Which essential questions will you ask a pediatric patient or their caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not? Studies show that diarrhea disease is the third cause of death among children younger than 5 years of age. According to World Health Organization (WHO), acute diarrhea is the passage of three of more loose or liquid stools per day, that last three or more and for less than 14 days.
Also, American Academy of Pediatrics (AAP) describes acute gastroenteritis (AGE) as the diarrhea of rapid onset, with or without additional symptoms and signs, such as nausea, vomiting, fever, blood or abdominal pain. Bloody stools in a sick child may be signs of severe abdominal pathology (Florez, AlKhalifah, Sierra, Granados, Yepes-Nunez, Cuello-Garcia, Thabane, 2016).
The relevant clinical questions to ask would include the following: • Number of days diarrhea has been present and whether onset was abrupt or gradual · Description of the stools (watery, does the bloody stool have mucus? ) • Frequency of the stool and quantity of stool produced relative to the everyday pattern • Presence and severity of associated symptoms such as nausea, vomiting, fever, and abdominal pain • Relationship of diarrhea to the food intake.
Inquire if diarrhea continues at about level whether or not food is being consumed. This is asked because diarrhea that relents with fasting suggests a noninfectious source such as osmotic diarrhea that occurs with lactose intolerance · Inquire about quality of feeding, amount and frequency of feeding, level of thirst, irritability, activity level, number of wet diapers, or frequency of voiding in older children, and whether general behavior has changed since the onset of diarrhea. Establish amount and type of oral intake of both solids and fluids • Inquire about recent travel in order to resource-limited countries and relationship • Ask about daycare attendance • Ask about food consumption in the past 24-48 hours especially if there is a deviation from normal dietary intake such as having picnic or buffet. • Swimming or drinking untreated surface water from the lake or stream.
If there is recent visit to the zoo or recent contact with reptiles or pets with diarrhea · If there is anyone sick in the household, at social functions, or on cruise ships, that may suggest a common source foodborne outbreak • Ask about medication use such as antibiotics, magnesiumcontaining products that can cause diarrhea or any other underlying medical conditions predisposing to diarrhea The author strongly believe that the age and nutritional factors play an important role-the younger child has the higher risk for severe dehydration as a result of the high body water turnover and limited renal compensatory capacity than an older child (Uphold & Graham, 2013). How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
The causes of vomiting in pediatric population include severe abdominal pain, infection, bowel obstruction and neurological, metabolic or endocrine causes (Van Heurn, Pakarinen & Wester, 2013). Other causes of vomiting include acute diarrhea and allergic reaction (Gordon, 2013). Abdominal pain may be generally difficult to assess in younger children because they may not present with observable symptoms. However, extraabdominal disorders such as pneumonia and pharyngitis may present with pain (Van Heurn, et al, 2013). Whenever possible, physical examination maybe helpful in diagnosing the cause of pain; however, localization is often notoriously unreliable in children (Van Heurn, et al, 2013). In such cases, diagnostic tests such as radiological examination, ultrasonography and computer tomography (CT) may be necessary.
Plain abdominal x-rays and contrast studies are useful in diagnosing general acute abdomen, but ultrasonography is typically the first choice because it is fast, painless and relatively inexpensive. Ultrasonography can be used to diagnose acute appendicitis, intussusception, inguinal hernia, testicular torsion, and ovarian torsion (Van Heurn, et al, 2013). In some cases, CT scans may be necessary if a diagnosis cannot be made from the ultrasonography. For instance, CT has a higher sensitivity and specificity than ultrasonography in diagnosing appendicitis, thus, it may be preferred (Van Heurn, et al, 2013). MRI may similarly be preferred in diagnosing because it may have higher sensitivity and specificity; nevertheless, its use in children is limited because it generally requires anesthesia (Van Heurn, et al, 2013).
What are the various ways in which UTIs manifest in pediatric patients? How are UTIs managed differently, depending on the age of the patients? Which diagnostic studies would you recommend considering the age of a patient and why? When would you recommend prophylactic antibiotics to pediatric patients and why? Urinary Tract Infection (UTI) affects children under the age of 7 years at a rate of 8% in girls and 2% in boys (Williams, Hodson, Isaacs & Craig, 2010). UTIs can be grouped into 3: Asymptomatic bacteruria, which can be found without symptoms in children and should not be treated because the use of antibiotics may promote symptomatic disease and antibiotic resistance.
The second is cystitis occurs when the infection is limited to the urethra and bladder with symptoms such as frequency, urgency, dysuria, cloudy urine and lower abdominal discomfort. The third is pyelonephritis, which is typically associated with fever (Williams, et al, 2010). The recommended diagnostic studies include screenings (such as dipstick testing, and microscopy) and urine culture. The urine should be collected either via clean catch sampling or urine collection pad. Dipstick testing is useful for determining the presence of nitrite or leucocyte esterase, but false negative and false positives will necessitate urine culture. Microscopy test can be used to screen for white cells (pyuria) and/or bacteria. Urine culture is used to confirm the diagnosis (Williams, et al, 2010).
Infants that are 3 months or less should be treated with intravenous antibiotics until afebrile and oral antibiotics can be used for 7 – 14 days (Williams, et al, 2010). Infants older than 3 months should be given oral antibiotics for 7 – 10 days unless the child is seriously unwell or unable to take oral antibiotics. Prophylactic antibiotic is a premedication that can be used as a precaution against infection. Its use in children is neither advisable nor justifiable after an initial occurrence of UTI, but it should be considered in children at high risk of serious or recurrent infections which can be determined based on renal tract imaging (Williams, et al, 2010).
