The forceful emptying of the stomach contents is known as throwing up (vomiting). Two or more loose, watery stools constitute diarrhea. Vomiting and diarrhea without fever are common in children. Vomiting and diarrhea often occur together but may happen independently of each other and at any time. The symptoms, while frustrating and worrisome, may serve as the body’s natural method to rid itself of the offending cause. Extended periods of vomiting or diarrhea may lead to dehydration.
A child’s gastrointestinal system is sensitive and may react to certain medications or foods that are hard to digest, such as sweets or undercooked meats. Other causes of vomiting and diarrhea may be viruses, bacteria, or parasites. Viral gastroenteritis is the most common cause of vomiting and diarrhea, specifically Rotavirus and Norovirus.
The patient will have soft, formed stools; the patient will vomit less than 2 times in 24 hours; the patient will maintain adequate hydration
Vomiting / Diarrhea Nursing Care Plan
- Abdominal pain
- Irritability (infants and toddlers)
- Decreased appetite
- >2 loose, watery stools in 24 hours
Nursing Interventions and Rationales
- Assess patient for the degree of vomiting: mild (1-2x/day), moderate (3-7x/day) or severe (8 or more or vomits everything consumed)
Understanding the severity of symptoms can help determine the course of treatment.
- Obtain history and information from the patient’s parent or caregiver
Determine when symptoms began, any contributing factors, and if other families or household members are experiencing similar issues. This can help determine etiology and guide treatment. Other sick family members should be isolated from the patient.
Monitor for fever or signs of dehydration including tachycardia and tachypnea. Rapid respiratory rate may indicate possible aspiration of emesis.
- Assess for blood in stool or emesis
The presence of blood in vomitus or stools may indicate a more severe infection or issue in the GI system.
- Assess abdomen for distention, hyperactive bowel sounds and cramping
The patient may be guarding if unable to verbally express pain; note hyperactive sounds that may accompany diarrhea
- Monitor Intake and Output
Determine fluid balance and the need for rehydration intervention; prevent dehydration. Decreased wet diapers may be a sign of dehydration.
- Obtain samples of stool for culture
Determine if the cause of symptoms is due to a parasitic or bacterial infection; helps determine the course of treatment
- Provide perineal care following diarrhea
Help patient clean perineal area following stools to prevent skin breakdown and rash; apply barrier cream such as zinc oxide as needed
- Encourage oral hydration; Administer oral rehydration solution (ORS) as necessary or IV fluids as appropriate
Encourage parents to continue offering a normal diet. Patients are often more responsive to frozen juice bars, ice pops, and flavored gelatin. Supplementation of electrolyte solutions may be required. Breastfed infants should continue to breastfeed with ORS supplementation
- Educate patient and family on BRAT diet (Bananas, Rice, Applesauce, and Toast)
This diet is easy on the digestive system and helps to decrease diarrhea and replace nutrients lost. This is often still suggested even though research has not shown that this helps. This is not recommended for pediatric patients because of the low energy and lack of protein and fat content.
- Administer medications as appropriate
Typically, antidiarrheal medications are not recommended, as diarrhea usually resolves spontaneously once the virus or bacteria has been flushed out of the body. Anti-nausea medication may be given depending on the severity of vomiting. Antibiotics may be given if symptoms are related to bacterial infection
- Provide patient and family education to manage and prevent symptoms
Encourage good handwashing to prevent the spread of infection. Avoid sugary or high-fat foods that can make diarrhea worse. Encourage older children (>2yrs old) to drink chicken broth or sports drinks to help rehydration
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell