Anatomy and Physiology

Diarrhea is an increase in the frequency, volume, and

fluid content of the stool. In diarrhea, the water
content of feces is increased usually due to either
malabsoprtion or water secretion in the bowel. It is a
manifestation rather than a primary disease.
Diarrhea may be acute or chronic. Acute diarrhea,
which lasts less than a week is usually due to an
infectious agent. Chronic diarrhea that persists longer
than 3 to 4 weeks may be caused by an inflammatory
disorders, malaabsoprtion and or endocrine disorders.

Overview of the Disease
There are two general types of diarrhea -- acute diarrhea
and chronic diarrhea. Acute diarrhea improves within two
weeks. Chronic diarrhea lasts longer than two weeks.

There are many possible causes of acute diarrhea. A few of
the more common causes include:
Viral infections (see Stomach Flu , Norovirus , or Rotavirus)
Bacterial infections, such those involving Salmonella typhi
and E. coli
Parasites, such as Giardia
Medicines
Anxiety .







Acute Versus Chronic

Infections
Medicines
Certain medical conditions like:
Certain types of surgery, such as gastric bypass surgery
Travel.
Sometimes, the cause of chronic diarrhea remains
unknown. As long as it goes away on its own, an
extensive search for the cause is not usually necessary.















Specific causes of chronic diarrhea
include:

Large watery stools daily

Sign and Symptoms
Specimen analysis, Stool specimen, stool culture

Purpose and description: a sample of stool is collected
for gross and microscopic examination, as well as form
and consistency and color. Gross examination includes
volume and water content and the presence of any
blood, pus, mucus, or excess fat. Microscopic
examination idenstifies the presence of WBCs,
unabsorbed fat and parasites. When an enteric
pathogen is suspected, a stool sample is taken.

Diagnostic

Absorbant and protectant kaolin and pectin
(kaopectate, donagel-MB)

Bismuth subsalicylate (pepto-bismol)
Absorbant preparation act locally in the intestine
to bind substance that can cause diarrhea.
Absorbants are safe and are generally available over
the counter. Their efficacy hasnot been shown to be
somewhat effective in preventing and managing
travellers diarrhea, usually related to contaminated
water supplies. Bismuth salts are also have a protective
and antimicrobial effect.

Medical Treatment

Opium and opium derivatives ( camporated tincture of
opium ( paregoric)
Tincture of opium ( laudanum, opium tincture); Difenoxin
(motofen); Diphenoxylate ( lomotil, lotrol, others);
Loperamide hydrochloride ( Imodium).

This drugs act on the central nervous system to decrease
the motility of the ileum and colon, slowing transit time
and promoting more water absorption. They also
decrease the sensation of a full rectum and increase anal
sphincter tone. Paregoric and tincture opium have a
greater potential for abuse and are prescription drugs
subject to controls under the Federal Controlled
Substance Act of 1970.

Take medication as ecommended at the onset of
diarrhea ad after each loose stool.
These drugs may be a habit forming; use for no more
than 48hrs.
Avoid using alcohol and over the counter cold
preparation while taking these drugs.
These preparations may cause drowsiness, avoid
driving or operating machinery while taking them.



Health teaching for the client

Anticholinergic ( atropine, Belladonna alkaloids (
Donnagel, Donnatal)
Anticholinergic medications reduce bowel spasticity
and acid secretion in the stomach. They are used to
treat diarrhea that is associated with peptic ulcer
disease and irritable bowel syndrome. These are non-
specific drugs; their systemic effects are their major
drawback.

Take only as directed, stop the drug and notify the
physician if you develop eye pain, impaired urination,
constipation.
Do not operate machinery while taking this drug,
drowsiness may occur.
Hard candies help relieve oral dryness associated with
these preparations

Health teaching for the client

Risk for fluid volume deficit

Record intake and output
Monitor vital signs including orthostatic blood pressure
Provide fluid and electrolyte replacement solutions as
indicated.

Nursing diagnosis

Diarrhea
Monitor and record the frequency and characteristics
of bowel movements.
Measure abdominal girth and auscultate bowel
sounds every 8hrs as indicated.
Use standard precautions, including gloves and hand
washing provide ready access to bathroom,
commode and or bedpan.
Administer anti- diarrheal medications as prescribed.


Risk for impaired skin integrity
Assist with the cleaning of perianal area as needed.
Apply protective ointment to the perianal area.