Severe, poorly localizing abdominal pain that is combined with the bloody diarrhea should make the provider consider a rarer condition such as intussusception or volvulus which would indicate urgent action (Bousvaros, 2015). The color of the blood is very important to assess when discussing this issue with the parent or caregiver. Black blood can imply that the bleeding is coming from the esophagus, stomach, or duodenum (Bousvaros, 2015). Maroon-colored stool can suggest small intestinal bleeding that can come from a Meckel diverticulum (Bousvaros, 2015). Bright red blood implies that there is a colonic or rectal source of bleeding (Bousvaros, 2015). In babies 0-3 months the most common causes of rectal bleeding are anal fissure or allergic colitis (Bousvaros, 2015). Questions regarding formula type, diet of mom if breastfeeding, family history of allergies to milk or dairy, bowel movement consistency of the baby to rule out possibility of fissures, and questions regarding relationship or pattern of bloody diarrhea and feedings. Younger infants need to be asked specific questions about projective vomiting, masses felt in abdomen by parents, abdominal movements the parents have visualized during diaper changes, and the ability of the child to tolerate feedings. Young infants are establishing bowel habits and have brand new digestive systems that could be malformed or even become twisted during growth of the infant. Evaluation for pyloric stenosis or intussusception is very important to ensure proper nutrition and growth for the baby. Older infants and toddlers most likely have constipation, Meckel’s diverticula or polyps (Bousvaros, 2015). Questions regarding stool consistency, frequency, and effort can help to rule out constipation issues causing hard stool passing through tearing the intestine/rectum. Asking questions regarding stool shape, color, and consistency can also help to rule out possibility of polyps or Meckel’s diverticula (Bousvaros, 2015). Older children in school and
teenagers often have issues such as constipation, polyps, infections, and inflammatory bowel disease (Bousvaros, 2015). Children who enter school often get constipated because they are afraid to have bowel movements in the bathrooms at school, or children feel the bathroom at school is dirty and it creates a cycle of constipation for the child. For older children questions regarding pattern of bowel movements, color, consistency, triggers, effort of bowel movements, anxiety or stress in home, or presence of abdominal pain or fevers with bloody diarrhea. Regardless of age it will be important to assess whether the diarrhea wakes the child at night and if their growth had been affected due to malnourishment. Questions regarding how much liquid intake they are taking daily and how many times they pee is important to assess hydration status.
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- Summer '17
- Gastroenterology, Gastroenteritis, Vomiting, NSG6435 Week 6 Discussion