Running Head: PEDIATRIC NCP

Theresa Price Pediatric NCP The University of Southern Mississippi

PEDIATRIC NCP Section 1: Chart Note SCRMC CLINICAL NUTRITION SERVICES NUTRITIONAL ASSESSMENT Patient information: Pt is a 5 y.o. white male admitted with abdominal pain and vomiting. PMH: Cholecystitis Current Diet Order: NPO Supplements: N/A Wt: 40.3lb Ht: 40.5in BMI-for-age Percentile: Between the 75-85th percentile Weight-for-age Percentile: Just above the 50th percentile Height-for-age Percentile: Between the 5th and 10th percentile Nutritional Needs: Energy:1400kcal Protein:19g Fluid: 1.7L Labs: Glucose-117, H. Ast-122, H. Alp-159, H. Others noted. Pertinent medications: No pertinent medications related to nutrition noted. Nutritional Diagnosis: Inadequate oral intake RT decreased appetite level AEB current N/V and NPO status. Recommendations/Plan of care: Recommend advancing diet as tolerated by pt. Continue current plan of care. Will monitor/evaluate: Will monitor for pt intake. Will follow up and make nutritional recommendations as necessary.

PEDIATRIC NCP Section 2: Structured Abstract Citation: Baker, S. S., & Davis, A. M. (1998). Hypocaloric oral therapy during an episode of diarrhea and vomiting can lead to severe malnutrition. Journal of Pediatric Gastroenterology & Nutrition, 27, 1-5. Retrieved from

http://journals.lww.com/jpgn/Fulltext/1998/07000/Hypocaloric_Oral_Therap y_During_an_Episode_of_.1.aspx Study Design: Class: Quality Rating: The study design was a nonrandomized trial with historical controls. This is a class C study report. There was no quality rating found.

Researc The purpose of this study was to view previous medical records and current literature in order to determine if malnutrition associated with vomiting and diarrhea could be h Purpose: prevented if adequate caloric diets are administered to pediatric patients. Inclusio n Criteria: Exclusio n Criteria: The inclusion criteria included infant and pediatric patients admitted to the hospital, experienced diarrhea or vomiting, were ordered a clear liquid diet or intravenous fluids. The exclusion criteria included adolescents or adults and children without malnourishment problems due to diarrhea and vomiting.

Descripti The researchers collected medical records on pediatric patient charts. The cases were reviewed in full detail to determine all the information needed for data collection in on of the study. Study Protocol Data Collectio n Summar y: Descripti on of Actual Data Blinding was not used in this research study. The data collected and recorded included the length of hospital stay and illness, the treatment procedures, the diet order and dietary intake, and nutrition constraints. Another variable that was collected was the diet advancements and how they affected the children. There were two pediatric cases that were evaluated in full detail. One child was nearly four years of age, with vomiting and diarrhea that persisted for three weeks. The second pediatric case was a six week old infant, with vomiting and diarrhea for three weeks.

PEDIATRIC NCP Sample: Summar y of Results The four year old child had watery stools each day while on the clear liquid diet. After diet advancement to the BRAT diet the child was discharged and starting having soft to loose stools. This child appeared to have kwashiorkor and after a higher calorie diet with proper vitamins and minerals was initiated the child was progressively getting better.

The infant was given intravenous fluids and nothing by mouth. The infant had watery stools when progressed to diluted formulas and Pedialyte. Both pediatric patients experienced edema. Enteral feedings were not tolerated by the six week old infant. Marasmic kwashiorkor was present during hospitalization. Parenteral nutrition was supplemented until enteral nutrition could be tolerated and increased. The patients diet was progressed to oral formula before discharge. Author Conclusi on: Both patients reviewed for this study were able to have nutrition support initiation and ended up tolerating the feedings as well as thriving after nutrient infusion. Bowel rest and insufficient nutrient intake may be a cause of malnutrition among pediatric patients, which can result in a serious malnourishment condition such as kwashiorkor. The treatment of diarrhea and vomiting may be more beneficial if it changes to appropriate oral intakes instead of bowel rest and intravenous fluids.

One limitation of this study is the extremely small sample size that is unable to be Review Commen generalized to a larger population. The formatting for the study report does not suggest much research involved, it is more of a retrospective study approach, which ts: is a limiting factor. This study is somewhat limiting in information. A major strength of this study was that the researchers used a number of different articles and journals, which shows a broad area of literature reviewed for the study report.

PEDIATRIC NCP Section 3: EAL and Article Summary for My Patient

Literature suggests oral nutrition therapy as tolerated by pediatric patients during diarrhea and vomiting episodes is more beneficial to their nutritional status (Baker & Davis, 1998). When young children and infants are given very low calorie oral nutrition and bowel rest it can result in malnourishment risks such as kwashiorkor or marasmus. This study suggests that pediatric patients who are provided with oral nutrition as tolerated by the patient may benefit their overall nutritional status. The Cochrane Library concludes there is no significant difference between oral rehydration and intravenous rehydration but oral rehydration may have a lower failure rate; therefore, oral rehydration should be considered first before intravenous rehydration for dehydration (Hartlin, Bellemare, Wiebe, Russell, Klassen, & Craig, 2010). After reviewing the literature I suggest providing oral hydration for my pediatric patient as well as advancing his oral diet as tolerated. I will first discuss findings and ideas with the primary physician and determine if my recommendations coincide with his care plan. Then I plan to discuss findings with the other team members of the healthcare team to determine his tolerance to the dietary changes.

PEDIATRIC NCP References

Baker, S. S., & Davis, A. M. (1998). Hypocaloric oral therapy during an episode of diarrhea and vomiting can lead to severe malnutrition. Journal of Pediatric Gastroenterology & Nutrition, 27, 1-5. Retrieved from http://journals.lww.com/jpgn/Fulltext/1998/07000/Hypocaloric_Oral_Therapy_During_a n_Episode_of_.1.aspx Hartling, L., Bellemare, S., Wiebe, N., Russell, K. F., Klassen, T. P., & Craig, W. R. (2010). Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database of Systematic Reviews, 3, 1-66. doi: 10.1002/14651858.CD004390.pub2.