Diarrhea - Clinical Manifestations, Complications and Nursing Management

Diarrhea
  • Diarrhea is increased frequency of bowel movements (more than three per day), increased amount of stool (more than 200 g per day), and altered consistency (ie, looseness) of stool.
  • It is usually associated with urgency, perianal discomfort, incontinence, or a combination of these factors.
  • Any condition that causes increased intestinal secretions, decreased mucosal absorption, or altered motility can produce diarrhea.
  • Diarrhea can be caused by certain medications (eg, thyroid hormone replacement, stool softeners and laxatives, antibiotics, chemotherapy, antacids), certain tube feeding formulas, metabolic and endocrine disorders (eg, diabetes, Addison’s disease, thyrotoxicosis), and viral or bacterial infectious processes (eg, dysentery, shigellosis, food poisoning).
  • Other disease processes associated with diarrhea are nutritional and malabsorptive disorders (eg, celiac disease), anal sphincter defect, Zollinger-Ellison syndrome, paralytic ileus, intestinal obstruction, and acquired immunodeficiency syndrome (AIDS).

Diarrhea - Clinical Manifestations, Complications and Nursing Management
Clinical Manifestations
  • In addition to the increased frequency and fluid content of stools, the patient usually has abdominal cramps, distention, intestinal rumbling, anorexia, and thirst.
  • Painful spasmodic may occur with defecation.
  • Other symptoms depend on the cause and severity ofthe diarrhea but are related to dehydration and to fluid and electrolyte imbalances.

Complications
  • Complications of diarrhea include the potential for cardiac dysrhythmias because of significant fluid and electrolyte.
  • Decreased potassium levels cause cardiac dysrhythmias (ie, atrial and ventricular tachycardia, ventricular fibrillation, and premature ventricular contractions) that can lead to death.


Nursing Management
  • The nurse’s role includes assessing and monitoring the characteristics and pattern of diarrhea.
  • A health history addresses the patient’s medication therapy, medical and surgical history, and dietary patterns and intake.
  • Assessment includes abdominal auscultation and palpation for abdominal tenderness. Inspection of the abdomen and mucous membranes and skin is important to determine hydration status.
  • Stool samples are obtained for testing.
  • During an episode of acute diarrhea, the nurse encourages bed rest and intake of liquids and foods low in bulk until the acute attack subsides.
  • When food intake is tolerated, the nurse recommends a bland diet of semisolid and solid foods.
  • The patient should avoid caffeine, carbonated beverages, and very hot and very cold foods.
  • It may be necessary to restrict milk products, fat, whole-grain products, fresh fruits, and vegetables for several days.
  • The nurse administers antidiarrheal medications such as diphenoxylate (Lomotil) and loperamide (Imodium) as prescribed.
  • Intravenous fluid therapy may be necessary for rapid rehydration, especially for the elderly and those with preexisting GI conditions (eg, IBD).
  • It is important to closely monitor serum electrolyte levels.

by : JOFRED M. MARTINEZ, RN - http://www.slideshare.net/jofre/

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