DEFINITION CAUSE SIGNS AND STATISTICS PATHOPHYSIOLOG PROGNOSIS

SYMPTOMS Y

Diarrhea

COMPLICATIONS TREATMENT/ NURSING NURSING

DIAGNOSTICS PREVENTION
MEDICAL DIAGNOSIS INTERVENTIONS
 Definition
 A condition defined by an
increased frequency of bowel
movements (more than three
per day), increased amount
of stool (more than 200 g per
day), and altered consistency
(liquid stool). Types of diarrhea
include secretory, osmotic,
malabsorptive, infectious, and
exudative. It can be acute
(self-limiting and often
associated with infection) or
chronic (persists for a long
period and may return
sporadically).
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 Cause
 Certain Medications
 Tube Feeding Formulas
 Metabolic and Endocrine Disorders
 Viral and Bacterial infections
 Other causes are Nutritional and Malabsorption disorders,
Anal sphincter deficit, Zollinger – Ellison syndrome, Paralytic
Ileus, Immunodeficiency Syndrome (AIDS), and Intestinal
Obstruction.

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 Pathophysiology
 Types of diarrhea include secretory, osmotic, and mixed
diarrhea. Secretory diarrhea is usually high-volume diarrhea
and is caused by increased production and secretion of water
and electrolytes by the intestinal mucosa into the intestinal
lumen. Osmotic diarrhea occurs when water is pulled into the
intestines by the osmotic pressure of unabsorbed particles,
slowing the reabsorption of water. Mixed diarrhea is caused by
increased peristalsis (usually from IBD) and a combination of
increased secretion and decreased absorption in the bowel.

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 Statistics
 The infectious agents that cause diarrhea are present or are
sporadically introduced throughout the world. Diarrhoea is a rare
occurrence for most people who live in developed countries
where sanitation is widely available, access to safe water is high
and personal and domestic hygiene is relatively good. World-
wide around 1.1 billion people lack access to improved water
sources and 2.4 billion have no basic sanitation. Diarrhoea due to
infection is widespread throughout the developing world. In
Southeast Asia and Africa, diarrhoea is responsible for as much as
8.5% and 7.7% of all deaths respectively.

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 Signs and Symptoms
 Increased frequency and fluid content of stool

 Abdominal cramps, distention, intestinal rumbling (borborygmus), anorexia, and

thirst

 Painful spasmodic contractions of the anus and ineffectual straining (tenesmus) with
each defecation

 Other symptoms, depending on the cause and severity and related to dehydration
and fluid and electrolyte imbalances, include the following:

i. Watery stools, which may indicate small bowel disease

ii. Loose, semisolid stools, which are associated with disorders of the large bowel

iii. Voluminous greasy stools, which suggest intestinal malabsorption

iv. Blood, mucus, and pus in the stools, which denote inflammatory enteritis or colitis

v. Oil droplets on the toilet water, which are diagnostic of pancreatic insufficiency

vi. Nocturnal diarrhea, which may be a manifestation of diabetic neuropathy

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 Prognosis
 Many people with symptoms of acute diarrhoea will
improve within 2-4 days: rotavirus diarrhoea usually lasts
3-8 days, norovirus around 2 days and infection
with Campylobacter spp. and Salmonella spp. 2-7
days.
 Giardia spp. infection may persist and cause chronic
diarrhoea.
 Diarrhoea is the second leading cause of death
worldwide.

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 Complications
 Complications of diarrhea include cardiac
dysrhythmias due to fluid and electrolyte (potassium)
imbalance, urinary output less than 30 mL/h, muscle
weakness, paresthesia, hypotension, anorexia,
drowsiness (report if potassium level is less than 3.5
mEq/L [3.5 mmol/L]), skin care issues related to irritant
dermatitis, and death if imbalances become severe.

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 Diagnostic
 When the cause is not obvious:
i. Complete blood cell count
ii. Serum chemistries
iii. Urinalysis
iv. Routine stool examination
v. Stool examinations for infectious or parasitic organisms,
bacterial toxins, blood, fat, electrolytes, and white blood cells

Endoscopy or barium enema

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Treatment / Medical Management
 Primary medical management is directed at controlling
symptoms, preventing complications, and eliminating or treating
the underlying disease.
 Certain medications (eg, antibiotics, anti-inflammatory agents)
and antidiarrheals (eg, loperamide [Imodium], diphenoxylate
[Lomotil]) may reduce the severity of diarrhea and the disease.
 Increase oral fluids; oral glucose and electrolyte solution may be
prescribed.
 Antimicrobials are prescribed when the infectious agent has been
identified or diarrhea is severe.
 IV therapy is used for rapid hydration in very young or elderly
patients.

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 Prevention
 Safe water/ Adequate Sanitation - Treat water before
use and dispose of waste safely
 Routine Vaccination- Provide rotavirus vaccine
 Improved hygiene- Wash hands when appropriate

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 Nursing Diagnosis
 Diarrhea may be related to inflammation, irritation; infectious process, parasites;
Malabsorption; Laxative or alcohol abuse, toxins, contaminants; Adverse effects
of pharmaceutical agents, radiation; Tube feedings; Travel

 Acute Pain related to abdominal cramping and

 irritation or excroriation of skin.

 Impaired Skin Integrity related to effects of excretions on delicate tissue.

 Risk for deficient Fluid Volume related to excessive losses through gastrointestinal
tract.

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 Nursing Interventions
 Elicit a complete health history to identify character and pattern of diarrhea, and the following:
any related signs and symptoms, current medication therapy, daily dietary patterns and intake,
past related medical and surgical history, and recent exposure to an acute illness or travel to
another geo- graphic area.

 Perform a complete physical assessment, paying special attention to auscultation (characteristic

bowel sounds), palpation for abdominal tenderness, inspection of stool (obtain a sample for
testing).

 Inspect mucous membranes and skin to determine hydration status, and assess perianal area.

 Encourage bed rest, liquids, and foods low in bulk until acute period subsides.

 Recommend bland diet (semisolids to solids) when food intake is tolerated.

 Encourage patient to limit intake of caffeine and carbonated beverages, and avoid very hot
and cold foods because these increase intestinal motility.

 Advise patient to restrict intake of milk products, fat, whole grain products, fresh fruits, and
vegetables for several days.

 Administer antidiarrheal drugs as prescribed.

 Monitor serum electrolyte levels closely.

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