Review – Diarrhea / Burns

HESI-Comprehensive-Review-for-the-NCLEX-RN

Diarrhea

Description: Increased number or decreased consistency of stools

1. Diarrhea can be a serious or fatal illness, especially in infancy.
2. Causes include but are not limited to:
   1. Infections: bacterial, viral, parasitic
   2. Malabsorption problems
   3. Inflammatory diseases
   4. Dietary factors
3. Conditions associated with diarrhea are:
   1. Dehydration
   2. Metabolic acidosis
   3. Shock

Nursing Assessment

1. Usually occurs in infants
2. History of exposure to pathogens, contaminated food, dietary changes
3. Signs of dehydration
   1. Poor skin turgor
   2. Absence of tears
   3. Dry  mucous membranes
   4. Weight loss (5% to 15%)
   5. Depressed fontanel
   6. Decreased urinary output, increased specific gravity
4. Laboratory signs of acidosis:
   1. Loss of bicarbonate (serum pH <7.35)
   2. Loss of sodium and potassium through stools
   3. Elevated hematocrit (Hct)
   4. Elevated blood urea nitrogen (BUN)
5. Signs of shock
   1. Decreased blood pressure
   2. Rapid, weak pulse
   3. Mottled to gray skin color
   4. Changes in mental status

Analysis (Nursing Diagnoses)

1. Diarrhea related to . . .
2. Risk for deficient fluid volume related to . . .

Nursing Plans and Interventions

1. Assess hydration status and vital signs frequently.
2. Monitor intake and output.
3. Do not take temperature rectally.
4. Rehydrate as prescribed with fluids and electrolytes.
5. Calculate intravenous (IV) hydration to include maintenance and replacement fluids.
6. Collect specimens to aid in diagnosis of cause.
7. Check stools for pH, glucose, and blood.
8. Administer antibiotics as prescribed.
9. Check urine for specific gravity.
10. Institute careful isolation precautions; wash hands.
11. Teach home care of child with diarrhea:
    1. Provide child with oral rehydration solution such as Pedialyte or Lytren.
    2. Child may temporarily need lactose-free diet.
    3. Children  should  not  receive  antidiarrheals   (e.g., Imodium A-D).
    4. Do not give child grape juice, orange juice, apple juice, cola, or ginger ale. These solutions have high osmolality.

Burns

Description: Tissue injuries caused by heat, electricity, chemicals, or radiation

1. Burns are a major cause of accidental death in children younger than 15 (after automobile accidents).
2. It is estimated that 75% of burns are preventable.
3. Children younger than age 2 have a higher mortality rate due to:
   1. Greater central body surface area. In a child younger than 2, a greater part of the body surface area is concentrated in the head and trunk compared to an older child or an adult; therefore the younger child is more likely to have serious effects from burns to the trunk and head (see Fig. 4-10).
   2. Greater fluid volume  (proportionate  to  body  size)
   3. Less effective cardiovascular responses to fluid volume shifts
   4. In childhood,  a  partial-thickness  burn  is  considered  a major burn if it involves more than 25% of body surface.
4. A full-thickness burn is considered major if it involves more than 10% of body surface.
5. Because of the changing proportions of the child, especially the infant, the rule of nines cannot be used to assess the percent of burn (see Fig. 4-10).
6. An assessment tool such as the Lund-Browder chart, which takes into account the changing proportions of the child, should be used.
7. Fluid needs should be calculated from the time of the burn.
8. The Parkland formula is a commonly used guideline for calculating fluid replacement and maintenance. It is based on child’s body surface area and should include volume for burn losses and maintenance.
9. Adequacy of fluid replacement is determined by evaluating urinary output.
10. Specific gravity should be less than 025.
11. See Medical Surgical Nursing, Burns, 166.