Rotavirus Vaccine Offers Earlier Protection New Vaccine Could Prevent Thousands of Childhood Diarrhea-Related Hospitalizations Each Year By Kelli Miller Stacy WebMD Health News Reviewed by Louise Chang, MD April 8, 2008 -- A new vaccine approved by the FDA promises to provide earlier protection against a leading cause of potentially deadly diarrhea in children. GlaxoSmithKline's Rotarix vaccine helps prevent rotavirus gastroenteritis, a common childhood condition responsible for as many as 70,000 hospitalizations each year in the United States. The two-dose vaccine is a liquid taken by mouth and fully vaccinates infants by 4 months of age, 2 months earlier than the existing Rotateq vaccine, which is manufactured by Merck. The CDC recommends that rotavirus vaccination be completed by the time a child is 6 months old. However, one out of every five children admitted to the hospital with such infections is younger than 6 months. Becoming protected against the disease at an earlier age could reduce the number of emergency room visits made by families. About 2.7 million children in the U.S. develop rotavirus disease every year. Rotavirus- related gastrointestinal illness typically strikes the southwestern U.S. during the late fall and early winter and the Northeast by spring. "This vaccine provides another option to combat and reduce a potentially severe illness that affects so many children," Jesse L. Goodman, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, says in a news release. The CDC, The American Academy of Pediatrics, and the American Academy of Family Physicians all recommend rotavirus immunization for infants. According to an FDA news release, "without vaccination, nearly every child in the U.S. would likely be infected at least once with rotavirus by age 5." Studies involving 24, 000 infants showed that the Rotarix vaccine helped protect against both mild and severe rotavirus-associated
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Rotavirus Vaccine Offers Earlier Protection
New Vaccine Could Prevent Thousands of Childhood Diarrhea-Related Hospitalizations Each Year
By Kelli Miller StacyWebMD Health News
Reviewed by Louise Chang, MD
April 8, 2008 -- A new vaccine approved by the FDA promises to provide earlier protection against a leading cause of potentially deadly diarrhea in children. GlaxoSmithKline's Rotarix vaccine helps prevent rotavirus gastroenteritis, a common childhood condition responsible for as many as 70,000 hospitalizations each year in the United States.
The two-dose vaccine is a liquid taken by mouth and fully vaccinates infants by 4 months of age, 2 months earlier than the existing Rotateq vaccine, which is manufactured by Merck. The CDC recommends that rotavirus vaccination be completed by the time a child is 6 months old. However, one out of every five children admitted to the hospital with such infections is younger than 6 months.
Becoming protected against the disease at an earlier age could reduce the number of emergency room visits made by families. About 2.7 million children in the U.S. develop rotavirus disease every year. Rotavirus-related gastrointestinal illness typically strikes the southwestern U.S. during the late fall and early winter and the Northeast by spring.
"This vaccine provides another option to combat and reduce a potentially severe illness that affects so many children," Jesse L. Goodman, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, says in a news release.
The CDC, The American Academy of Pediatrics, and the American Academy of Family Physicians all recommend rotavirus immunization for infants. According to an FDA news release, "without vaccination, nearly every child in the U.S. would likely be infected at least once with rotavirus by age 5."
Studies involving 24, 000 infants showed that the Rotarix vaccine helped protect against both mild and severe rotavirus-associated gastroenteritis in children under age 2. The vaccine protects against the most commonly circulating strains of rotavirus.
Some children who receive the vaccine may experience side effects including fussiness, irritability, cough, runny nose, fever, lose of appetite, and vomiting.
An earlier rotavirus vaccine manufactured by Wyeth was pulled from the U.S. market after several children developed a potentially life-threatening intestinal condition called intussusception after being immunized. Researchers with GlaxoSmithKline evaluated more than 63,000 infants who received their vaccine and found no increased risk. However, the FDA has requested post-market testing to provide additional safety information.
Initial Assessment upon Admission: August 16, 2009
**Taken from the chart
Skin: No jaundice, No rashes
Head EENT: anicteric sclerae, pale palbepral conjunctivitis
Lymph Nodes: no mass
Chest:
Lungs: (-) crackles on both lungs
Cardiovascular: No murmur
Breast: no mass
Abdomen:
The abdomen was distended, soft and there was no palpable mass felt upon palpation. Hypoactive bowel sound heard upon auscultation. The patient vomited 3-5 times a day and defecated more than 6 times a day with watery stool.
Genito-Urinary System:
Patient voided 60 – 350 cc per shift as weighed and yellow in color.
PHYSICAL ASSESSMENT
Date: August 17, 2009 Clinical Area : Pedia ward
BODY
PARTS
ASSESSED
TECHNIQUES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION
1.Skin
a. Moisture Palpation Moisture in skin folds and axillae Dry skin Deviated due to slight
dehydration
b Texture Palpation Smooth Rough Deviated due to slight
dehydration
c. Turgor Inspection and
Palpation
Springs back immediately to
previous state
Moves back slowly Deviated due to slight
dehydration
2. Mouth
a. LipsInspection Pink in color, soft moist, smooth
texture, symmetrical no
tenderness, no lesions
Dry lipsDeviated due to slight
dehydration
b.Mucosa Inspection and
Palpation
Uniform pink color Dry and slightly pink in color Deviated from normal due
to slight dehydration
c. Gums Inspection and
Palpation
Pink gums, moist, firm texture Pink gums, dry, firm texture Deviated from normal due
to slight dehydration
3.
Abdomen
Bowel
sounds
Auscultation Audible bowel sounds Hyperactive bowel sound Deviated due to diarrhea
III. REVIEW OF SYSTEM
Digestive System
The primary function of the digestive system is to break down the food we
eat into smaller parts so the body can use them to build and nourish cells and provide
energy. There occurs propulsion which is the movement of food along the digestive
tract. The major means of propulsion is peristalsis, a series of alternating contractions
and relaxations of smooth muscle that lines the walls of the digestive organs and that
forces food to move forward. It secretes digestive enzymes and other substances
liquefies, adjusts the pH of, and chemically breaks down the food. Mechanical
digestion is the process of physically breaking down food into smaller pieces. This
process begins with the chewing of food and continues with the muscular churning
of the stomach. Additional churning occurs in the small intestine through muscular
constriction of the intestinal wall. This process, called segmentation, is similar to
peristalsis, except that the rhythmic timing of the muscle constrictions forces the
food backward and forward rather than forward only. Chemical digestion which is the
process of chemically breaking down food into simpler molecules. The process is
carried out by enzymes in the stomach and small intestines. Then absorption or the
movement of molecules (by passive diffusion or active transport) from the digestive
tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the
digested food into the body. And lastly, defecation which is the process of
eliminating undigested material through the anus.
But because of acute gastroenteritis the normal functions were altered.
The infectious agents that cause acute gastroenteritis causes diarrhea by
These mechanisms result in increased fluid secretion and/or decreased
absorption leading to diarrhea. This produces an increased luminal fluid content that
cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes
and nutrients.
FATHER
HPN
MOTHER
SISTER 1 SISTER 2
Asthma
ALVIN MONEZA
Acute Gastroenteritis
With SevereDHN, Intestinal Parasitism
and 1st Degree of Malnutrion
IV. DEVELOPMENTAL TASK
Erik Erikson-Psychosocial development
The patient is currently in the early childhood stage (3-6 y/o) wherein the
central task is Initiative vs. Guilt. During this stage, initiative adds to autonomy
the quality of undertaking, planning, and attacking a task for the sake of being active
and on the move. The child is learning to master the world around him or her, learning
basic skills and principles of physics; things fall to the ground, not up; round things roll,
how to zip and tie, count and speak with ease. Guilt is a new emotion and is
confusing to the child; he or she may feel guilty over things which are not logically guilt
producing, and he or she will feel guilt when his or her initiative does not produce the
desired results. At this stage the client wants to begin and complete her own actions
for a purpose.
Interpretation: Positive Resolution
Jean Piaget’s Cognitive Development
The patient is under the Pre-operational stage. In this period intelligence is
demonstrated through the use of symbols, language use matures, and memory and
imagination are developed, but thinking is done in a nonlogical, nonreversible manner.
Egocentric thinking predominates. The patient was able to do make believe play and
able to imitate others, like her mother doing some household chores as verbalized by
the "SO".
Interpretation: Positive Resolution
ELECTROLYTES NURSING RESPONSIBILITIES
SERUM SODIUM
SERUM POTASSIUM
Before getting sample:
Explain to the patient that this test is used to determine the sodium, potassium, calcium content of blood.
Tell the SO of the patient that the test requires blood sample.
Explain who will perform the diagnostic tests and when.
Explain that the patient may experience slight discomfort from the needle.
During getting sample:
Assess the physical appearance of the patient
Try to get a sample once
After getting sample:
Encourage the patient to relax
Send the specimen to the laboratory immediately.
Diagnostic/ Laboratory Procedures
Date ordered
Date result(s)
In;
Indication(s) or Purpose(s)
Result
(1st, 2nd , 3rd )
Normal value
(units used in the hospital)
Analysis and Interpretation of results
SODIUM Date Ordered
8 - 16 - 09
Date Results in
8 - 16 - 09
To measure serum levels of sodium in relation of the amount of water in the body.
Used to evaluate fluid electrolyte acid base balance and related renal and adrenal functions.
124.7 mEq/L 135-150 mEq/L Decreased sodium level or altered state of hydration may be found
Diagnostic/ Laboratory Procedures
Date ordered
Date result(s)
In;
Indication(s) or Purpose(s)
Result
(1st, 2nd , 3rd )
Normal value
(units used in the hospital)
Analysis and Interpretation of results
POTASSIUM Date Ordered
8 – 16 - 09
Date results in
8 – 16 - 09
To evaluate clinical signs of potassium excess (hyperkalemia) or potassium depletion (hypokalemia)
To measure serum levels of potassium in relation in the amount of water in the body.
2.5 mEq/L 3.5 – 5.2 mEq/L Decreased potassium level due to diarrhea and vomiting in relation to decrease amount of water in the body
SYNTHESIS OF THE DISEASE
Definition of the disease
Acute Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications such as dehydration
Description of the disease
Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms in the United States annually. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.
The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus, adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all over the world. Exposure typically occurs through the fecal-oral route, such as by consuming foods contaminated by fecal material related to poor sanitation. However, the infective dose can be very low (approximately 100 virus particles), so other routes of transmission are quite probable.
Typically, children are more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Annually, worldwide, rotaviruses are estimated to cause 800,000 deaths in children below age five. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.
Children are also susceptible to adenoviruses and astroviruses, which are minor causes of childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major symptom.
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food—conditions common in developing nations. Natural or man-made disasters can make underlying problems in sanitation and food safety worse.
In developed nations, the modern food production system potentially exposes millions of people to disease-causing bacteria through its intensive production and distribution methods. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. Cholera and Shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway
Pathophysiology: Infectious agents usually cause acute gastroenteritis. These agents cause diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production. These mechanisms result in increased fluid secretion and/or decreased absorption. This produces an increased luminal fluid content that cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.
Pathogenesis
Diarrhea results when secretory process for water and electrolytes predominates over absorption.There is much overlap in the following mechanisms which cause diarrhea." Osmotic" Secretory" Increased motility" Inflammatory
Osmotic Diarrhea
When there is an absorbable solute in the lumen e.g. lactose, there is water retention instead of the normal absorption, resulting in diarrhea. Some enteric infections can cause damage to epithelial cells leading to brush border villi destruction and malabsorption, hence osmotic diarrhea.
Secretory Diarrhea
When there is active secretion of water into the gut lumen e.g. in infections such as cholera. Noninfectious causes can be VIP and gastrin mediated diarrhea; Bile acids & fatty acids in the lumen; Laxatives; Congenital chloride diarrhea.
Combined Osmotic and Secretory Diarrhea
Can occur due to: Clostridium difficile endotoxin; Shigella (Shiga toxin); E. coli; Rotavirus gastroenteritis, wherein the virus causes disruption of the brush border resulting in osmotic diarrhea and also Non-Structural Protein (NSP4) causes Ca++ dependant transepithelial Cl- secretions from crypt cell with resultant secretory diarrhea.
As in IBS, can cause stasis, inflammation, bacterial overgrowth and secondary bile acid deconjugation and malabsorption.
Inflammatory Diarrhea
Exudation of mucus, proteins and blood in the gut lumen cause water and electrolyte loss resulting in diarrhea. Most common cause is infections which can cause mucosal damage directly and via enterotoxins. Intestinal inflammation due to Inflammatory Bowel Disease and Celiac disease can also cause diarrhea. The etiology is multifactorial, but mostly secondary to malabsorption.
It is most ikely that Mary Ann is showing the effects of a Combined Osmotic and Secretory Diarrhea. The most common form of infdectious diarrhea, likely in a day-care child - is rota virus. This is associated with a stool sodium concentration of 70 milliEquivilents/liter (mEq/L). Note that the mother is giving her a sugar beverage without sodium. This will be discussed below.