00:01
Hi, I'm Dr. Jackie Calhoun.
00:03
And today we're going to talk
about pediatric vomiting.
00:06
This is what we're going
to cover in our lecture,
which is the definition, causes,
signs and symptoms,
diagnosis and management
of the condition.
00:17
First, how is vomiting defined?
I'm sure as you
probably all experienced
vomiting is the forceful
injection of gastric contents
out of the mouth.
00:28
It's not dribbling or drooling.
00:31
It's not slow,
it's usually very fast.
00:34
And it's definitely something
that the patient can't control.
00:37
So now that we talked about
what it is, what can cause it?
There are a number of things,
the first of which is infection.
00:46
And this can either be caused
by a virus or a bacteria.
00:51
It can be caused by high
intracranial pressure
Gastrointestinal or GI
obstruction is another cause.
00:59
And that can be anywhere
from the stomach,
to the small intestine,
to the large intestine.
01:06
Gastrointestinal reflux.
You might have heard it,
sometimes people say GERD
is where the stomach contents
reflux up out of the
stomach into the esophagus.
01:18
And if that happens often
enough, or forcefully enough,
it can present as vomiting.
01:23
There's Pyloric stenosis,
which is a malformation
or thickening
of the pyloric muscle or sphincter
that exits out of the stomach
that allows food to pass through.
01:35
So when that's too big, it doesn't
allow food to move through,
and then it backs up as vomit.
01:41
There's in this intussusception,
where you have
two parts of the small intestine
that are next to each other
that slide over one another,
that can cause a blockage,
which leads to the same thing.
01:55
Food can't get through, it backs up
and then the patient vomits.
01:59
And the same thing
happens with foreign body.
02:01
So a child may swallow
something that's not digestible,
such as a toy,
or a coin, or a battery.
02:09
And it gets stuck in the intestine,
and that it doesn't allow
food to pass through.
02:14
Its the same thing. Gets blocked.
The food backs up and they vomit.
02:19
So what are the signs
and symptoms of vomiting?
One thing that we look at,
and it's important
are the fluid imbalances with this.
02:27
And the first question that we ask
either a patient or
the caregivers of that patient,
is how much are they vomiting?
And how often are they vomiting?
Because that's going to
make a big difference
in how we think about this patient.
02:40
So if they're vomiting, one time
over the course of an entire day,
or are they vomiting every
five minutes for an hour,
or for 24 hours for that often,
they could be either
just a little bit sick,
or they could end up
being really sick.
03:00
So how often they're vomiting
and how much they're vomiting,
contributes to their fluid status.
03:06
So as a nurse,
it's very important to think about
your ins and outs
for your patients,
which is something you've
probably heard about before,
but we can talk about it again now.
03:15
So your ins, are how much is a
patient taking in or getting in?
So how much are they drinking?
How much are they eating?
And then if they're in the hospital,
how much IV fluids are they getting?
And then their outs are,
how much are they putting out?
And that can be,
how much of the vomiting?
But then in that calculation,
you also need to add in
how much are they making urine and
how much stool are they making?
And then you compare the two.
03:44
So if the ins are much
greater than the outs,
the patient probably
isn't dehydrated,
they're probably in a
pretty good state of health.
03:52
But if the outs are much,
much bigger than the ins,
then the patient is
probably be dehydrated,
and may have some
electrolyte balances
that we need to be concerned about.
04:05
Some of those electrolyte balances
and we measure these with
laboratory tests like with the blood
are sodium, potassium,
and bicarbonate.
04:15
And these are lab tests that
are ordered by providers
that the nurses will draw.
04:20
But even though that
you're not ordering them,
it's important for you
to know these numbers
and to know if your
patient's electrolytes
are high, low, or normal.
04:29
One condition that is affected
or can be affected
by a patient's electrolytes
or results from a
patient's electrolytes
is called metabolic alkalosis.
04:39
And if we think back to chemistry,
you remember
things that are alkalotic
are higher than a pH of 7.4.
04:46
And when a patient is vomiting,
they're losing certain electrolytes,
particularly chloride.
04:49
And if they lose too much of this,
that makes them more alkalotic,
so their pH rises above 7.4.
04:59
Signs of metabolic alkalosis.
We'll cover those in a second.
05:01
Are lethargy,
neuromuscular irritability,
tetany, which is like a
rigidity of your muscles
where you can't relax your muscles.
05:12
And sometimes you think of
tetany is related to tetanus,
but you always think you might
have heard of locked jaw with that,
where patients literally
can't open their mouth.
05:21
And the picture of the
hand here is also similar
where your hand is so
rigid, you can't relax it.
05:27
And that's because of these
electrolyte imbalances
in this alkalosis.
05:31
And then lastly,
this can even result in seizures
because of this pH disturbance.
05:38
Another dangerous side effect,
or consequence of
pediatric vomiting is aspiration.
05:45
And aspiration occurs when
a patient is vomiting,
or can even occur
when they're trying to swallow
it can happen in both situations,
and the contents
that should either be
coming out of their
stomach with vomiting,
or going into their stomach
while eating,
or going into their lungs instead.
06:07
Some ways that you
as the nurse can assess for this
is by listening to the
patient's breath sounds.
06:14
You can observe them swallowing.
06:16
So if you notice that they have
a very uncoordinated swallow,
or they might seem like
you can hear the formula,
or the food not leaving their mouth
correctly, it sounds very wet,
when they're either
talking or breathing
outside of eating,
that might be a sign.
06:35
They may have foul smelling
breath because of that
They may have green sputum
for the same reason
for that same food that
sitting in there is
They may have shortness of breath,
which goes back to the fact
that they have things
in their lungs,
stuff in their lungs
that they shouldn't.
06:49
And it's making it harder
for them to breathe normally.
06:52
So they may be
breathing too quickly.
06:54
They may be not being
able to take deep breaths.
06:59
They may have frequent
chest infections.
07:02
There's a lot of
bacteria in your mouth
and in your stomach that
doesn't belong in your lungs.
07:08
And if patients are
swallowing that,
and it's getting into the lungs
instead, it can cause pneumonias.
07:16
And then lastly, a symptom of
aspiration can be cyanosis.
07:21
And cyanosis is a symptom,
or a sign of having a decreased
oxygen level in your blood.
07:31
So if a patient's lungs
aren't working properly,
because they have
stomach contents in them,
they're not performing
blood exchange correctly,
so their blood oxygen
levels not normal.
07:44
They're not getting as much oxygen
to their tissues as they should.
07:49
And where you can see
this is you may see
blue tips of their fingers
or blue tips of their toes
or especially in younger kids,
you can see what called
perioral cyanosis,
where it's around
their lips and mouth
can be blue, or
gray, or even purple
depending on the
patient's skin color.