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Counseling on AGE & Mx : IV fluids + ORS

Acute gastroenteritis (past year stream 5)


Questions: Kevin 2 years old boy was admitted to the ward due to acute gastroenteritis with
moderate to severe dehydration. He has diarrhoea and vomiting. He was given IV fluid and
oral rehydration salt. This is the first hospital admission. Explain his condition to the guardian
and the management was done on him. DO NOT ask history. DO NOT report to examiner

3. Explain the child’s condition.


Ex : We have examined him. What’s wrong?
4. Explain management
5. Do you understand what I have said? Do you have any quiries?

1. Introduction
- Introduce yourself
- Ask the parent’s name, how should I address you?
- Assess knowledge.
- Ex : Good afternoon, my name is Dr. Ali, I am the one who seeing your child. So are you
Kevin’s father/ mother? How should I address you? Are you the one who brought him to the
hospital?

2. Explain purpose of the conversation and the child’s condition (may need to ask some
questions?)

Purpose
- So I have examined your child, and i would like to talk to you about his current condition.
3. Explain the child condition.

Condition and management done


-As you know, he has had a few episodes of diarrhea and vomiting. That has caused him to have
lost a lot of fluid from his body. When he came in, he looked lethargic and very dehydrated. So,
we have started him on a drip to replace the fluid loss.
Explain the medical condition
- Now, the reason your son is having diarrhea and vomiting is because he has acute
gastroenteritis
** ANALOGUE : There are a lot of virus(rotavirus) inside your child stomach, and there are
having a war/ fighting with each other in her stomach causes her stomach so much
uncomfortable that’s why she having diarrhea.
Reassure (use calm tone, reassess parent’s response. Reassure if worried.)
- Don’t worry, it’s basically an infection in the gut and bowel which is caused by some virus,
Counseling on AGE & Mx : IV fluids + ORS

bacteria or parasite. Usually, it’s just due to a virus (Rotavirus) and will slowly resolve on it’s
own.
# Ask whether the parent understand what you just explained
4. Explain the management was done

Short term management


- At the moment, our treatment is to replace the water he lost. He has not enough fluid in the
body hence we give him fluid via the branula.
Long term management
- He still can tolerate orally, hence we also give him oral rehydration solution which can replace
the fluid, ions and electrolytes loss into the stool and vomits.

* Since the infection is normally due to a virus, we do not immediately start on antibiotics as that
will not benefit your son, Kevin. We shall take some tests to confirm the cause and then proceed
with further management. As for now, it is crucial to keep him hydrated.

- there is no need to explain to the mother on how to calculate the amount of fluid the child has
to take in a day. It is good to explain what is ORS, why it is given and a simple way to prepare it,
however, there is no need to go in depth on how much ORS is needed to give to the child.

4. Feedback
- Do you understand what I am saying?
- Do you have any questions? So what do you concern about?

5. Reassure
- Do not worry so much. Your child will get well soon after we replace the fluid loss. What can
you do right now is being by his side and comfort him. You can offer him orally if he can
tolerate it. Offer him some plain water, fruits juice or soft food like porridge.

6. Others
- Questions can be asked by parents?
a) Do my child need antibiotics/ antiemetic/ or antidiarrhoeal?
No need antibiotics because like I said the most common pathogen causing acute
gastroenteritis would be virus. Unless :
a) dysentery + high fever + concurrent symptoms of septicaemia.
Counseling on AGE & Mx : IV fluids + ORS

b) blood culture : bacterial (bacteraemia, septicaemia)

* AGE + stool culture have bacteria -> no need antibiotic


due to give antibiotic will not improve recovery but may prolonged diarrhea.

We won’t give antiemetic because it can have bad side effect especially to the brain. The
child can have drowsiness. (antiemetic – can caused CNS effect, abnormal movements: oculo
gyric crisis).
Eg : ordansetron (chemo pt), maxolon or metochlopromide, prochlorperazine or stemetil.

* oculo gyric crisis : dystonic reaction to certain drugs/ medical


characterized by a prolonged involuntary upward deviation of the eyes.
- restlessness, agitation, malaise, fixed stare.

Antidiarrhoeal also no need because we want him to pass out stool so all the pathogen can be
wash out/ come out too.

b) Is ORS is medication?
No. It is a form of treatment, but not a drug/ rather than medication I would say ORS is
replacement of fluids, ions or electrolyte loss due to vomiting and diarrhoea.

c) How long it takes for the symptoms to resolve?


Maybe after 2 to 3 days.

d) What is in this ORS that you mention?


It contain electrolytes which are substances that is required for the body to function well/ it
contain salt that is required for the body to function well. As your son will lose these vital
substances through vomiting and diarrhea, this ORS will compensate the salt that your son had
lost.
e) Can I feed him orally since he has a drip?
Yes.
f) Patients need to know how to calculate fluid deficit?
No need. We will calculate for them.

g) No medical jargons.
Ex: IV/ intravenous
Counseling on AGE & Mx : IV fluids + ORS

h) What would AGE due to?


Bacteria / Virus ( more common )

i) Body language
- eye contact
- facial expression
- tone of voice

j) Main concern : Dehydration


Main treatment : Rehydration

k) If patient ask the questions that you can’t answer …..


“ I can’t recall the details, need to double check, or consult my superior, later I will come back to
you. “
l) Discharge home need to tell when to come?
- lethargic / cannot pass urine (sx of dehydration)
m) Need to teach parents how to do ORS?
- No nid to go for details.
- Important when need to discharge patient( not in this case.)
- In this case, the nurse will assist parent to do ORS.
- ** NID TO FEED child REGULARLY.

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