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Diarrhoeal diseases

Diarrhoeal diseases. Prepared by: Mrs. Renita Priya Dsouza Asst. Professor YNC. INTRODUCTION :  Leading cause of childhood morbidity & mortality in developing countries Important cause of malnutrition 80% of deaths due to diarrhoea occur in the first two years of life.

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Diarrhoeal diseases

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  1. Diarrhoeal diseases Prepared by: Mrs. Renita Priya Dsouza Asst. Professor YNC

  2. INTRODUCTION :  • Leading cause of childhood morbidity & mortality in developing countries • Important cause of malnutrition • 80% of deaths due to diarrhoea occur in the first two years of life. • Children <3 years of age in developing countries experience around three episodes of diarrhoea each year.

  3. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. • Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhoea.

  4. Diarrhoea is defined as the passage of three or more loose or liquid or watery stools per day. • There are three clinical types of diarrhoea: • Acute watery diarrhoea – lasts several hours or days, and includes cholera; • Acute bloody diarrhoea – also called dysentery; and • Persistent diarrhoea – lasts 14 days or longer.

  5. ETIOLOGY OF ACUTE DIARRHOEA :  • Viral : • Rota Virus • Adenovirus • Norwalk Agent • Bacterial : • V. Cholera • Salmonella • Shigella • Campylobacter • Fungal : Candida

  6. Parasitic Infection : • GiardiaLamblia • Cryptosporidium E • entamoebaHistolytica • Drugs : • Laxatives • Sorbitol • Antacids • Lactulose • Theophylline • Antibiotics • Quinidine • Diet : • Food Poisoning • Food allergy

  7. Contributing factors: • Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea.. • Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea.

  8. Other factors: • Diarrhoeal disease can also spread from person-to-person, • aggravated by poor personal hygiene. • Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. • Water can contaminate food during irrigation. • Fish and seafood from polluted water may also contribute to the disease.

  9. Pathophysiology of acute diarrhea :  • Increased secretion of fluid and electrolytes • Decreased digestion and absorption of nutrients • Abnormal transit due to aberrations of intestinal motility

  10. Assessment of the child with diarrhoea :  • History :Ask the mother or other caretaker about: • Presence of blood in the stool; • Duration of diarrhoea; • Number of watery stools per day; • Number of episodes of vomiting; • Presence of fever, cough, or other important problems (e.g. convulsions, recent measles); • Pre-illness feeding practices; • Type and amount of fluids (including breastmilk) and food taken during the illness; • Drugs or other remedies taken; • Immunization history.

  11. Dehydration • The most severe threat posed by diarrhoea is dehydration. • During a diarrhoeal episode, water and electrolytes are lost through liquid stools, vomit, sweat, urine and breathing. • Dehydration occurs when these losses are not replaced.

  12. The degree of dehydration is rated on a scale of three. • Early dehydration – no signs or symptoms. • Moderate dehydration: • thirst • restless or irritable behaviour • decreased skin elasticity • sunken eyes • Severe dehydration: • symptoms become more severe • shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin.

  13. Prevention Key measures to prevent diarrhoea include: • access to safe drinking-water; • use of improved sanitation; • hand washing with soap; • exclusive breastfeeding for the first six months of life; • good personal and food hygiene; • health education about how infections spread; and • rotavirus vaccination.

  14. Treatment : Home therapy to prevent dehydration and malnutrition :  • Children with no signs of dehydration need extra fluids and salt to replace their losses of water and electrolytes due to diarrhoea. If these are not given, signs of dehydration may develop.

  15. Four rules of Treatment Plan :  • Rule 1: give the child more fluids than usual • Suitable fluids : two groups: Fluids that contain salt : • ORS solution • Salted drinks (eg. Salted rice water or a salted yoghurt drink) • Vegetable or chicken soup with salt. Fluids that do not contain salt, such as: • Plain water • Water in which a cereal has been cooked • Unsalted soup • Yoghurt drinks without salt • Green coconut water • Weak tea (unsweetened) • Unsweetened fresh fruit juice.

  16. Unsuitable fluids • Drinks sweetened with sugar, which can cause osmotic diarrhoea and hypernatraemia. Some examples are: • Commercial carbonated beverages • Commercial fruit juices • Sweetened tea. • Coffee • Some medicinal teas or infusions.

  17. How much fluid to give The general rule is: Give as much fluid as the child wants until diarrhoea stops. • Children under 2 years of age: 50-100 ml (a quarter to half a large cup) of fluid; • Children aged 2 up to 10 years: 100-200 ml (a half to one large cup); • Older children and adults: as much fluid as they want.

  18. Rule 2: Give supplemental zinc (10 - 20 mg) to the child, every day for 10 to 14 days • Dose : • infant – 0.5 mg/kg/day • <6 mth – 10 mg/day • >6 mth – 20 mg/day

  19. Rule 3: Continue to feed the child, to prevent malnutrition • Food should never be withheld • Breastfeeding should always be continued. • Aim - give as much nutrient rich food as the child will accept.

  20. Rule 4: take the child to a health worker if there are warning signs of dehydration or other problems • Starts to pass many watery stools; • Has repeated vomiting; • Becomes very thirsty; • Is eating or drinking poorly; • Develops a fever; • Has blood in the stool; or •The child does not get better in three days.

  21. ANTIBIOTICS: According to the causative organism

  22. Key measures to treat diarrhoea include the following: • Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.

  23. Rehydration: with intravenous fluids in case of severe dehydration or shock. • Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well.

  24. Reference • Hockenberry, Wilson, Judie. Wong’s essentials of pediatric Nursing. South India Edition. Elsevier publication. • Dorothy R Marlow, Barbara A Redding, Raman Kalia. Marlow’s textbook of pediatric Nursing. Harcourt Brace & Company Asia Pte Ltd. • ParulDatta. Pediatric Nursing. 4th edition. Jaypee Publishers. New Delhi.

  25. THANK YOU

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