Gastroenteritis history taking


  • Gastroenteritis
  • Gastrointestinal History Taking
  • The child should feel involved, but the parents may have more objective or detailed observations. Ensure the environment is comfortable and allows the child to be occupied while you gather information.

    Determine the reliability of the child or parent. Would a different caregiver be more suitable for detailed day-to-day questions? Confidentiality is important in all patient interactions.

    In particular, older children and adolescents should have a good understanding of the confidentiality of their medical interview and examination.

    Document a complete growth record, dietary information, and patterns of feeding and bowel movements in addition to obtaining the presenting complaint and history of presenting illness. If appropriate, start with history from birth. Is there another reason they are visiting the doctor today? Presenting complaint A brief description by the patient or parent of the complaint s bringing the child to see the doctor. History of present illness Timing of the problem: onset, frequency, time of day, and duration.

    Is it ongoing? Has it happened before? If so, characterize. Pinpoint location of the symptoms or pain as much as possible, and ask about position, quality, radiation, and severity. Bowel movements? School avoidance? Associated symptoms: ask about vomiting, character of vomitus, colour of vomitus bilious? Are any symptoms associated with eating or bowel movements?

    How do the symptoms affect the child and the family? What does the child or parent think is causing the symptoms? What would you like to get out of the visit today? Peri- and Postnatal History: APGAR score, onset of crying, first breath, breathing problems, birth weight, birth length, head circumference, presence of jaundice or cyanosis, presence of convulsions, fever, haemorrhage or birth injury, congenital abnormalities, presence of meconium, feeding history, number of days in hospital, NICU admission, discharge weight, illness in first month of life.

    Screening procedures types, such as sickle cell, G6PD, lead, HIV, genetic or metabolic screens, and results ; immunizations ages, types, presence of reactions, seasonal influenza. Infant nutrition: formula type, concentration, amount with each feeding and within 24 hours, changes, duration, problems, burping, regurgitation ; breast frequency, length, problems, weaning — how were they weaned, and at what age , introduction to solid foods when, how, what types, how were they taken, what was the reaction to the solid foods , following Canada Food Guide.

    Overfeeding can be a common problem for new breastfeeding mothers. General childhood health Past illnesses: infections type, quantity, severity, age , past hospitalizations age, indication , past operations age, indication , allergies insulting agent; ask patient or parent to specify the reaction; if anaphylactic, ask if they carry an EpiPen.

    History of trauma. Family history: age and health status of immediate family members, communicable disease history, genetic disease history, health status of living children. Current health status Allergies food, medications, environmental irritants, eczema, asthma, allergic rhinitis.

    Safety measures car seats, choking, falls, injury prevention, drowning, bicycle safety, seat belts, sexual practices, violence Exercise type, duration, frequency Sleep: length of sleep at night, naps, and character of sleep. Does the child experience nightmares? Elimination: urination patterns discomfort, blood, control.

    Personal habits: nail biting, thumbsucking, tobacco, alcohol, caffeine, drug use. Review of systems Serves to obtain additional symptoms or signs and to probe further systems related to the present illness. Skin: rashes for example, eczema or diaper rashes , hair, skin texture, colour, hives.

    Eyes: vision, crossed eyes, foreign body, nystagmus, colour, glasses. Ears, nose, throat: sore throat, post-nasal drip, frequent infections, congestion, ear infections, hearing, sneezing, snoring. Cardiorespiratory: chest pain, cyanosis, edema, syncope, tachycardia, dyspnea, coughing, wheezing, sputum, stridor, secretions, snoring, sleep apnea. Gastrointestinal: vomiting, abdominal pain, type of stool diarrhea, constipation.

    Genitourinary: urinary patterns dysuria, polyuria, enuresis, frequency , toilet training, urine character hematuria, pyuria , discharge, menstrual history, abnormalities of genitalia, precocious puberty. Neuromuscular: headache, anxiety, dizziness, tingling, convulsions, seizures, problems with movement eg. References Byrnes K. Conducting the pediatric health history: a guide. Pediatric Nurs ; 22 2 Chen YA, Tran C.

    The Toronto Notes, 27th edition. Gallagher R.

    In a large number of cases it is a benign self-limiting illness. Despite this, many patients present to health care services and it can be a cause of significant morbidity and mortality. Definition Infective gastroenteritis is a temporary disorder due to an enteric infection.

    It is most commonly caused by viruses, but can also be due to bacterial or parasitic infection. It is typically characterised by sudden onset diarrhoea with or without vomiting. The vast majority of patients do not have a stool sample sent. Public Health England reviewed laboratory reports over two weeks in and demonstrated that the most common isolates were Rotavirus and Campylobacter 3.

    Adenovirus, which commonly results in respiratory infections, can also be a cause of gastroenteritis in children. Viral causes of gastroenteritis Rotavirus Most common cause of infantile gastroenteritis.

    The majority of children will have this infection before their 5th birthday 2. As immunity is long lasting, it is uncommon in adults. It is given at 8 and 12 weeks 4. Rotavirus is spread by the faecal oral route or by environmental contamination, incidence peaks over the winter months. Norovirus Refers to a group of single stranded RNA viruses. They are the commonest cause of gastroenteritis in all age groups across England and Wales 2. Norovirus is spread by the faecal oral route or by environmental contamination.

    Adenovirus It is more commonly known for causing infections of the respiratory system. However, they can also cause gastroenteritis, especially in those under 2 years of age. Bacterial causes of gastroenteritis Campylobacter This is the most commonly reported bacterial cause of gastroenteritis in the UK 2. It can cause bloody diarrhoea and is usually due to consumption of undercooked meat and unpasteurised milk. Escherichia coli Most strains of E-coli are harmless, however, some strains verocytotoxin producing E-coli aka VETC cause significant illness.

    Clinical Features Gastroenteritis is primarily a clinical diagnosis and therefore a careful history and examination should be performed. It is important to recognise those children who are at risk of dehydration. Those at greatest risk include 1 : Young children especially under 6months. Children who have stopped breast feeding during the illness.

    History of present illness Timing of the problem: onset, frequency, time of day, and duration. Is it ongoing? Has it happened before? If so, characterize. Pinpoint location of the symptoms or pain as much as possible, and ask about position, quality, radiation, and severity. Bowel movements? School avoidance? Associated symptoms: ask about vomiting, character of vomitus, colour of vomitus bilious?

    Are any symptoms associated with eating or bowel movements?

    How do the symptoms affect the child and the family? What does the child or parent think is causing the symptoms? What would you like to get out of the visit today?

    Peri- and Postnatal History: APGAR score, onset of crying, first breath, breathing problems, birth weight, birth length, head circumference, presence of jaundice or cyanosis, presence of convulsions, fever, haemorrhage or birth injury, congenital abnormalities, presence of meconium, feeding history, number of days in hospital, NICU admission, discharge weight, illness in first month of life.

    Screening procedures types, such as sickle cell, G6PD, lead, HIV, genetic or metabolic screens, and results ; immunizations ages, types, presence of reactions, seasonal influenza.

    Gastroenteritis

    Infant nutrition: formula type, concentration, amount with each feeding and within 24 hours, changes, duration, problems, burping, regurgitation ; breast frequency, length, problems, weaning — how were they weaned, and at what ageintroduction to solid foods when, how, what types, how were they taken, what was the reaction to the solid foodsfollowing Canada Food Guide.

    Overfeeding can be a common problem for new breastfeeding mothers. General childhood health Past illnesses: infections type, quantity, severity, agepast hospitalizations age, indicationpast operations age, indicationallergies insulting agent; ask patient or parent to specify the reaction; if anaphylactic, ask if they carry an EpiPen. History of trauma. Family history: age and health status of immediate family members, communicable disease history, genetic disease history, health status of living children.

    Current health status Allergies food, medications, environmental irritants, eczema, asthma, allergic rhinitis. Safety measures car seats, choking, falls, injury prevention, drowning, bicycle safety, seat belts, sexual practices, violence Exercise type, duration, frequency Sleep: length of sleep at night, naps, and character of sleep. Does the child experience nightmares?

    Gastrointestinal History Taking

    Elimination: urination patterns discomfort, blood, control. Personal habits: nail biting, thumbsucking, tobacco, alcohol, caffeine, drug use. Excess alcohol intake increases the risk of gastrointestinal malignancy e. Offer support services to assist the patient in reducing their alcohol intake. See our alcohol history taking guide for more information. Recreational drug use Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use.

    Intravenous drug use is a risk factor for hepatitis. Gambling Ask the patient if they gamble and if they feel this is a problem. Gambling is causative of several decrements to health directly, such as increased sedentary behaviour during the time spent gambling, poor sleep, reduced levels of self-care and anxiety.

    Patients with a gambling problem are also more likely to have substance misuse issues. A low fibre diet and inadequate fluid intake is a common cause of constipation. Patients with coeliac disease may report abdominal pain, nausea and diarrhoea when eating gluten-containing foods. Patients with biliary colic may report that fatty foods trigger right upper quadrant pain.

    Exercise Ask if the patient regularly exercises including frequency and exercise type.


    thoughts on “Gastroenteritis history taking

    • 19.08.2021 at 11:13
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    • 19.08.2021 at 13:24
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