Acute Diarrheal Diseases

Assessment of diarrhea pt for dehydration

TMT PLAN (A) TO TREAT DIARRHOEA AT HOME

                        -Patients first seen with no signs of dehydration can be treated at home.

                        -Explain three rule for treating diarrhoea at home

1.      Give the child more fluids than usual to prevent dehydration – give home available fluid.

2.      Give the child plenty of food to prevent under nutrition continue Breast feeding.

3.      Take the child to HW if the child does not get better in 3 days (or) develops

(1)   Many watery stools

(2)   Repeated vomiting

(3)   Marked thirst

(4)   Poor eating

(5)   Fever

(6)   Blood in stool.

-         Give ORs packets to take home.  Give enough packets for 2 days. Demonstrate how ils prepare and give the solution.

PLAN (B) TO TREAT SOME DEHYDRN

Approx Ors in just 4 hrs

NB  :-  1. Use  pts age only when you do not know that the wt. Approx amt of ORs required (in ml) can be calculated by multiplying pts wt in gms x 0.075.

2.      If child wants more ORs give more

3.      Encourage the mother to continue Breast feed.

4.      For infants < 6/12 , if not breast fed, give 100 – 200 ml clean water during this period.

Observethe child carefully & helpthe mother give ORs soln:-

1)      Show her how much ORs soln to be given to child.

2)      A teaspoon ful  every 1 – 2 mts & 2 yr; frequent tips from a cup for older child.

3)      When vomiting is pst, wait 10 mts and continue ORs slowly.

4)      If the child’s cyclids become puffy, slop or  and give plain water (or) breast milk, give ORs according ls plan A when puffiness is gone.

-         After 4 hrs seassen the child using the Assessment chart.  Then select plan A,B (or) C to continue tmt.  Reassesment after 4 hrs

No signs of dehydration  à plan A

Some dehydration  à Repeat plan B but start milk juice and food

Severe dehydration  à Start plan C

Treatment plan C to treat severe Dehydration

1)  Can give IV7 immediately à Start IV7 ; if the pt can drink give ORs until drip is ready.

Give 100 ml / kg RL (or) NS

-         Reason the pt every 1 – 2 hr If no improvement à give IV drop most rapidly.

-         Also give ORs as soon as pt can drink.

-         Evaluate the pt using Assessment chart after 6 hrs (or) 3 hrs and choose appropriate plan A / B / C to continue tmt.

2)      Cannot give IV7 immediately

But IV7 available nearby in 30 mts

-         send pt immediately for IV7 there.

-         Give ORs if pt can drink during trip.

3)      No IV7 available nearb

But you are traited to use Naso-gastric tube

-         Start rehydration thus NG tube in ORs give 20 ml / kg / hr for 6 hrs.

-         Reassess the pt every 1-2 hrs

-         If no improvement in hydration send for IV7

-         After 6 hrs reassess the pt and choose appropriate Tmt plan.

4)      You are not trained in use a NG tube

But pt can drink

-         Start rehydration thus NG tube in ORs give 20 ml / kg / hr for 6 hrs.

-          Reassess the pt every 1-2 hrs

-          If there is repeated vomiting give slowly.

-          If no improvement after 3 hrs send pt for IVF therapy

-          After 6 hrs reassess the pt and choose appropriate Tmt plan.

5)      If the pt is > 2 yrs and there is chotera in your area, give appropriate antibiotic after pt is alert.