Thursday, February 9, 2012

Ask A Nurse About: The Stomach Flu

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I
encounter numerous questions about health, medications, and random concerns such
as "What does it mean when my poop turns green?".  And so I begin a new feature here,
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy
and physiology of the human body.  Am I an expert?  Hardly.  But I am an
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw
from my experiences in my medical practice, my journey through motherhood, and
my endless collection of credible nursing textbooks and resources.  Remember: this is
just a blog.  Just as you should never base any serious decision on internet ramblings,
so should you not take anything you read here as concrete fact.  When in doubt, consult
your doctor/naturopathic/guru.
This week's topic: The Stomach Flu
Also known as gastroenteritis, most of us have encountered a bad case of vomiting
and/or diarrhea at some point in our lives.  It brings with it the very worst of bodily
functions and typically a ton of laundry.
Let's break it down, shall we?
What is the stomach flu and what causes it?
The stomach flu is marked by inflammation of the gastrointestinal tract including both
the stomach and the small intestines causing vomiting, diarrhea, and abdominal
cramping.  The onset of vomiting is typically sudden and can be accompanied by a high
fever.  In adults, the virus is most commonly caused by the norovirus, in kids the
common culprit is the rotavirus.  There are no blood or stool tests to
confirm diagnosis.
How can you tell the difference 
between a stomach flu and food poisoning?
With a stomach flu, the onset of vomiting is very sudden and the patient usually has a
fever.  With food poisoning, the onset of vomiting usually occurs 2-12 hours after eating
and is caused by bad bacteria present in something you ate.  This can be hard to
differentiate so here are a couple of foods that are notorious for causing food
poisoning:  seafood, chicken, spoiled mayonnaise, and beef.  Vomiting with food
poisoning typically does not last longer than 12 hours.  So, if the vomiting does not occur
with a fever, you have an identifiable food source, and you stop vomiting within 12 hours
or so: you more than likely have food poisoning.  No worries, your body will eliminate
the bad stuff for you via the toilet.
There are other causes of vomiting such as Salmonella, E. coli, and intestinal obstructions,
but we'll just stick to the basics today.

With the stomach flu:
The first stage of vomiting is severe.  This is often referred to as "worshiping the
porcelain gods".  Vomiting occurs every 5-30 minutes and may or may not
occur simultaneously with diarrhea.  During this phase of vomiting, do NOT attempt to
eat or drink anything.  Many people fear dehydration and believe they have to keep
sipping fluids in order to stay hydrated.  At this stage, there is no point, your body will
simply throw it all back up.  You are only taxing your gastrointestinal system more by
putting food and fluids into it.
Important: Breast feeding moms: this goes for you, too.  I know, I know: us
breastfeeders DO NOT like to be told we can't breastfeed our babies, EVER.  But this is
one of those instances where even breast is not best.  REST is best and you will often
hear doctors say that during this active phase of vomiting, the patient needs gut rest.
So relax, it actually takes persistent vomiting for several hours to cause severe
dehydration.
During the second phase, vomiting decreases to about once every hour to two hours.
At this point, you may start taking small sips of fluids.  It is best to drink an oral
electrolyte solution like Pedialyte, and, of course, breast milk.  Pedialyte offers popsicles
that are perfect for rehydration and also soothing to the belly.  Coconut water is an
excellent source of electrolytes as well.  Peppermint, chamomile, ginger, and lemon all
have anti-emetic properties in them and can soothe an aching belly.  Gatorade and
Powerade contain large amounts of sugar as do apple, pear, and cherry juice.  Therefore,
use these drinks sparingly as sugar can exacerbate vomiting and diarrhea. 
Remember: SMALL sips.  Don't overwhelm your already sensitive,
overworked belly.
During the third phase, vomiting slows down to about every 2-4 hours.  It is now safe to
eat small bites of food.  For both children and adults, it is best to start with the
BRAT diet: bananas, rice, applesauce, and toast.  This diet is bland and will not put too
much stress on the body.  Continue small sips of liquids.
Oral medications will not be of much use to you when you are actively vomiting because
they will just come right back up.  If a high fever occurs and vomiting is persistent, 
rectal suppositories of Acetaminophen for fever and Phenergan for vomiting can 
be prescribed by your doctor.  Phenergan is typically only given for severe 
vomiting, however, so use it conservatively.
Signs and Symptoms of Dehydration:
When monitoring your child for dehydration:
Assess the inside of their mouth: is it moist and pink?  Is there saliva present?  Good
sign!! During dehydration, the inside of the mouth and lips will appear dry.  As it
becomes more severe, there will be very little saliva present.
Assess the eyes and tear ducts: is there moisture present?  Do they have tears when
they cry?  Good sign!!  During dehydration, there will be no tears when they cry.  When
it becomes severe, eyes will appear sunken in.
Assess their activity level: are they a little less active then usual but still playing
and interacting?  Good sign!!  During dehydration, they will become lethargic, meaning
they are limp and not responding to your voice or touch.
Assess how often they are urinating: are they still peeing like normal, maybe a little bit
less?  Good sign!!  During dehydration, you will notice a decrease in the number of
wet diapers or trips to the potty.  Pay close attention to toileting during a virus.  It is
one of the best indicators of dehydration!  When dehydration is severe, urine will
become darker in color and have a strong odor.
Use these assessments as a guideline.  They are applicable to adults as well.  For mild
to moderate dehydration, use the oral electrolytes and BRAT diet mentioned above.
When it becomes severe as in little to no urine, no tears, sunken eyes, and dry mouth:
HEAD TO THE ER!!  Severe dehydration needs to be treated with IV fluids.
When to worry:
1.  If vomiting occurs in babies less than 6 months of age
2.  If stage one vomiting continues past 8 hours in children under one, 12 hours in children 
      one through three years old, and 16 hours in kids four and older.
3.  Severe dehydration
In these cases, contact your medical provider.
Remember, the best line of defense against viruses and bacteria is good old fashioned
hand washing.  

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future post.  
Or, email me at vasqueztribe@yahoo.com.  


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9 comments:

deanna@delirious-rhapsody said...

When owsley was a month old I got a stomach virus. My neighbor told me to keep nursing and without even really thinking about it I did. Sheesh. I was miserable.

Olivia Grace said...

Deanna: let me clarify before a get a ton of hate mail:) You can continue to breastfeed when you are sick. In fact, you SHOULD because you are giving your baby antibodies through your breast milk that will help them fight off illness. You are right, though, it can be pretty miserable! What you should NOT do is breastfeed your baby when they are in the first, most active stage of vomiting themselves. Don't bother putting things in their bellies because they will just throw it all back up. I hope that helps!!!

tiffany @ seetheskyline said...

uhhh, this just went through our home (and all of san diego pretty much!) no fun, but it's good to be informed.

CatholicMom said...

Wow...glad I stumbled on your blog! Thanks for this article, it is interesting :-)

Emily Lum said...

Thank you for this post. So informative. Especially the part about not Drinking or eating during the first phase. And thank you for mentioning not to breast feed a vomiting baby. My first child had moderate diarrhea for two weeks when she was 9 months. She acted pretty normal that whole time and even learned to pull herself up in bed so I knew she wasn't very dick, but I was concerned because it wouldn't go away. Her doctor kept telling me to not breast feed and I would stop for a while but then couldn't take it. I felt like I was starving her. But the doctor kept saying that's what I needed to do so I finally did and it went away. I must have called the advice nurses 4 times in those 2 weeks and even they were shocked that the doctor said to stop breast feeding. Their standard treatment guidelineswas to keep breast feeding. I'm glad you brought that point up!

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