Pediatric Nursing and Gastroenteritis

Gastroenteritis
Gastroenteritis only shows relatively mildly in children and lasts for a few days. On many occasions of the illness, parents manage it at home and may not even seek professional help. While many children who develop gastroenteritis do not need specialized care, still, they end up in hospital facilities and are admitted as inpatients. Such patients are kept in hospital for a significant period. This is a notable strain on the health sector. Admitting these children in the hospital also poses a risk of infecting other children who have been admitted on other issues at the hospital. Some of these at-risk may be highly vulnerable due to their health conditions (Hockenberry & Wilson, 2019).
The recommended approaches for managing Gastroenteritis keep evolving. There are new management strategies and treatments proposed every day. Some of the proposals could be controversial. New approaches are being tested for fast rehydration using intravenous fluids. There have been several assessments of the severity of dehydration and consequent computation of fluid deficits in patients proposed. Several therapies, such as antidiarrheal and anti-emetic methods have been suggested for Gastroenteritis treatment. However, uncertainties exist regarding the safety and efficacy of such agents (Hockenberry & Wilson, 2019).
It has been found that the pediatric Intensive Care Unit often places children under the risk of psychological and behavioral difficulties after they have been discharged. Although medical technology has advanced a lot, 25% of the admitted to PICU show negative behavioral and psychological outcomes within the first year after they have been discharged. Thus, it is important to explore a broader spectrum of risk factors and indicators of outcomes when looking out for long term psychological morbidity so that the areas that need health enhancement and healthcare interventions can be pointed out (Caplin& Cooper, 2007).
Critical illness for children exposes them to stressors in the end. They are subjected to invasive procedures, separated from their families, exposed to other children who are critically ill, and even some who are dying. These are true extremes for people of such tender age. They are further subjected to light changes, multiple strangers having to administer complicated medical procedures to them, and more. The children, in turn, show their stress through the loss of sleep through numerous awakenings. Once children are admitted, they are exposed to a completely new environment. They are removed from familiar territory. The attachment to parents and other caregivers at home is severed. It does not matter how friendly the hospital may be; it is still a highly strange and discomforting territory to be in for children; a different routine, a different bed, and even bed position- generally little they are used to happens. Children react to stress through varying behavior changes, which can be drastic sometimes (Caplin& Cooper, 2007).
One of the common reactions by children to hospitalization is that their development tends to regress. It involves losing some of what they had gained and learned earlier. It also happens to be a predictable reaction across the range of ages and is expected by medics. It is said to be a healthy reaction to hospitalization by children. It helps them cope with the hospital experience. The regression is usually reversed as soon as the hospitalization term ends. A continuum of development is shown when an approach that is tied to the age of the hospitalized patient is used (Caplin& Cooper, 2007).
Children in pre-school tend to tolerate separation from their parents more, compared to toddlers. It has been observed that at the pre-school stage, the children's cognitive repertoire is more developed and can understand that the pare3nt who is absent will come back. Still, though, the advanced memory and imagination could lead them to think of extraordinary aspects regarding their illness. They may create a casual hypothesis of what their ailment is about and what their role in it is. Things like: "I fell sick because I deserved it" "If I behave well, I will recover." ” (Caplin& Cooper, 2007).
The effect of hospitalization on the entire family
Both the hospitalized child and the family are subjected to undue stress. Such children and their families may experience fear and loss of control. Such emotional upheavals interfere with the healing process. The focus of healthcare workers should now be on how to develop a hospital environment that facilitates the healing process and allows for family control. Where possible, both the child and family should be prepared in advance for hospitalization. Thus, they will have been informed about the details of care that will be accorded at the hospital. The physician will also have a chance to know the expectations of the family regarding the hospitalization (Hockenberry & Wilson, 2019).
If hospital care does not involve the primary care physician going round to see patients, the family should be informed of who will provide such care and how the communication from physicians will be managed and coordinated. There should be effective communication between physicians at admission so that there will be satisfactory care. If possible, allow the child and family to make a pre-visit to the hospital where the child will be admitted and even shown who will be providing the care. A proactive child life service should be in charge of pre-hospitalization events (Hockenberry & Wilson, 2019).
Assessment
A lot of children with gastroenteritis conditions do not need any lab exams. Many children and infants commonly experience short episodes of diarrhea and are attended to by their parents. They usually do not seek medical advice for the same. Even when parents seek such advice, healthcare personnel usually believe that clinical evaluation is what will portray the right picture. However, there may be cases when it is helpful to conduct a diagnosis. There is usually no attempt to conduct stool investigations to establish the specific particular enteric pathogen that has caused gastroenteritis in a child. Some situations call for microbial investigation though (National Collaborating Centre for Women's and Children's Health, 2009).
Identifying specific pathogens is important because some pathogens may be of interest and import. For example, dysentery that is caused by amoeba will need to be treated with antimicrobial therapy. E. coli O157:H7, on its part, is linked with the hemolytic uraemic syndrome. The later can be a fatal disorder. Bloody diarrhea could also be observed from critical conditions that are non-infective such as inflammatory bowel disease. In these cases, isolating pathogens will help designate the treatment regimen. It is thus an important step to establish the frequency with which enteric pathogens were picked out via stool investigation. The child showing signs of diarrhea and was returned recently from the Diaspora is another case of interest because the pathogens could be different (National Collaborating Centre for Women's and Children's Health, 2009).
Gastroenteritis in children is caused by Rotavirus. It may be caused by other pathogens, but they are relatively rare suspects. Norovirus is one of the commonest among the rare group of pathogens that lead to gastroenteritis. Other rare suspects include calicivirus, astrovirus, and adenovirus. Salmonella and campylobacter bacteria, protozoa such as cryptosporidium, could also lead to gastroenteritis (National Collaborating Centre for Women's and Children's Health, 2009).
In case is uncertainty exists on the part of the clinician regarding the diagnosis of gastroenteritis, isolating the stool pathogen could help to reassure. By the use of the usual examinations such as stool microscopy, standard viral detection, and culture, a pathogen responsible for infection can easily be picked out in most gastroenteritis patients. Children presenting mucoid and bloody diarrhea should be examined since these are signs of potentially critical disorders. Many noninflammatory and non-infective bowel cases could present with bloody stool. Infants may present with bloody diarrhea that results from a wide range of colitis infections. It may even be an allergic indication, although there is often uncertainty in the etiology (National Collaborating Centre for Women's and Children's Health, 2009).
The inflammatory bowel disease can start at an early age and be easily confused with gastroenteritis. Both conditions come with bloody diarrhea. If there is no diagnosis, it is not possible to distinguish between amoebic, bacterial dysentery, ulcerative colitis, or Crohn's colitis. A wide range of disorders that result from surgery is linked to bloody/mucoid stool. Usually, children with bloody diarrhea do not need microbial therapy; there are exceptions, though (National Collaborating Centre for Women's and Children's Health, 2009).
Infection with enterohaemorrhagic E. coli commonly causes bloody stool diarrhea. Children in such a condition are exposed to the risk of developing HUS, which can be fatal. The sooner the diagnosis is carried out, the better chance of dealing with the condition. Children rarely present with bloody diarrhea associated with pseudomembranous colitis. In the latter case, C. dificile could be detected in the patient stool. When children's diarrhea problem persists for a period exceeding seven days, it calls for further examination. Some treatable infections, such as giardiasis, could be involved. If a child with a diarrhea indication is critically ill and there is a chance of septicemia that calls for antibiotic therapy is real, there may a need to conduct a microbial investigation. Stool culture could help in identifying the responsible pathogen in some patients with bacterial dysentery with bacterial septicemia (National Collaborating Centre for Women's and Children's Health, 2009).
Behavioral Assessment
Owing to the fantasy and egocentric thinking patterns, children in pre-school are limited in their understanding of the situations they undergo. Children do not quickly understand the circumstances when they are hospitalized. Therefore, interacting with their body systems becomes a challenge. Children experience another sickness apart from the obvious one that has brought them to the hospital. They often develop psychological problems as a result of hospitalization. For children in pre-school, hospitalization is horrific. They cannot think abstractly about the temporal nature of situations (Campos, Rodrigues & Pinto, 2010).
The effect of hospitalization can cause significant damage to children if their families are not prepared for the episode. According to research, the reaction of children such as gazing, moving, expression of feelings, and talking range at levels 1 and 2 before therapeutic play sessions. However, they proceed to level 3 after the therapeutic play session (Campos, Rodrigues & Pinto, 2010).
Earlier research shows that pre-school children who were hospitalized for a while after birth displayed aggression, hyperactivity/impulsive, regression, and dependent traits compared to children in daycare, who had not been exposed to the hospitalization experience. The outcomes for somatic concerns and aggression tend to follow the same train. The mean for children who have been hospitalized before and those who have not is similar, though, irrespective of their care status. Therefore, it seems that being exposed to both experiences thaws the aggressions (Emde & Harmon, 2012).
There seems to be a developmental change between the ages of 4 and 5. Something at this stage makes a child less vulnerable to the negative effects of hospitalization, irrespective of other factors. It seems that the increased competence in emotional, cognitive, and social skills gives the child capacity to put things in perspective, including hospitalization. Thus, they are enabled to cope better. Nevertheless, the comprehension of specifics regarding a child's given hospitalization is influenced by a myriad of factors that tend to be related to the level of risk (Emde & Harmon, 2012).
Theory of Play
Since the children are not familiar with the hospital environments and the procedures carried out therein, the experience exerts significant psychological pressure on them. One of the most common responses reported about children in such situations is anxiety. Anxiety is harmful to children, physiologically, and psychologically. Further, when it is in its extreme form, the children's response to medication and coping with the effects is compromised. It encourages negative behavior and anger towards healthcare givers. The play is a normal developmental activity among children and should be encouraged. It is also commonly used to mitigate stress among pediatric patients and their families in the period of hospitalization. The children are provided with an opportunity to master themselves, the environment and the world through play activities (Hockenberry & Wilson, 2019)
When one is admitted, there is immediate attention paid to alleviating the clinical symptoms of the illness and reducing the psychological strain. Consequently, no one thinks of play or just dismissed as a minor aspect. Nevertheless, the value of play increases as the child continues to stay in the hospital. Play enhances emotional, self-esteem, self-confidence, and psychological wellbeing, regardless of their physiological condition. Children make sense of the world through play. In a hospital environment, play helps children to develop and learn, hence reduces their anxiety. Thus, they can cope with treatment better. They are provided with a chance to make choices hence develop a feeling of control again (Koukourikos et al., 2015).
Medical play is commonly applied in hospital environments by medical professionals. It's a therapeutic program in which children are exposed to medical themes and materials for their play. Through observing how the children play, adults can infer what the children feel and think. Their concerns, fears, and misconceptions can be learned through the play activity. Such information can help health professionals to develop strategies to help the children to cope with their situation. There are various types of recreational and diversional games provided to counter boredom and to enhance normalization. Patients could be allowed to listen to their favorite music, watch movies, cartoons, play bouncing, in water, and balling, among other relevant games (Koukourikos et al., 2015).
Developmental play is another form of play commonly used. It enhances all aspects of a child's development. It involves learning activities such as cutting with scissors, gluing, building using blocks, drawing using crayons, board games, adult assisted reading, playing chutes, and ladders, among others. The last type is a therapeutic play. It enhances expression, mastery of the healthcare experience and coping, and helping the achievement of the goals of healthcare. Using dolls and puppets, stuffed animals, playing house peer play are some of the ways the therapeutic play is facilitated (Koukourikos et al., 2015).
Play intervention plan
Eva Madison, in her play, was accorded hospital play interventions. Since the healthcare facility is extremely busy, the healthcare expert proposed that she should be allowed a full dose of 30 minutes play every day. Such play is what should constitute preparation for hospitalization for children based on their age/psychological, social, cognitive development, and health-related matters (Li et al., 2016).
In Eva's case, the play strategies included both structured and unstructured activities. In the course of treatment, she received the interventions in a playroom, except those that could be done in bed. Some were bedside games. Parents were advised to stay with their children when they played. The play intervention protocol was standardized for varying medical procedures, but the specialists of the interventions would choose befitting play activities for Eva. She was also granted a chance to choose between a range of play activities (Li et al., 2016).
The play experts, for instance, would engage Eva in playing blocks and puppets to elicit experiences of the sensory system. She was also engaged in activities that came with a high level of cognitive demand, such as board games and word puzzles. The activities also included logging the duration of time and the nature of the play. The VAS was used to measure the level of anxiety. The VAS is made of a 10 cm drawing on a card. It has varying facial expressions inscribed with the wording: "I have no anxiety at one end" and "I have a lot of anxiety" at the other. The higher the score, the higher the level of anxiety on the measure. She was assessed for emotional balance using CEMS, the observation scale. It has five categories, calibrated from 1 to 5 with scores that are summed, ranging from 1 to 25. Higher scores on this scale indicate intensifying emotional status (Li et al., 2016).
When asked to comment on the play interventions at the hospital, she confessed that they learned a lot about hospital procedures through the games. The children also confessed that they felt less anxious because of the games. Parents also expressed similar views. The reported that Eva settled more after she was engaged in the play interventions. She was also much more at home with the procedures at the hospital.
The findings support the positive effect of hospital play on the wellbeing of children and their responsiveness to therapy and medical procedures in the hospitalization period. Play is a crucial aspect of children's development and should be facilitated even in hospital settings. The most important among the gains that accrue from hospital play is that it helps the hospitalized children to cope with their condition and relieves them stress (Li et al., 2016).
Conclusion
Play is an important part of the development of a child. It is also a way through which a child communicates. Although disease, physical and psychological setbacks may affect the ability of a child to play, hospital play can greatly mitigate the effects of sickness and hospitalization. The play also helps health professionals to investigate what the children feel and think of their hospitalization and health condition. The knowledge of such mental status of children helps in developing strategies to help children to cope and respond better to hospitalization and therapeutic procedures. The play exhibits multiple characteristics that can be used not only in the treatment context to improve healthcare outcomes but also aid the improvement of the child's general function and development across domains. Play can be used by healthcare professionals as a treatment strategy for hospitalized children. The importance of play increases as the child's condition moves to critical status, disability, and even life-threatening health conditions. Play restores continuity in a child's psychosocial life. Healthcare professionals can gain useful insights regarding the child's health and mental condition through the use of play and observing the responses of the children engaged in the course of hospitalization. Children also have a chance to gain control of their bodies and situation. Consequently, hospitalization can, for once, be viewed by the children as a good development to help their condition. However, play is not just playing; there are standardized games that target specific responses and sequential evaluation of the child's condition. Thus, play activities must be selected carefully because they must be appropriate. The parents of hospitalized children should also be encouraged to bring along their children's favorite toys.
References
Campos, M. C., Rodrigues, K. C. S., & Pinto, M. C. M. (2010). Evaluation of the behavior of the pre-school one just admitted in the unit of pediatrics and the use of the therapeutic toy. Einstein (São Paulo), 8(1), 10-17.
Caplin, D., & Cooper, M. (2007). Child development for inpatient medicine. In Comprehensive pediatric hospital medicine (pp. 1285-1292). Mosby.
Emde, R. N., & Harmon, R. J. (Eds.). (2012). Continuities and discontinuities in development. Springer Science & Business Media.
Hockenberry, M. J., & Wilson, D. (2019). Wong's nursing care of infants and children E-book. Elsevier Health Sciences.
Koukourikos, K., Tzeha, L., Pantelidou, P., & Tsaloglidou, A. (2015). The Importance of Play during Hospitalization of Children. Materia socio-medica, 27(6), 438–441. https://doi.org/10.5455/msm.2015.27.438-441
Li, W. H., Chung, J. O. K., Ho, K. Y., & Kwok, B. M. C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC pediatrics, 16(1), 36.
National Collaborating Centre for Women's and Children's Health; UK. (2009). Diarrhea and vomiting caused by gastroenteritis: diagnosis, assessment, and management in children younger than 5 years.