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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 severe 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
altered skin integrity.
Nurses and the members of the healthcare team must take precautions to prevent transmission
of infection associated with some causes of diarrhea.
Related Factors
Anxiety
Alcohol abuse
Chemotherapy
Gastrointestinal disorders
Increased secretion
Laxative abuse
Radiation
Stress
Surgical procedures: bowel resection, gastrectomy
Tube feedings
Defining Characteristics
Abdominal pain
Cramping
Urgency
The following are the common goals and expected outcomes for Diarrhea:
Patient defecates formed, soft stool every day to every third day.
Nursing Assessment
Thorough assessment is important to ascertain potential problems that may have lead
to Diarrhea as well as handle any conflict that may appear during nursing care.
Assessment Rationales
Evaluate pattern of defecation. Assessment of defecation pattern will help direct treatment.
Assess for fecal impaction. Liquid stool (apparent diarrhea) may seep past fecal impaction.
Skin turgor Decreased skin turgor and tenting of the skin occur in dehydration.
Assess the condition of perianal Diarrheal stools may be highly corrosive as a result of increased
skin. enzyme content.
Nursing Interventions
Interventions Rationales
An accurate daily weight is an important
Weigh patient daily and note decreased weight.
indicator of fluid balance in the body.
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.
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.
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.
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
protect the skin.
If skin is still excoriated and desquamated, apply a wound
hydrogel.
Change feeding tube equipment according to institutional Contaminated equipment can result to
policy, but no less than every 24 hours. 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.
Allow the patient to communicate with caregiver if diarrhea This should be reported immediately to
occurs with prescription drugs. prevent worsening of diarrhea.
Educate patient or caregiver the proper use of antidiarrheal Appropriate use of antidiarrheal
medications as ordered. medications can promote effective bowel
elimination.
Discuss the importance of fluid replacement during diarrheal Fluid intake is necessary to
episodes. prevent dehydration.
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.
Further Reading