Chapter 11
Vanessa Lockyer-Stevens

This presentation investigates diarrhoea and vomiting, a
major cause of the need for hydration therapy.

In conjunction with the book chapter, these slides should
enable you to:
• Identify the population at risk of diarrhoea and vomiting
• Examine the nurse’s role in the assessment, planning,
implementation and evaluation of care for a child with
severe diarrhoea and vomiting and their family
• List support agencies involved in the child’s care following

Diarrhoea and vomiting (D&V) in the under 5s
is still a leading cause of morbidity and
mortality globally.

Diarrhoea kills 2.5 million children every year,
accounting for approximately 21% of all-cause
mortality for children under five years old in
developing countries. This equates to ‘one
child dying every twelve seconds, or a jumbo
jet full of children crashing every 90 minutes’.
(Kosek et al 2003).
Use the book, or your own sources to
answer the following questions within your
learning groups:

Q. What is diarrhoea and vomiting?

Q. What are the common causes?

Q. What are the signs and symptoms?
Q. Look at the list of issues below. How
might each of these affect the treatment you
provide to a child with extreme diarrhoea and
vomiting, and the advice you give to his
•   Physical well-being
•   Psychological well-being
•   Socio-economic circumstances
•   Cognitive development
•   Environment:
    -   Disruption of routine
    -   Effects on parents
    -   Institutional factors
    -   Increased nutrition factors
         Assessing the Child

• General impression - Does the child look unwell?

• Airway, Breathing, Circulation – are they within
  normal limits for the child’s age?

• Does the child exhibit gaze aversion?

• Do they have dry skin, sunken eyes, a positive
  pinch test? Calculate the severity of dehydration.

• Have there been less than 3 wet nappies in 24
  hours, or less than 2-3 mls/kg for infant; 1-2 mls for
  young child 4 or ½ ml/kg for older child?

• How many bouts of diarrhoea and vomiting has the
  child had?

The child needs to be isolated, so where in the
ward are they best located? Check room to
include oxygen, suction, cot or bed

Get: disposable gloves and linen, weighing
equipment, stool specimen bottle, cannulation
equipment, intravenous and oral fluids

Identify: nursing documentation, residency
arrangements for parents and who to contact in
the first instance (medical staff, play specialists,
• Record, report and revaluate neurological state,
  breathing, pulse, temperature and if required, blood
• Weigh child to assess percentage of
  dehydrationAssist with intravenous cannulation.
• Calculate emergency resuscitation fluids (if
• Calculate replacement fluids
• Calculate maintenance fluids over 24 hours
• Accurately record & report all intake: fluid and food
• Accurately record & report all output: vomit, urine
  and diarrhoea
• Communicate plan and procedures to parents at all
• Send off stool specimen
• Pay meticulous attention to child’s skin hygiene
  particularly buttocks and perineum

To track recovery, assess whether the
  child is:
• More responsive to surroundings?
• Less irritable, lethargic or distressed?
• Displaying vital signs within normal
• Hungry and thirsty?
• Passing more urine?
• Having fewer episodes of diarrhoea
  and vomiting?
• Has sodium levels that are returning to
       Checklist for Discharge

• Eating and drinking
• No further vomiting
• Seen by Dietician
• Advice given about reducing the incidence of re-
  infection and cross infection
• Information given about open access.
• Information given about who will follow up and
  where it will take place
• Parents happy with the discharge plan
After Care – Who Can Help?

    • Open access
    • NHS Direct
    • Heath Visitor
    • Practice Nurse
    • Nurse Practitioner

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