CONTROL OF DIARRHEAL DISEASES BRIEF HISTORY A 2 years old client was admitted at with chief complaint of loose bowel

l movement for more than ten times a day prior to consultation and was attended by the physician with the following physical assessment of hyperactive bowel sound, soft abdomen and diagnosed with acute gastroenteritis.

DIARRHEA

Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person
Is an increased frequency of bowel movements ( more than three per day), an increased amount of stool ( more than 200 g/day) , and altered consistency ( increased liquidity) of stool Usually associated with urgency, peri anal discomfort, incontinence or a combination of these factors Any condition that causes increased intestinal secretions, decreased mucosal absorption or alatered motility can produce diarrhea o Irritable bowel syndrome , inflammatory bowel disease and lactose intolerance are frequently the underlying disease that causes diarrhea

Oral rehydration solutions (ORS) with modest amounts of salts and zinc tablets are the treatment of choice and have been estimated to have saved 50 million children in the past 25 years. In cases where ORS is not available, homemade solutions are often used
o

Acute Diarrhea Most often associated with infection and is usually self limitiIng lasting up to 7 to 14 days Chronic Diarrhea Persists for more than 2 to 3 weeks and may return sporadically Causes of Diarrhea Medications o Thyroid hormone replacement, stool softeners and laxatives , antibiotics, chemotheraphy , antiarrythmics, anti hypertensive, magnesium-based anatacids Viral or Bacterial infectious processes o Dysentery, shigellosis , food poisoning , Norwalk virus Nutritional and Malabsorptive disorders ( celiac disease) , anal sphincter defect, Zollinger Ellison syndrome, paralytic ileus, intestinal obstruction and AIDS

Classification or Types of Diarrhea

Secretory o Usually high volume diarrhea , often associated with bacterial toxins and neoplasm, it is caused by increased production and secretion of waterand electrolytes by the intestinal mucosa into the intestinal lumen. Osmotic o Occurs when water is pulled into the intestines by the osmotic pressure of unabsorbed particles, slowing the reabsorption of water . It is caused by lactase deficiency, pancreatic dysfunction or intestinal hemorrhage. Malabsorptive o Combines mechanical and biochemical actions, inhibiting effective absorption of nutrients manifested by markers of malnutrition that include hypoalbuminemia . Low serum albumins lead to intestinal mucosa swelling and liquid stool. Infectious o Exudative o Is caused by changes in mucosal integrity , epithelial loss or tissue destruction caused by radiotheraphy or chemotheraphy.

Clinical Manifestations Increased frequency and fluid contest of stools, abdominal cramps, distention, intestinal rumbling ( borborygmus) anorexia and thirst. Painful spasmodic contraction of the anus and ineffective straining ( tenesmus) may occur with defecation. Other symptoms depend on the cause and severity of diarrhea but are related to dehydration and to fluid and electrolyte imbalances o

Watery stools are the characteristics of disorders of the small bowel , where as loose, semisolid stools are associated more often with the disorders of the large bowel

COMPLICATIONS OF DIARRHEA Potential for cardiac dysrhythmias because of significant fluid and electrolyte loss ( especially loss of potassium ) Urinary output of less than 30 ml per hour for 2 o 3 consecutive hours, muscle weakness, paresthesia, hypotension, anorexia and drowsiness with a potassium level of less 3.5 mEq/L GERONTOLOGIC CONSIDERATIONS Can become dehydrated quickly and develop low potassium levels ( hypokalemia ) as a result of diarrhea

Observe for clinical manifestations of muscle weakness, dysrhtmias or decreased peristaltic motility that may lead to paralytic ileus. Older patient taking digitalis ( digoxin ) must be aware of how quickly dehydration and hypokalemia can occur with diarrhea . o Teach the patient to recognize the symptoms of hypokalemia because low levels of potassium potentiate the action of digitalis , leading to digitalis toxicity NURSING MANAGEMENT Assessment includes abdominal auscultation and palpation for tenderness. Inspection of the abdomen, Mucuos membranes and skin is important to determine hydration status. Stool samples are obtained for testing. It is also necessary to assess the perianal area. During an episode of acute diarrhea o Encourage bed rest and intake of liquids and foods low in bulk until the acute attack subsides o When patient is able to tolerate food intake , recommend a bland diet of semi solid and solid foods o Intrsuct to avoid caffeine, carbonated beverages, and very hot and very cold foods because they stimulate intestinal motility