NUR 660 Team Week 12 Discussion 1 Case Study Discussion A: Gastroenteritis

NUR 660 Team Week 12 Discussion 1 Case Study Discussion A: Gastroenteritis

NUR 660 Team Week 12 Discussion 1 Case Study Discussion A: Gastroenteritis

Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. As part of your history, you discover Baby K. had some milk custard that may not have been properly stored. The most likely diagnosis is gastroenteritis, secondary to Staphylococcus aureus from the milk custard.

Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.

According to Hubert & VanMeter (2018), inflammation of the gastric mucosa stimulates vomiting and diarrhea results from when the inflammation of the intestines causes increased motility, impaired absorption, and increased secretions. Due to the inadequate storage of the custard, enterotoxin invaded the body. The body’s natural defense is to get rid of the infectious agent, which manifested as vomiting and diarrhea.

What fluid and electrolyte imbalances would you expect in Baby K.? Please describe how at least one fluid and one electrolyte imbalance could develop in this situation.

The loss of fluid, particularly water, from vomiting and diarrhea can lead to dehydration. The vomiting of gastric or intestinal contents most commonly involves the loss of fluid that contains chloride, potassium, sodium, and bicarbonate. Diarrhea can also result in hypokalemia (Tello et al., 2017). Hypovolemia, hyponatremia, hypernatremia, and hypokalemia are common and significant concerns for patients with profound fluid loss, like in Baby K.

Describe the signs of dehydration that can be expected in a child of this age. What about in an older child?

In babies, cardinal signs of dehydration include fewer than six wet diapers per day (for infants), no wet diapers or urination for eight hours (in toddlers), as well as sunken soft spots (fontanel) on the infant’s head. In children of all ages, other signs of dehydration include dry tongue and dry lips, no tears when crying, sunken eyes, dry and wrinkled skin, deep/ rapid breathing, and cool and blotchy hands and feet (Cleveland Clinic, 2021).

Explain the process and factors involved by which a young child can quickly develop vascular collapse if vomiting and diarrhea are severe.

If vomiting and diarrhea are severe, severe dehydration will occur. Vega & Avva (2021) discuss how severely dehydrated patients can present with vascular collapse. These signs include altered mental status, lethargy, tachycardia, hypotension, signs of poor perfusion, weak thready pulses, and delayed capillary refill. The body’s natural response is to protect the vital organs, such as the heart, brain, kidneys, and lungs. Poor perfusion, weak thready pulses, and delayed capillary refill are a result of the blood and remaining fluid protecting the vital organs. Tachycardia and hypotension are a result of the body pumping blood and fluids to the organs to compensate for the losses.

Explain why water alone would not be adequate treatment for Baby K.

Water alone is not an adequate treatment for Baby K because it does not replace the electrolytes lost through vomiting and diarrhea. Oral rehydration therapy, which includes fluids, salts, and other electrolytes, should be used for moderate dehydration and the initiation of intravenous fluids for severe dehydration.

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What other gastrointestinal conditions could cause vomiting and diarrhea in a young child? How will you definitively determine what condition is causing her symptoms?

Other gastrointestinal conditions that can cause vomiting and diarrhea in young children are seasonal viral infections, bacterial, or parasitic infections.  Viral infections include rotavirus, influenza, and the Norwalk virus. Bacterial infections include E. coli, C. difficile, and Salmonella. These can all cause gastrointestinal upset. To help determine what condition is causing the patient’s symptoms, a quick history of the patient’s symptoms, food log, or any recent travels can be discussed. Blood and stool specimens may also be needed to help diagnose the specific infectious agent.

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References: 

Cleveland Clinic. (2021). Dehydration in Children: Signs, Treatments. https://my.clevelandclinic.org/health/articles/8276-dehydration-and-your-child

Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions (Access Code and Textbook Package) (6th ed.). Saunders.

Tello, L., & Perez-Freytes, R. (2017). Fluid and Electrolyte Therapy During Vomiting and Diarrhea. The Veterinary clinics of North America. Small animal practice, 47(2), 505–519. https://doi.org/10.1016/j.cvsm.2016.09.013

Vega R. M., & Avva U. (2021). Pediatric Dehydration. StatPearls. Treasure Island (FL): StatPearls Publishing

Team A: Gastroenteritis

Week 12 Discussion Team A Worksheet (Word)

Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. As part of your history, you discover Baby K. had some milk custard that may not have been properly stored. The most likely diagnosis is gastroenteritis, secondary to Staphylococcus aureus from the milk custard.

• Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.
• What fluid and electrolyte imbalances would you expect in Baby K.? Please describe how at least one fluid and one electrolyte imbalance could develop in this situation.
• Describe the signs of dehydration that can be expected in a child of this age. What about in an older child?
• Explain the process and factors involved by which a young child can quickly develop vascular collapse if vomiting and diarrhea are severe.
• Explain why water alone would not be adequate treatment for Baby K.
• What other gastrointestinal conditions could cause vomiting and diarrhea in a young child? How will you definitively determine what condition is causing her symptoms?

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