Diarrhea: Passage of loose, unformed stools.

Diarrhea is an increase in the frequency of bowel movements, as well as the water

content and volume of the waste. It may arise from a variety of factors, including
malabsorption disorders, increased secretion of fluid by the intestinal mucosa, and
hypermotility of the intestine. It may also due to infection, inflammatory bowel diseases, side
effects of drugs, increased osmotic loads, radiation, or increased intestinal motility.

Diarrhea can be an acute or a servere problem. Mild cases can be recovered in a few
days. However, severe diarrhea can lead to dehydration or severe nutritional problems.
Problems associated with diarrhea include fluid and electrolyte imbalances, impaired
nutrition, and alered skin integrity

Nuses and he members of the health care team must take precaution to prevent transmission
of infection associated with some causes of diarrhea.

a. Related Factors

Here are some factors that may be related to Diarrhea:

Anxiety

Alcohol abuse

Chemotherapi

Disagreeable dietary intake

Enteric infections: viral, bacterial, or parasitic

Gastrointestinal disoders

Increased secretion

Laxative abuse

Malabsorption (e.g., lactase deficiency)

Motor disorders: irritable bowel

Mucosal inflamation : Crohn’s disease or ulcerative colitis

Rdiation

Short bowel syndrome

Side effects of medication on use

Stress

Surgical procedures: bowel resection,gastrectomy

Tube feedings

Defining characteristics

Diarrhea is characterized by the following sign and symptoms:

Abdominal pain

Cramping

Frequency of stools (more than 3/day)

Hyeperactive bowel sounds or sensations

Loose or liquid stools

Urgency

Dx :

1. Diarrhea
2. Nutrition
3. Elimination and exchange
4. Activity/rest
5. Perception cognition

b. Goals and outcomes

The following are the common goals and expected outcomes for diarrhea:

Patient explaint cause of diarrhea and rati onale for treatment

Patien consumens at least 1500-2000mL of clear liquid within 24 hours peroid

Patient mantiens good skinturgor and weight at usual level

Patient reports less diarrhea within 36 hours

Patient defecates formed,soft stool every day to every third day

Patient maintains a rectal area free of irritation

Patient states relief from cramping and less or no diarrhea

Patient has negative stools cultures

c. Nursing assesment

Thorought assesment is important to ascertain potential problem that mayhave lead to

diarrhea as well as handle any conflic that may appear during nursing care.

Assessment Rationales

Assess for abdominal

discomfort, pain, cramping,
frequency, urgency, loose or These assessment findings are usually linked with diarrhea.
liquid stools, and hyperactive
bowel sensations.

Evaluate pattern of defecation. Assessment of defecation pattern will help direct treatment.

Testing will distinguish potential etiological organisms for the

Culture stool.
diarrhea.

Inquire about the following:

Diarrhea is a typical indication of lactose intolerance. Patients with

Tolerance to milk and other lactose intolerance have insufficient lactase, the enzyme that digests
dairy products lactose. The presence of lactose in the intestines increases osmotic
pressure and draws water into the intestinal lumen.
 Foods may trigger intestinal nerve fibers and cause
increased peristalsis. Some foods will increase intestinal osmotic
Food intolerances pressure and draw fluid into the intestinal lumen. Spicy, fatty, or high-
carbohydrate foods; caffeine; sugar-free foods with sorbitol; or
contaminated tube feedings may cause diarrhea.

Diarrhea may also be due to inadequately cooked food, food

contaminated with bacteria during preparation, foods that are not
Food preparation
maintained at appropriate temperatures, or contaminated tube
feedings.

Drugs such as laxatives and antibioticsusually cause

Medications the patient is or has
diarrhea. magnesium and calcium supplements can also cause
been taking
diarrhea.

Alterations in eating schedule can cause changes in intestinal function

Change in eating pattern
and can lead to diarrhea.

Hyperosmolar food or fluid draws excess fluid into the gut,

Osmolality of tube feedings
stimulates peristalsis, and causes diarrhea.

Certain individuals respond to stress with hyperactivity of the

Current stressors
gastrointestinal tract.

Assess for fecal impaction. Liquid stool (apparent diarrhea) may seep past fecal impaction.

Assess hydration status, including:

Input and output Diarrhea can lead to profound dehydration

Moisture of mucous membranes Dehydration causes dry mucous membranes.

Skin turgor Decreased skin turgor and tenting of the skin occur in dehydration.

Check for a history of the following:

Gastrointestinal diseases Diseases such as gastroenteritis and Crohn’s disease can result in
 malabsorption and lead to chronic diarrhea.

Radiation causes sloughing of the intestinal mucosa, decreases usual

Abdominal radiation
absorption capacity, and may result in diarrhea.

Diarrhea is normal 1 to 3 weeks after bowel resection. Patients who

have gastric partitioning surgery for weight loss may experience
Previous
diarrhea as they begin refeeding. Diarrhea is a manifestation of
gastrointestinal surgery
dumping syndrome in which an increased osmotic bolus entering the
small intestinedraws fluid into the small intestine.

Foreign travel, ingestion of

Patients may acquire intestinal infections from eating contaminated
unpasteurized dairy products, or
foods or drinking contaminated water.
drinking untreated water.

Assess the condition of perianal Diarrheal stools may be highly corrosive as a result of increased
skin. enzyme content.

Examine the emotional impact

Loss of control of bowel elimination that occurs with diarrhea can lead
of illness, hospitalization, and/or
to feelings of embarrassment and decreased self-esteem.
soiling accidents.

Nursing interventions

The following are the therapeutic nursing interventions for diarrhea:

Interventions Rationales

An accurate daily weight is an important

Weigh patient daily and note decreased weight.
indicator of fluid balance in the body.
Have patient keep a diary that includes the following: time of
day defecation occurs; usual stimulus for defecation;
consistency, amount, and frequency of stool; type of, amount
of, and `time food consumed; fluid intake; history of bowel Evaluation of defecation pattern will help
habits and laxative use; diet; exercise patterns; direct treatment.
obstetrical/gynecological, medical, and surgical histories;
medications; alterations in perianal sensations; and present
bowel regimen.

Avoid using medications that slow peristalsis. If an The increase in gut motility helps
infectious process is occurring, such as Clostridium eliminate the causative factor, and use of
difficile infection or food poisoning, medication to slow antidiarrheal medication could result in a
down peristalsis should generally not be given. toxic megacolon.

Most antidiarrheal drugs suppress

gastrointestinal motility, thus allowing for
more fluid absorption. Supplements of
Give antidiarrheal drugs as ordered. beneficial bacteria (“probiotics”) or
yogurt may reduce symptoms by
reestablishing normal flora in
the intestine.

Provide the following dietary alterations:

Bulking agents and dietary fibers absorb

Bulk fiber (e.g., cereal, grains, Metamucil) fluid from the stool and help thicken the
stool.

“Natural” bulking agents (e.g., rice, apples, matzos, cheese)

Avoidance of stimulants (e.g., caffeine, carbonated Stimulants may increase gastrointestinal
beverages) motility and worsen diarrhea.

Record number and consistency of stools per day; if desired, Documentation of output provides a
use a fecal incontinencecollector for accurate measurement baseline and helps direct replacement
of output. fluid therapy.

Evaluate dehydration by observing skin turgor

Severe diarrhea can cause deficient fluid
over sternum and inspecting for longitudinal furrows of the
volume with extreme weakness and cause
tongue. Watch for excessive thirst, fever, dizziness,
death in the very young, the chronically
lightheadedness, palpitations, excessive cramping, bloody
ill, and the elderly.
stools, hypotension, and symptoms of shock.

Encourage fluids 1.5 to 2 L/24 hr plus 200 mL for each loose

Increased fluid intake replaces fluid lost
stool in adults unless contraindicated; consider nutritional
in the liquid stool.
support.

Monitor and record intake and output; note oliguria and dark, Dark, concentrated urine, along with a
concentrated urine. Measure specific gravity of urine if high specific gravity of urine, is an
possible. indication of deficient fluid volume.

Older, frail patients or those patients

Evaluate the appropriateness of protocols for bowel
already depleted may require less bowel
preparation on basis of age, weight, condition, disease, and
preparation or additional intravenous
other therapies.
fluid therapy during preparation.

Provide perianal care after each bowel movement.

Cleanse with a mild cleansing agent (perineal skin cleanser). Mild cleansing of the perianal skin after
each bowel movement will prevent
Apply protective ointment prn. excoriation. Barrier creams can be used to

If skin is still excoriated and desquamated, apply a wound protect the skin.

hydrogel.

Avoid the use of rectal Foley catheters.
Rectal Foley catheters can cause rectal
necrosis, sphincter damage, or rupture,
and the nursing staff may not have the
time to properly follow the necessary and
very time-consuming steps of their care.

The loss of proteins, electrolytes, and

If diarrhea is associated with cancer or cancer treatment,
water from diarrhea in a cancer patient
once infectious cause of diarrhea is ruled out, provide
can lead to rapid deterioration and
medications as ordered to stop diarrhea.
possibly fatal dehydration.

For patients with enteral tube feeding, employ the following:

Change feeding tube equipment according to institutional Contaminated equipment can result to
policy, but no less than every 24 hours. diarrhea.

Extremes of temperature can

Administer tube feeding at room temperature.
stimulate peristalsis.

Starting a tube feeding at a slow infusion

Initiate tube feeding slowly. rate allows the gastrointestinal system to
accommodate intake.

Decreasing the rate of infusion or

Decrease the rate or dilute feeding if diarrhea persists or
osmolarity of the feeding prevents
worsens.
hyperosmolar diarrhea.

If diarrhea is chronic and there is an indication of A hydrolyzed formula has protein that is
malnutrition, discuss with primary care practitioner for a partially broken down to small peptides
dietary consult and possible use of a hydrolyzed formula to or amino acids for people who cannot
maintain nutrition while the gastrointestinal system heals. digest nutrients.

Encourage patient to eat small, frequent meals and to Bland, starchy foods are initially
consume foods that normally cause constipation and are easy recommended when starting to eat solid
to digest. food again.
Educate the patient or caregiver about the following dietary
measures to control diarrhea:
These dietary changes can slow the
Avoid spicy, fatty foods, alcohol, and caffeine. passage of stool through the colon and

Broil, bake, or boil foods; avoid frying. reduce or eliminate diarrhea.

Avoid foods that are disagreeable.

Allow the patient to communicate with caregiver if diarrhea This should be reported immediately to
occurs with prescription drugs. prevent worsening of diarrhea.

Appropriate use of antidiarrheal

Educate patient or caregiver the proper use of antidiarrheal
medications can promote effective bowel
medications as ordered.
elimination.

Discuss the importance of fluid replacement during diarrheal Fluid intake is necessary to
episodes. prevent dehydration.

Hygiene reduces the risk of perianal

Impart to patient the importance of good perianal hygiene.
excoriation and promotes comfort.

Educate patient and SO on how to prepare food properly and These could prevent outbreaks and spread
the importance of good food sanitation practices of infectious diseases transmitted through
and handwashing. fecal-oral route.

Diarrhea can be a great source of

Provide emotional support for patients who are having embarrassment to the elderly and can lead
trouble controlling unpredictable episodes of diarrhea. to social isolation and a feeling of
powerlessness.
 Further reading

Recommended books and resources:

Nursing care palns: diagnoses, interventionsn and outcomes

Nurses’s pocket guide: diagnoses, prioritized 9interventions and rationales

Nursing diagnosis 2015-17: definitions and classificatoins

Diagnostic and statistical manual of mental disorders

Manual of psychiatric nursingcare planning

Maternal newbornnursing care plans

Delmar’s maternal-infant nursing care plans

Maternal newborn nursing care plants