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DAVAO DOCTORS HOSPITAL

DEPARTMENT OF PEDIATRICS

Clinical Pathway for: NON-ULCER DYSPEPSIA/ACUTE GASTRITIS

Definition: Inflammation of the Stomach

Inclusion Criteria:
1. Patients 2 months old but < 19 years old who are presenting with nondescript epigastric
discomfort, loss of appetite, nausea/vomiting, abdominal pain, tympanitic distention of
stomach
2. Patients with vomiting with duration of symptoms less than 2 weeks
3. Patients with/without dehydration
4. Patients who are unable to tolerate Oral Rehydration Therapy

Exclusion Criteria:
1. Patients who are critically ill
2. Patients who have chronic illness and are on maintenance medications

Legend:
Required
Options

Patient: ______________________Age/Sex: ____Birthdate:_________Hospital Number:___________


Last Name First Name M.I.
Weight: ____kg;z score:____ Height: ____cm; z score:____ Head Circumference:___cm ; z score:____

ER / DAY OF ADMISSION (M___D___Y___)


Goals for the day:
1. Alleviate signs and symptoms
2. Prevent dehydration and electrolyte imbalance
PHYSICIANS NOTES ORDERS Var Sign
Admit to ________ under the service of Dr. _____________
Vital sign monitoring: BP, heart rate, respiratory rate,
temperature
Q hourly
Q 2 hours
Q 4 hours
Input and output monitoring
Q 4 hours
Q 8 hours
Hydration rounds
Q hourly
Q 2 hours
Q 4 hours
Diet Order:
NPO X _______ hours
If breastfeeding, continue breastfeeding per demand
If not breastfeeding, continue giving usual milk at least
every 3 hours
Small frequent feedings for older children every 3 or 4
hours

1
Diagnostic Procedures:
Complete Blood Count (CBC with platetet count)
Urinalysis (midstream or pedia urine specimen
collector)
Fecalysis
Serum electrolytes (___________________)
Pregnancy test (for sexually active female)
Others _____________________
Start IV fluids at ____ ml/ hr for _____ hours
D5 0.3 NaCl
Plain LR
Plain NSS
For reassessment of hydration status c/o PROD after 4 hours
IVF to follow at ____ ml/ hr for _____ hours
D5 0.3 NaCl
D5LR
D5IMB
D5NM
Ordered by: _________________________
IVF to follow at ____ ml/ hr for _____ hours
D5 0.3 NaCl
D5LR
D5IMB
D5NM
Ordered by: _________________________
Medications: Var Sign
Paracetamol (10-15mg/kg/dose every 4 hours)
______________________
Domperidone (0.25-0.3mg/kg/dose every 6 hours)
______________________

Ondansetron IV (0.15mg/kg/dose every 8 hours)


______________________

Metoclopromide IV/PO
_______________________
Antacid/H2blocker/Proton Pump Inhibitor
Antacid_______________________
H2blocker_______________________
Proton Pump Inhibitor______________________
Others ______________________________
Activity/Safety Orders:
Bed Rest
Activity as tolerated
Patient/ family education:
Provide disease information and possible disease
complication
Explanation of treatment and laboratory test
Explanation of usual hospital routines

Activated by: Acknowledged by:


__________________________ _______________________________
Attending Physician/Resident Nurse-in-charge
(Signature over Printed Name) (Signature over Printed Name)
2
Date and Time:_____________ Date and Time:_____________

Variance Codes:
A. Patient/ Family C. DDH System
1. Patients medical condition 1. Results/Data availability
2. Patient/family decision 2. Suppies/equipment related
3. Patient/family availability 3. Appointment Availability
4. No funds 4. Weekend/Holiday
5. Other reasons 5. Other reasons
B. Physician D. Outside DDH
1. Medical order 1. Transportation availability
2. Provider(s) decision 2. Home Care availability
3. Provider(s) response time 3. Other reasons
4. Other reasons

3
Patient: _____________________________________ Age/Sex: ______ Birthdate: _________
Last Name First Name M.I.
Hospital Number: _______________
DAY 2, 3, 4, 5 (M___D___Y___)
GOALS:

1. Alleviate signs and symptoms


2. Prevent dehydration and electrolyte imbalance
PHYSICIANS NOTES ORDERS Var Sign
Vital sign monitoring: BP, heart rate, respiratory rate,
temperature
Q hourly
Q 2 hours
Q 4 hours
Input and output monitoring
Q 4 hours
Q 8 hours
Hydration rounds
Q 2 hours
Q 4 hours
IVF to follow at ____ ml/ hr for _____ hours
D5 0.3 NaCl
D5IMB
D5NM
Shift to heplock
Consume and Discontinue IVF
Ordered by: _________________________
Diagnostic Procedures:
Serum electrolytes _________________
Abdominal X-ray __________________
Ultrasound of the abdomen
Others: ________________________
Diet Order:
NPO X _______ hours
Breastfeeding per demand
Small frequent feeding of energy-rich food (every 3 or
4 hours)
Medications:
Paracetamol (10-15mg/kg/dose every 4 hours)
______________________
Domperidone (0.25-0.3mg/kg/dose every 6 hours)
______________________
Ondansetron IV (0.15mg/kg/dose every 8 hours)
______________________
Metoclopromide IV/PO
_______________________
Antacid/H2blocker/Proton Pump Inhibitor
Antacid__________________
H2blocker__________________
Proton Pump Inhibitor ____________
ORS ___________________________
Others ______________________________

4
Consult/Referral to: ________________________________
Activity/Safety Order:
Bed rest
Activity as tolerated
Patient/ family education:
Provide disease information and possible disease
complication
Explanation of treatment and laboratory test
Explanation of usual hospital routines
Discharge Criteria:
Adequate food intake
Absence or fewer episodes of vomiting
Absence of other signs and symptoms

Discharge Plans:
Medications
ORS _________________________
Domperidone _______________________
Ondansetron oral (<11 y/o 4mg every 8 hours for 1-2
days; > 11y/o 8mg every 8 hours for 1-2 days)
____________________________________
Others: ______________________________
Diet: _______________________________
Home Instructions:
1. ______________________________________
2. ______________________________________
Follow-up visit on: ____________________________
Advised

Activated by: Acknowledged by:


_________________________ _________________________
Attending Physician/Resident Nurse-in-charge
(Signature over Printed Name) (Signature over Printed Name)
Date and Time:_____________ Date and Time:_____________