Pediatric Vomiting: Diagnosis (Nursing)

00:00 All right, so how is pediatric vomiting diagnosed? Let's talk through this checklist.

00:07 So this is a list of all the things that you should be looking for with your patients and talking to your patients and caregivers about to give you a sense of how this vomiting has been going on and progressing.

00:18 So the first question you want to ask is when did the vomiting start? Has it been just sense, you know, earlier in the day? Or has it been going on for a couple of weeks? Because those can mean very different things.

00:29 How often is the patient vomiting? Are they vomiting every hour? Or are they vomiting every five minutes? Or are they vomiting just once a day? Or maybe after they eat a certain food? How much are they vomiting at a time? Does it seem like they're emptying their entire stomach at a time? Or does they have just a little, like more than a spit up, but like just a small amount? And then what does the emesis look like? This is important.

00:57 So does the emesis look bilious? And remember bilious? It comes from the word bile and bile is green. So does it look green at all? Does it look bloody at all? Those are the two things we really want to rule out or does it just look like food? Does it look like what they ate? Is the child still making the same amount of urine and stool as they did before the vomiting started? This is an important question because it kind of leads us towards whether the patient is dehydrated or not.

01:28 Because if they're making the same amount of urine and stool, they're probably not dehydrated.

01:33 But if those things have tapered off, like if they're not making as much, that's more of a concern that they may be dehydrated.

01:40 Do they have any symptoms of infection, for example, the viral causes of vomiting are very common.

01:49 And usually, if a child does have a virus that's making the vomit, they often have a fever.

01:55 They may have symptoms of a cold that go along with it and vomiting.

01:58 So maybe they have a runny nose, they may have a cough.

02:03 They may have congestion.

02:04 And then lastly, what and when did the patient last eat? So has it been a few days since they were were able to tolerate anything? And they have been vomiting since then? Or did they eat a different kind of food for the first time or maybe from a different place, and they started vomiting after that.

02:24 And that might have been the culprit for behind what caused the vomiting.

02:30 The next thing we want to do with these patients is give them a thorough physical exam.

02:33 And that starts with examining the patient's level of consciousness.

02:38 So is the patient awake and alert? Are they interacting with their caregivers, or you, or their environment? Or are they sleepier than you expect? We want to check their hydration status.

02:54 And part of this we know is we look at their mucous membranes.

02:58 Do they have enough normal amount of spit in their mouth? Or are the mucous membranes tacky? Are they starting to get dry? Do they have normal skin turgor? And we can think about this, we talk about skin tenting.

03:12 If someone is very dehydrated, their skin doesn't bounce back normally.

03:17 If you would pull it up, either, me it's seen hydrated, or on the baby, you can see they're pulling on the abdomen.

03:24 Sometimes we pull a little bit on their shoulder, and all those places should go back to normal very quickly.

03:30 But in dehydrated patient, the skin might look loose, or just kind of slowly go back to how it was.

03:38 In every patient, you can look for the production of tears.

03:42 This is extra easy and babies because they cry more.

03:45 But any patient is going to have tears or not whether they're dehydrated or not.

03:51 You need to check and signs of like how good their volume status is.

03:56 Like how much do they have the right amount of fluid in their veins and arteries.

03:59 And we do this by checking their pulses and perfusion.

04:02 Also, we can in terms of capillary refill.

04:06 So are their pulses normal throughout their body both their central or their distal or their central pulses, the ones closer to the center of their body.

04:14 And then their capillary refill does if you squeeze the tip of their finger or toe does it gets white and then does the pink come back within a normal amount of time? So less than three seconds.

04:25 Now we move on to the abdominal exam in these patients.

04:29 We know the first thing we do with an abdominal exam is we listen or we inspect first and then listen, I got ahead of myself.

04:37 So you look first and then listen because you're going to maybe make their bowel sounds more active than they really are.

04:43 So we look at their abdomen does it look distended? Does it look bigger than it should? Do you see any abnormal movements? Are their intestines working harder than you would expect them to? And then we listen to bowel sounds.

04:57 And remember, you want to listen in all four parts of their abdomen.

05:00 Even on babies, you can still divide it up into four parts and you want to listen for normal active bowel sounds.

05:07 But sometimes in the case of pediatric vomiting, their bowel sounds might be more active than the normal.

05:13 When we palpate the baby's abdomen is there any pain involved? And you can assess this in either an older kids as well.

05:22 Do they wince? Are they guarding? Do they not want you to push in places? Those can all be signs of pain.

05:29 We want to feel for any masses.

05:31 And this is important if we're trying to rule out some sort of a problem with their intestines.

05:36 So do they have like a pyloric stenosis where you could feel a little mass? Or do they have an intussusception where you could feel where the intestine might be a little bit thicker in one spot, or a foreign body that could be causing the obstruction?