BAB II

DISCUSSION
A. Definition

Diarrhea is a symptom of digestive disorders, absorption and secretion functions

(Wong, 2001 : 883). Diarrhea is the passage of stool and the consistency of soft or liquid,
often with or without the discomfort caused by the effects of chemotherapy on apitelium
(Tusker,1998:816).Diarrhea is a lot of fluid and electrolytes lost through feces (Behiman,
1999 : 1273).

Diarrhea is a state of the frequency of bowel more than four times in infants and
more than 3 times in children, watery stool consistency, can be green or adapat also
mixed with mucus and blood.

So diarrhea is a symptom of digestive disorders such as defecation with feces as a

liquid or semi-liquid with a frequency of more than 3 times a day for children that refers
to loss of fluid and electrolytes.or mucus only (Ngastiyah, 1997 : 143).

B. Classification
Diarrhea is divided into two, namely :
1. Acute Diarrhea
Acute diarrhea is characterized by a sudden change in the frequency of defecation
2. Chronic Diarrhea
Chronic diarrhea is diarrhea more than 2 weeks.

C. Etiology
Causes of diarrhea can be divided into several factors:
1. factors infection
a. Internal factors : infection of the digestive tract eat, which is a major cause of
diarrhea in children. Covers internal infection as follows
 1) Infeksi Bacteria: vibrio, E. coli, salmonella, campylobacter, yersinia,
Aeromonas, etc
2) Viral infection: enterovirus (ECHO virus, cakseaclere, poliomyelitis),
adenovirus, rotavirus, Astrovirus and others
3) Parasitic infections: worms (askanis, Trichuris, Oxyuris, Strong
Yolkless, protozoa (Entamoeba histolytica, Giarella lemblia,
tracomonas homonis), fungi (Candida albicans).
b. Parenteral infection is an infection outside the digestive tract of food, such as
acute otitis media (AOM), tonsilitist tonsilofasingitis, bronchopneumonia,
encephalitis and so on. This situation is mainly found in infants and children
under the age of 2 years.
2. factors malabsorption
a. Carbohydrate malabsorption: a disaccharide (lactose intolerance, maltose, and
sucrose), monosaccharides (glucose intolerance, fructose, and galatosa).
In infants and children the most important and intolerance terseirng lactation.
b. Fat malabsorption
c. Protein malabsorption
3. Dietary factors
Stale food, toxic, allergic to food.
4. Faktor psikologis
Rasa takut dan cemas (jarang, tetapi dapat terjadi pada anak yang lebih besar).

D. Pathophysiology
The basic mechanisms that cause diarrhea are:
1. Osmotic Disruption
Due to the presence of food or substance that can not be absorbed will cause
osmotic pressure in the intestinal cavity rises, resulting in a shift of water and
electrolytes into the gut cavity. Excessive intestinal cavity contents will stimulate the
intestine to remove it causing diarrhea.
2. Impaired secretion
 As a result of certain disorders (eg, by a toxin) in the intestinal wall will increase the
secretion of water and electrolytes into the intestinal cavity and subsequent
diarrhea due to an increase in the content of the gut cavity.

3. Gut motility disorders

Hiper will result in reduced opportunities intestine to absorb food, causing diarrhea,
decreased intestinal peristalsis otherwise if would result in excessive growth of
bacteria which in turn can cause diarrhea as well.

E. Clinical manifestation
At first the patient whiny, fidgety, body temperature usually increases, the appetite is reduced
or absent.
1. Then, accompanied by diarrhea, liquid stools, possibly accompanied by mucus or blood
mucus.
2. The color of the stool the longer turn greenish because mixed with gall.
3. Anus and scuffed areas that arise because of frequent defecation and fecal increasingly
acidic so as a result of increasingly acidic so as a result the more lactic acid derived from
latosa are not in absorption by the intestine during diarrhea.
Vomiting can occur before or after diarrhea and can be caused by co-inflamed stomach or due
to disorders of acid-base and electrolyte balance. If the patient loses a lot of fluids and
electrolytes, eyes and fontanel cekugn (in infants) mucous membranes of the lips and mouth
and the skin looks dry (Ngastiyah, 1997).

F. Management
medical:
Basic treatment of diarrhea are:
1. Giving fluids: fluid types, how to provide a liquid, the amount of the gift.
2. dietetic (way of feeding)
3. Drugs
1) Giving fluids
Fluid administration in patients with diarrhea and pay attention to the degree of
dehydration and general condition.
a. Giving fluids
Patients with mild and moderate dehydration fluids given orally in the form of a
liquid containing NaCl and Na HCO 3, KCl and glucose due to acute diarrhea and in
children over the age of 6 months sodium levels 90 ml g / L. in children under 6
 months of dehydration mild / moderate levels of sodium 50-60 MFA / L, full formula
is often called: ORS.
b. parenteral fluid
Actually there are several types of fluid required in accordance ith the needs
of the patient, but all of it tergantugn availability stempat fluid. In general,
liquid Ringer lactate (RL) is given depending on the weight / rignan
dehydration, which diperhitugnkan with fluid loss in accordance with his age
and BB.
- No dehydration
Orally as many kids want to drink / 1 cup each defecation.
- Mild dehydration
1 The first hour: 25-50 ml / kg orally
hereinafter: 125 ml / kg / day
- Dehydration was
1 hour first: 50-100 ml / kg orally (sonde)
The next 125 ml / kg / day
- Severe dehydration
Depending on the patient's age and BB.
2) Dietetic treatment
For children under 1 year and children over 1 year to less than 7 kg BB types of food:
- Milk (breast milk is milk that contains lactose low lactose and unsaturated fatty
acids, for example, LLM, al Miron).
- Half the solid food (porridge) or solids (nasitim), if the child does not want to drink
milk because home is not unusual.
- Milk specially adapted to the abnormalities found in milk does not contain lactose /
medium chain fatty acids
3) Drugs
The principle of treatment for diarrhea is to replace fluids lost through stool with /
without vomiting with fluids containing electrolytes and glucose / other carbohydrates
(sugar, water starch, rice flour as follows).
- Anti secretion
Aspirin, 25 mg / c with a minimum dose of 30 mg.
Klorrpomozin, a dose of 0.5 to 1 mg / kg / day
- Drug spasmolytic, etc. generally spasmolytic drugs such as papaverine, beladora
extract, opium loperamia not be used to treat acute diarrhea again, drugs stool
hardeners such as kaolin, pectin, charcoal, tabonal, there is no benefit to treating
diarrhea sehingg not given anymore.
- Antibiotics
Generally, antibiotics are not given when there is no obvious cause when the cause
of cholera, tetracycline diberiakn 25-50 mg / kg / day.
Antibiotics are also given bile diseases such as OMA, pharyngitis, bronchitis /
bronchopneumonia.
G. Complication
Diarrhea, loss of fluids and electrolytes sudden complications can occur as follows:
1. Dehydration (mild, moderate, severe, hypotonic, isotonic or hypertonic)
2. hypovolemic shock
 3. Hypokalemia (with miteorismus symptoms, muscle hypotonia, fat, bradycardia,
changes elektrokardiagram).
4. Hypoglycemia
5. Intolerance secondary to damage to the villi of the intestinal mucosa and lactation
enzyme deficiency.
6. Convulsions in hypertonic dehydration
7. The protein energy malnutrition (due to vomiting and diarrhea, if prolonged or
chronic).

Nursing care
A. Assessment
1. Biodata general
2. medical history
A history of gastroenteritis, giardiasis, celiac disease, colon irritability syndrome, acute otitis
media, tondilitas, encephalitis and other
3. Medical history in advance
Never experienced diarrhea, had suffered from gastrointestinal diseases
4. Family medical history
Ever suffered from gastrointestinal disease
5. Main complaint
Children often cry, do not want to eat and drink, body weakness
6. Functional Health Patterns
a. Sanitation
Personal hygiene children less: the habit of nail maternal nurturing children, wash
hands before eating, the food served is not closed, stale food
b. Nutrition and Metabolic
Hyperthermia, weight loss total to 50%, dnoteksia, vomiting.
c. Elimination defecation
Watery feces, the frequency varies from 2 to 20 per day.
d. activity
Weakness intolerant of activity.
e. sensory
Pain is marked by crying and feet up into the abdomen.
7. Physical examination
a. general state
Seem weak and in pain.
b. vital signs
- Body weight decreased by 2% mild dehydration
- Body weight decreased 5% moderate dehydration
- Body weight decreased by 8% severe dehydration
- TD decreased due to dehydration
- RR increased due hipermetabolisme, fast and deep (kusmoul)
- Temperature increases when the reaction occurs inflmasi
- Increased pulse (peripheral pulse weakened)
c. Eyes: sunken
d. Mouth: Dry mucous
e. Abdomen: turgor ugly
 f. Skin: Dry, capillaries refil> 2 '

B. Nursing diagnoses
1. Lack of fluid volume associated with frequent and watery bowel movements.
2. Changes in nutrition less than body requirements associated with reduced intake and reduced
absorption of food and fluids.
3. Hipertermi ditandi associated with infection with damage to the intestinal mucosa.

C. Focus Intervention
1. Diagnosis : Lack of fluid and electrolyte volume associated with frequent and watery
bowel movements.
Objective : fluid balance can be maintained within normal limits.
Expected results :
a. Pengisien back capillary <2 seconds
b. elastic turgor
c. Mucous membranes moist
d. Body weight did not show a decline.
intervention:
- Assess intake and output, muscle and observation defecation frequency,
characteristics, and a number of trigger factors
Rational: determine the loss and fluid requirements.
- Assess TTV
Rationale: helps assess patient consciousness.
- Assess hydration status, fontanel, eyes, skin turgor, and mucous membranes.
Rational: determine the loss and the needs of their fluids.
- Measure BB every day
Rational: evaluate the effectiveness or need for change of nutrition.
- Children rested
Rationale: improve circulation.
- Collaboration with parenteral fluid administration
Rational: to increase consumption more.
- Provision of anti-diarrhea medication, antibiotics, anti-pyretic and anti emeti according
to the program.
Rational: reducing bowel movements and vomiting.

2. Diagnosis : Changes in nutrition less than body requirements associated with reduced
intake of food absorption.
Objective : Children tolerant appropriate diet.
Expected results :
- BB within normal limits
- No recurrence of diarrhea.
 Intervention :

- Weigh BB every day

Rational: evaluate the effectiveness in the delivery of nutrients. /

- Restrictions on the activity during the acute phase of illness

Rational: reducing reyurtasi.
- Keep the patient's mouth
Rational: the mouth of the net increase appetite.
- Monitor intake and output
Rational: observation nutritional needs.

3. Diagnosis : Hipertermi associated with infection is characterized by damage to the

intestinal mucosa.
Purpose : to restore body temperature to normal.
Expected results :
- The body temperature returned to normal 36-37oC

intervention:
- Avoid and prevent the use of an external source
Rational: reducing the risk of peripheral vasodilation and collapse paskuler.
- Monitor the body temperature of patients and reported improvement of the patient's
baseline value normal temperature.
Rational: detecting an increase in body temperature and the onset of hyperthermia.
- Instruct children not to wear clothes / blankets thick.
Rational: reducing an increase in body temperature.
- Collaboration of anti-infective drugs anti Gronik.
 BAB III
CLOSING

Conclusion
In this globalization era diarrheal diseases is increasing, this is because people are not
maintaining environmental hygiene and eating habits hygiennya less food and a lack of public
knowledge about diarrhea and its prevention.
The impact of diarrheal disease can cause a variety of problems in children such as
child's activity is reduced, the nutritional needs unbalanced, causing impaired child
development. Diarrhea occurs in infants and very dangerous because it can lead to death due to
lack of fluids.