1. Acute gastroenteritis (AGE)
    1. Introduction: In infants and young children, gastroenteritis is a common acute illness that can rapidly progress to dehydration, hypovolemic shock, and severe electrolyte disturbances.
    2. Assessment:
      1. Diarrhea: often watery, green, explosive, contains mucus and blood.
      2. Abdominal cramping and pain, often accompanied by bouts of diarrhea.
      3. Dehydration.
      4. Irritability, restlessness, alterations in level of consciousness.
      5. 19 Electrolyte disturbances.
    3. Analysis/nursing diagnosis:
      1. Fluid volume deficit related to vomiting and diarrhea.
      2. Altered nutrition, less than body requirements, related to AGE and its treatment, i.e., dietary restrictions.
      3. Pain related to abdominal cramping, diarrhea.
      4. Impaired skin integrity related to diarrhea.
      5. Altered tissue perfusion related to dehydration and hypovolemia.
      6. Knowledge deficit regarding diagnosis, dietary restrictions, treatment.
    4. Nursing care plan/implementation:
      1. Goal: prevent spread of infection.
        1. Standard precautions to prevent infection.
        2. Enforce strict hand washing.
        3. Institute and maintain enteric precautions-follow policies regarding linens, excretions, specimens (“double bag, special tag”).
        4. Tape diapers snugly; keep hands out of mouth.
        5. Obtain stool culture to identify causative organism; then administer antibiotics as ordered.
        6. Identify family members and others at high risk, obtain cultures.
      2. Goal: restore fluid and electrolyte balance.
        1. Administer IV fluids and electrolytes as
        2. Monitor for appropriate response to therapy: decreased specific gravity, good skin turgor, normal vital signs.
        3. Monitor weight, I&O, specific gravity.
        4. Oral feedings-oral rehydration therapy (ORT) with Pedialyte or comparable solution; resume normal diet as quickly as possible.
        5. Ongoing assessment of stools: note Amount, Color, Consistency, Timing 9 (ACCT).
      3. Goal: maintain or restore skin integrity.
        1. Frequent diaper changes (use cloth diapers).
        2. Keep perineal area clean and dry.
        3. Apply protective ointments, (petroleum jelly, A and D emollient ointment).
        4. If feasible, expose reddened buttocks to air (but not with explosive diarrhea).
      4. Goal: provide discharge teaching to parents.
        1. Careful review of diet to be followed at home.
        2. Review principles of food preparation and storage to prevent infection.
        3. Instruct in disposal of stools at home.
        4. Emphasize importance of good hygiene.
    5. Evaluation/outcome criteria:
      1. No spread of infection noted.
      2. Fluid and electrolyte balance normal.
      3. No skin breakdown noted.
      4. Parents verbalize understanding of home care.