Question

Rota Virus Concept Map ( for pediatric):

pathophysiology,

clinical manifestations,

diagnostic evaluation,

therapeutic management,

nursing care management,

prevention

Answer 1

Ans) Rotavirus: According to Center of Disease Control and Prevention, Rotavirus is an infection that causes diarrhea. It's the most common cause of diarrhea in infants and children worldwide.

Pathophysiology:

- Rotavirus invades and damages the cells of the intestinal mucosa.

- The transport of glucose and salt are disrupted, leading to increased water in the intestine; sugar malabsorption occurs as the result of a decrease in the levels of intestinal disaccharides.

- The action of such enzymes as maltase, sucrose, and lactase is reduced.

- The virus replicates, releasing an enterotoxin that causes atrophy and ischemia of the small intestinal villi.

- Stimulation of the intestinal nervous system leads to increased water secretion in the gastrointestinal tract.

- Damage to the villi decreases viable absorptive surfaces, causing an imbalance of secretion and absorption that results in diarrhea.

- Incubation ranges from 12 hours to 4 days.

Clinical manifestation:

- Hyperactive bowel sounds
- Diarrhea; possibly as many as 20 stools per day
- Signs of dehydration:

• Hypotension
• Drymucous membranes
• Concentrated urine
• Poor tear production
• Poor skin turgor
• Oliguria
• Sunken eyeballs
• Tachycardia

Diagnostic Test Results-Laboratory

Rotavirus enzyme-linked immunosorbent assay is positive for viral protein in stool.
Stool assays may be positive for reducing substances.

Therapeutic management:

- Skin care

- Symptomatic

- Contact precautions:

• Proper hand-washing technique
• Use of PPE ( Personal Protective Equipments)

- Diet:

• Small, frequent meals
• Increasedfluid intake and rehydration
• Avoidanceof sports drinks and other hyperosmolar beverages to prevent hypernatremia.

- Activity:

• Rest periods when fatigued

- Medication:

• None (antibiotics and antimotility drugs contraindicated)
• I.V. fluids if dehydration is severe
• Rotavirus vaccine as a prevention.

Nursing management:

Nursing diagnosis:

- Activity intolerance
- Acute pain
- Fatigue
- Hyperthermia
- Imbalanced nutrition: Less than body requirements
- Impaired skin integrity
- Risk for imbalanced fluid volume

Expected outcome:

- Return to previous activity levels
- Report decreased levels or the absence of pain
- Verbalize or demonstrate increased energy
- Remain afebrile
- Maintain an adequate nutritional status
- Exhibit improved or healed lesions or wounds
- Maintain normal fluid volume and electrolyte balance.

Nursing intervention:

- Institute contact precautions for the duration of the illness; adhere to standard precautions.
- Enforce strict hand washing and careful cleaning of all equipments.
- Implement measures to ensure adequate hydration; offer frequent sips of fluid initially, gradually increasing amounts as tolerated.
- Check skin turgor and mucous membranes; obtain the patient's daily weight, if appropriate; if dehydration is severe, initiate I.V. fluid therapy, as ordered; ensure patent I.V. access.
- Ensure resumption of oral intake within 24 hours of the illness; give lactose-free, carbohydrate-rich foods; avoid juices and sodas because of their high sugar content.
- Inspect the perianal area for redness, irritation, or breakdown; keep the area clean and dry; clean the patient's perineum thoroughly to prevent skin breakdown; apply soothing ointments or skin protectants, as indicated.
- Auscultate bowel sounds; check stools for occult or frank bleeding.
- Provide frequent rest periods; cluster care to minimize energy expenditure.

Nursing monitoring:

- Vital signs
- Fluid balance/hydration status
- Daily weight
- Nutritional status
- Perianal skin integrity
- Bowel elimination pattern
- Activity level

Patient/Family teaching:

- Disorder, underlying cause, diagnosis, and treatment, including the route of transmission (fecal-oral route) and that diarrhea may last for 5 to 7 days
- The disorder is usually self-resolving
- Proper hand-washing technique
- Contact precautions
- Immunization for rotavirus as recommended by the Centers for Disease Control and Prevention
- Instructions on thorough cleaning of the perineum and all affected surfaces
- Need for increased fluid intake; suggestions for appropriate fluids such as electrolyte replacement solutions and appropriate foods such as lactose-free, high-carbohydrate foods; the need to avoid juices and soda because of their high sugar content.
- Importance of notifying the practitioner of increased diarrhea or signs of dehydration.

Prevention:

- Good sanitation and hygiene

- Exclusive breastfeeding for six months

- Improved water quality

- Rotavirus vaccination