.

24
Causes of vomiting
  • Causes of vomiting are classified according to
    different periods
  • 1- In newborn
  • Physiological vomiting at or soon after birth as
    a normal process by which swallowed blood and
    amniotic fluid are removed. It may occur once or
    twice.
  • Congenital esophegeal obstruction, which is
    manifested by regurgitation, chocking and perhaps
    cyanosis with first feed.
  • Intestinal obstruction gives symptom usually in
    the first 24 hours after birth.
  • Imperforated anus gives symptoms that begin on
    the first 24-36 hours of life with abdominal
    distention,, vomiting and meconium is passed.
  • Cerebral birth injuries due to stimulation of
    vomiting center in the brain.

25
  • 2. In infancy
  • Improper feeding habit
  • Over feeding or underfeeding.
  • Error in feeding technique.
  • Failure to eructate.
  • Too small teat.
  • Excessive handling after feeding.

26
  • Placing baby on left side after feeding.
  • Too tight clothing especially around the abdomen.
  • Infections such as otitis media, tonsillitis,
    pyelitis and pneumonia.
    Acute diarrheal diseases due to bacterial or
    viral infection in the intestinal tract.
  • Intestinal obstruction e.g. pyloric stenosis or
    intussusception.
  • Cerebral causes as hydro-cephalus

27
  • 3- In older children
  • Dietary causes e.g. ingestion of unripe fruits or
    contaminated food.
  • Acute infections such as streptococcal
    pharyngitis, diphtheria, reflex vomiting in
    pertussis or intestinal infection as food
    poisoning.
  • Drugs as digitalis, sulphonamides, broad-spectrum
    antibiotics.
  • lntracranial hemorrhage and brain tumors.
  • Organic nervous diseases e.g. meningitis,
    encephalitis.
  • .Metabolic disturbances as in diabetic acidosis.
  • Psychogenic vomiting as by forcing a child with
    poor appetite to eat more than he wants.
  • Acute peritonitis due to development of paralytic
    ileus.

28
  • Assessment
  • Failure to gain weight.
  • Feible, weak child with free perspiration.
  • Sometimes feeling of nausea.
  • Stomach pain.
  • Dehydration.
  • Alkalosis due to failure to retain food inside
    the body.
  • Nursing diagnosis
  • Fluid volume deficit related to nausea and
    vomiting.
  • Goal
  • To promote hydration.

29
Nursing intervention
  • Correct the cause of vomiting.
  • Discontinue fluids and foods for older children
    by mouth for 12-24 hours permitting only crushed
    ice to alleviate dryness of the mouth and resort
    to parental fluid.
  • In milder cases sips of cold drinks or glucose
    water.
  • Correct dehydration by parental fluid.
  • Mummy restraints to protect the IV and child as
    needed.
  • Mouth care after vomiting to prevent aspiration
    of vomitus.
  • Close observation if infant tends to vomit,
    whether he tolerates food or not, or if he vomits
    immediately after feeding (congenital
    abnormalities).

30
  • Nursing care should be planned to eliminate
    unnecessary movement after feeding.
  • Bubbling is very important.
  • Place child on right side and elevate head of the
    bed after feeding.
  • Change soiled clothes and linen to prevent skin
    irritation.
  • weight infants daily.
  • Charting amount, color, nature, odor,
    consistency, and time in relation to feeding.

31
  • Expected outcome
  • Child shows signs of adequate hydration.
  • Nursing diagnosis
  • Altered comfort related to acute pain in the
    stomach.
  • Goal
  • Relieve pain.
  • Intervention
  • Refer to lecture of congenital anomalies.
  • Expected outcome
  • Child rest quietly, shows no evidence of
    discomfort, verbalizes no complaints of
    discomfort.

32
D- Colic
  • Definition
  • Paroxysmal intestinal cramps occurring due
    to accumulation of excessive gases and cause
    discomfort and pain. It is most common during the
    first 3 or 4 months of life.

33
Etiology
  • The causative factors are not known, but it might
    be due to
  • Excessive swallowing of air.
  • Too much excitement.
  • Excessive intake of carbohydrate leads to gas
    formation.
  • Over rapid feeding.
  • Diseases of GIT e.g. gastroenteritis,
    constipation .

34
  • Hernias diaphragmatic, inguinal, or umbilical.
  • Parasites.
  • Allergy to certain foods.
  • Hunger .
  • Intestinal obstruction e.g. pyloric stenosis .
  • Emotional stress or tension between parent and
    child.

35
Assessment
  • Sudden attack of abdominal pain.
  • Cry in loud voice more or less continuous.
  • Distended and tense abdomen.
  • Congestion of face may be cyanotic in severe
    cases.
  • Legs are drawn up on the abdomen.

36
  • Feet are often cold.
  • Arms are flexed and drawn to the body.
  • Neck may be flexed.
  • Infant may pass flatus or feces.

37
  • Nursing diagnosis
  • Altered comfort related to colic.
  • Goal
  • To relive pain.
  • Nursing intervention
  • Bubble infant frequently and gently use upright
    position to help eructation.
  • Give infant hot watery fluids (as caraway) to
    help expulsion of gases or use hot water bottle.
  • Turn the infant on abdomen to help expulsion of
    gases.

38
  • Loving care to relief his tension (hug him).
  • Teach mother the details of good feeding
    techniques.
  • Doctor may order small warm enema or change
    formula.
  • Doctor may order drugs as atropine to reduce
    intestinal movement.
  • Expected outcome
  • Infant/child is resting and shows no evidence of
    discomfort.

39
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40
Constipation
  • Definition
  • Difficulty or insufficient passage of hard
    stools at infrequent intervals.
  • Causes
  • Underfeeding with insufficient intake of milk or
    fluid.
  • Intestinal obstruction .
  • Pyloric stenosis .
  • Congenital Megacolon.
  • Infant receiving cow's milk.
  • Starvation.

41
  • Assessment
  • Colic and passage of gases.
  • Passage of infrequent hard dry stools, which
    occasionally fissures the rectum while being
    expelled.
  • Distension of the rectum and colon.
  • Anxiety.
  • Nursing diagnosis
  • Altered comfort related to acute colic.
  • Goal
  • Infant/child will feel comfort.

42
Nursing intervention
  • Increase fluid intake.
  • Laxative fluids e.g. orange juice relives mild
    constipation.
  • Small soapy enema may be given.
  • Milk of magnesia may be used as a temporary
    measure.
  • Establish or maintain regular bowel action by
    nature means rather than using purgatives.
  • Psychological support to express his fear and his
    own emotional reactions.
  • Expected outcome
  • Infant/child will show no evidence of discomfort
    and passes stool according to his habit.

43
Diarrhea Disorders
  • Definition
  • It is defined as "An increase in the
    fluidity, volume and number of stools relative to
    the usual habits of each individual".

44
Morbidity and Mortality in Egypt
  • Morbidity
  • Diarrhea is a leading cause of illness among
    children in developing countries. In Egypt a
    child under five years suffers an average three
    bouts of acute diarrhea yearly that is to say 10
    millions children suffer 30 millions episodes of
    diarrhea every year.
  • Mortality
  • Diarrhea accounts for 25 - 30 of deaths among
    children under five years. It is estimated that
    15000 Egyptian infants and preschool children die
    yearly from diarrhea (about 42 deaths every day),
    80 of them being in the first two years of life.

45
Factors promoting the transmission of enteric
pathogens
  • Failure to breast feed exclusively for the 1st
    4 6 months.
  • Using infant feeding bottles (easily
    contaminated).
  • Inappropriate storing of cooked food.
  • Using drinking water contaminated with fecal
    bacteria.
  • Failing to dispose of feces hygienically

46
  • Failing to wash hands after defection.
  • Host factors young age (highest incidence in the
    age group 6 12 months).
  • Malnutrition.
  • Measles in the previous 4 weeks.
  • Immunodeficiency.
  • Season
  • Bacterial diarrheas are more frequent in summer.
  • Rotavirus is more frequent in winter but occur
    throughout year.

47
Types of diarrhea
  • Acute Watery Diarrhea (80 of cases)
  • This refers to diarrhea that begins suddenly it
    persists for 3 - 4 days then gradually improves
    over another 4 - 5 days. It is usually
    self-limited (lasts less than 14 days) and
    involves the passage of frequent loose or watery
    stool without visible blood.
  • Dysentery (5 10 of cases)
  • This is diarrhea with visible fresh blood in the
    stools. Its sequelae include anorexia and damage
    to the intestinal mucosa.
  • Persistent Diarrhea (10 of cases)
  • Post infectious diarrhea that begins actually and
    lasts at least 14) days. Persistent diarrhea is
    not chronic diarrhea which is recurrent or long-
    lasting due to non-infectious causes. (e.g.
    metabolic disorders).

48
  • Dangers of diarrhea
  • Dehydration, which might lead to death if not
    properly, treated.
  • Malnutrition diarrhea is worse in persons with
    malnutrition and can make it worst because
  • Nutrition is lost from the body in diarrhea.
  • The patient may not be hungry (due to diminished
    absorption).
  • Mothers may not feed their children during the
    episode or even for some days after the diarrhea
    improves.
  • N.B. The life span of intestinal mucosal cells is
    3-5 days. New normal cells will replace the
    destroyed cells damaged by toxins, within this
    period. This is why diarrhea is usually a
    self-limited disease of 3-5 days duration.

49
  • Incidence of diarrhea
  • The peak incidence of diarrhea is between
    6 months to 2 years.
    This is due to
  • Declining level of maternal antibodies.
  • Exposure to enteric pathogens through
    contaminated weaning food.
  • The pleasure of picking -up contaminated objects
    and putting them in the mouth while crawling.
  • Seriousness of diarrheal disorders during infancy
  • Their higher needs for water exchange to meet
    their high metabolism.
  • Greater susceptibility of infants to infection .
  • Lower power of their kidneys to concentrate
    urine, which results in relative polyuria.
  • Their smaller metabolic reserves of water and
    electrolytes.
  • Therefore, with limited intake and /or extra loss
    of fluid during diarrhea, acute dehydration
    usually occurs

50
Causes of diarrhea
  • 1- Enteropahtogenic (infectious diarrhea)
  • Viruses (rotavirus) (15 25 of cases).
  • Bacteria (E.Coli 10 20 of cases), (shigell 5
    15 of cases).
  • Protozoa (cryptosporidium 5-15 of cases).
  • Other less common pathogens include (Giardia -
    doudenaris, Entamoeba histoloticày andsalomnella).

51
2- Dietary
  • A-Formula feeding problems
  • Contaminated feeding bottles.
  • Overfeeding.
  • Over concentrated formula.
  • Excess sugar or fat in formula.

52
  • B-Weaning food problems
  • Introduction of food, which is not suitable for
    the age.
  • Unripe fruits.
  • Introduction of new food.
  • Improperly cooked diet.
  • Malnutrition .
  • 3- Some parenteral infections
  • Pneumonia and otitis media may be accompanied by
    diarrhea. It may actually be due to an associated
    intestinal infection.
  • Communicable diseases (e.g. measles) diarrhea
    occurs due to immunological impairment.

53
  • 4- Miscellaneous
  • Emotional tension Irritable colon.
  • Heavy metal poison (arsenic, lead, mercury).
  • Antibiotic
  • 5- Malabsorption
  • Cystic fibrosis, ciliac disease.

54
N.B.
  • Teething is not a cause of diarrhea. Diarrhea
    that occurs during teething is usually caused by
    an intestinal infection and should be treated
    properly.

55
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Dehydration
  • Definition
  • It is one of the consequences of watery
    diarrhea. It is caused by the loss of water and
    electrolytes in liquid or loose stools and
    vomitus. Fever can make it worse as it causes
    additional loss of water. Dehydration can lead to
    hypovolemia, cardiovascular collapse, and death
    if not treated promptly.
  • The signs of dehydration are the result of 2
    important factors
  • Type of dehydration Isotonic, hyperonic,
    hypotonic.
  • Degree Mild, moderate or sever.

57
Types of dehydration
  • 1- Isotonic (isonatremic) dehydration This is
    the most common result of acute
    watery cliarrhea (more than 75 of cases).
    Deficits of water and sodium are balanced .
  • 2- Hypertonic (hypernatremic) dehydration the net
    loss of water is greater than that of sodium .
    The condition is more common in young infants who
    can't verbally ask for water . It results from
    the intake of large amounts of hpertonic fluids (
    high content of sodium or sugar ) during
    diarrhea.
  • 3- Hypotonic (hypontremic) dehydration it is
    less common and the net loss of sodim is greater
    than that of water. This result from the intake
    of large amounts of water or hypnotic fluids
    during diarrhea.

58
Therapy of dehydration
  • Oral rehudration
  • The rehydrauon therapy in the form of ORS is
    considered an effective treatment of dehydration,
    It is a mixture of water, glucose, and
    electrolytes and is used to correct or prevent
    dehydration. Glucose is added (2) to promote
    sodium absorption. Increasing the concentration
    of glucose by 2 increase the osmolarity of the
    solution and may cause osmotic diarrhea.

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60
Composition of ORS
Amount G/L Components g/1
3.5 G/L Sodium chloride.
2.9 G/L Trisodium citrate.
1.5 G/L potassium chloride
20.0 G/L Glucose
61
  • N.B. The use of citrate increases the shelf life
    of ORS and therefore lowers its cost. Tape
    water(200 ml) is used to dissolve the mixture and
    needs no boiling. It is given by cup and spoon,
    but
  • It can be given by nasogastric tube in the
    following conditions
  • When the patient is unable to drink but not in
    shock, or has severe dehydration or paralytic
    ileus.
  • When the patient has severe repeated vomiting, or
    if dehydration is not improving when ORS is given
    slowly by cup and spoon.

62
Nursing management of diarrhea
  • Nursing Assessment
  • It includes taking the patient's history,
    measuring weight and temperature and Assessing
    the degree of dehydration.
  • 1- History
  • Personal characteristics (age and sex) and
    socioeconomic background (home environment,
    income, education, occupation, beliefs .... etc).
  • Duration of the episode.
  • Frequency and consistency of stool.

63
  • Presence or absence of mucus, pus or blood in
    stool.
  • Patient's ability to drink and or presence of
    thirst.
  • Presence of vomiting, fever or other problems
    (cough, otitis media).
  • Last time urine passed.
  • Feeding practices before and during illness.
  • Treatment during this episode (ORS, drugs).
  • Vaccination taken especially measles vaccine.
  • 2- Assessment of the degree of dehydration
  • Assessment of the degree of dehydration is based
    on 4 signs which are the most important to be
    detected

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Assessment of the degree of dehydration.
C Severe dehydration loss gt 10 of body weight B Some dehydration loss 5 10 of body weight A No signs of dehydration loss lt 5 of body weight Sings
Lethargic, floppy unconscious Restlessness and irritable Well and alert G-General condition
Very sunken and dry Sunken Normal E- Eyes
Drinks poorly or unable to drink. Thirsty, drinks eagerly Drinks normally M- Thirst
Goes back very slowly (gt2 seconds). Goes back slowly Goes back quickly S-Skin pinch
If 2 or more signs are present there is severe dehydration. If 2 or more signs are present, there is moderate dehydration. Patient has no sings of dehydration (mild) Decide
Plan C Plan B Plan A Select treatment plan
66
Other signs that are used in the assessment of
dehydration are
  • Anterior fontanel normal, depressed or severely
    depressed.
  • Mucous membrane of the mouth and tongue moist,
    dry or very dry.
  • Tears present in mild dehydration, absent in
    severe dehydration.
  • Pulse (radial) as dehydration increase, pulse
    becomes more rapid. In severe dehydration pulse
    becomes weak.
  • Extremities in severe dehydration, skin becomes
    cool and moist and the nail bed may be cyanosed.
  • Breathing rapid deep breathing is a sign of
    acidosis.
  • Weighing is essential as it helps to estimate the
    amount of fluid required, for an initial
    rehydration . Patient should be weighted to the
    nearest 50 100 grams at the beginning of the
    assessment and recorded. Towards the end of
    rehydration , the child should have gained
    weight.

67
Nursing diagnosis
  • Bowel elimination is altered related to diarrhea.
  • Fluid and electrolyte balanced is altered related
    to diarrhea.
  • Altered nutrition less than body requirement
    related to loss of appetite.
  • High risk for infection related to body
    resistance.
  • Altered parenthood related to knowledge deficit
    about child care.

68
  • Nursing intervention
  • The aim of nursing intervention is
  • To hydrate the infant.
  • To feed the infant.
  • To deal with associated problems.

69
Plan C Plan B Plan A Treatment
In hospital In OP rehydration center At home Where
Give IV fluids Gives ORS Give more fluid than usual 1- Fluid therapy
Pansol .Ringer's lactate. Normal saline. Home made fluids (rice, water, tea without sugar, soup, yogurt). What type
100 ml/kg of body wt. given in 3 6 hrs. 1st 30 ml/kg given in 1/2 to 1 hr. Next 70 ml/kg given in 2.5 5hrs, longer time is used for infant lt 1 year. (NB) Goes back slowly Give after each loose stool for child lt2 years 50 100ml For child gt 2 years 100 200 ml. How much
I.V. Slowly (1 spoon 1-2 min) by cup and spoon, cup alone, dropper/syringe. Nasogastric tube. Slowly (1 spoon 1-2 min) By cup and spoon, cup alone, dropper/syringe. How given
70
B) Reassess the patient's condition. If no signs of dehydration shift to plan A. Some dehydration shift to plan B Severe dehydration shift to plan C. Further assessment A) Advice the mother to bring the child to a health facility if Frequent large stools. Repeated vomiting Increased thirst No improvement after days Bloody stools . Fever.
71
Guidance during intervention
  • Mothers should be taught how to give ORS (one
    teaspoonful every 1-2 minutes and the child
    should be in a semi-sitting position).
  • Give ORS as much as the desires.
  • If vomiting occurs, wait 10 minutes. then
    continue giving ORS solution but more slowly (one
    teaspoonful every 2-3 minutes).
  • Watch for puffy eyes as a sign of over hydration.
    If this occurs, stop ORS solution and give breast
    feeding and plain water. When puffiness is gone,
    the child is considered fully dehydrated .
    Further treatment should follow treatment plan A.

72
Feeding during and after the episode
  • During diarrhea give the child as much food as he
    wants.
  • Offer food every 3-4 hours.
  • Small frequent feeding are better tolerated than
    less frequent and large feedings.
  • Children will anorexia have to be gently
    encouraged to eat.
  • After stoppage diarrhea, give one extra meal per
    day for 2 weeks in normal child and longer period
    in malnourished one .

73
Advantage of continued feeding during
diarrhea.(important point)
  • Preserves body weight and sustains growth, thus
    maintaining strength and health avoiding lowered
    resistance.
  • The contact of foodstuffs with the gut mucosa
    protects its absorptive capacity and stimulates
    the production of digestive enzymes.
  • Easily digestible foods may enhance intestinal
    salt and water absorption by providing organic
    molecules, which facilities their absorption.
  • Studies have shown that continued feeding
    actually hastens recovery from a diarrheal
    episode.

74
Assessment of the progress of rehydration
  • The patient's progress should be assessed at
    least every hour .
  • The signs of a satisfactory response are
  • Return of a strong radial pulse.
  • Improved consciousness level.
  • Ability to drink.
  • Much improved skin turgor.
  • Passage of urine

75
Drugs therapy in diarrhea
  • 1- Antibiotic are ineffective and may lead to(
    prolonged diarhea cause malabsorption-have side
    effect prolong the duration of infection
    their abuse will increase the resistance of
    organism).
  • 2 - Anti - diarrheal drugs.
  • 3 - Anti -motility drugs.
  • 4 - Anti emetics.

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Prevention of diarrhea
  • 1- Promotion of breast-feeding
  • 2- Improved weaning practices
  • 3- Proper use of water for hygiene and drinking
  • 4- Personal hygiene
  • 5- Use of latrines
  • 6- Safe disposal of stools of young children
  • 7- Measles vaccination

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An ounce of prevention better than cure ????
????? ???? ?? ????? ????
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