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1. Dysentery
Dysentery is diarrhoea presenting with loose frequent stools containing blood.(WHO, 2000 )
Dysentery is an infection of the intestine that causes diarrhoea containing blood or mucus.
The inflammation of the intestine accompanied by abdominal pain, frequent stools containing
blood and mucus mixed is called dysentery. It is especially severe in infants and in children
who are malnourished, develop clinically evident dehydration during their illness or are not
breastfed.
Definition
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in
severe diarrhoea containing blood and mucus in the faeces with fever, abdominal pain, and
rectal tenesmus (a feeling of incomplete defecation), caused by all kind of infection.
Dysentery is an inflammation of the intestine, especially of the colon, that may be caused by
chemical irritants, bacteria, protozoa, parasites. - Mosby’s Dictionary.
Incidence
Worldwide, approximately 140 million people develop dysentery each year, and about
600,000 die. Most of these deaths occur in developing countries among children under age
five. In the United States, only about 25,000 to 30,000 cases occur each year.
In north India 1663 episodes of diarrhoea and 23 diarrhoea related deaths were recorded in
1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery
diarrhoea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhoea. Most of
the episodes lasted less than a week; 5.2% became persistent (duration > 14 days).
Source:- https://pubmed.ncbi.nlm.nih.gov/1421937/
Causes
It results from viral infections, bacterial infections, or parasitic infections. These pathogens
typically reach the large intestine after entering orally, through ingestion of contaminated
food or water, oral contact with contaminated objects or hands and so on.
a) Bacillary dysentery: shigella, e.coli, salmonella
b) Amoebic dysentery: entamoeba histolytica
Types
1). Amoebic dysentery (amoebiasis) due to ulceration of the bowel caused by the invasion of
the mucosa by entamoeba histolytica
2). Bacillary dysentery ( shigellosis): It is common in children from 6 month to 2 years of age
the unset is sudden with anorexia, abdominal pain, intestinal cramps tenasmus and passage
of mucus and blood mixed stool. The number of stools per day may be 20- 30 times.
Condition Bacillary Amoebic
Onset Acute Less acute
Fever Present Absent
Dehydration Present Usually absent
Stool macroscopic Blood and mucous only Usually with faecal matter

2. Appearance and mucous
Stool microscopic
Appearance
Plenty of red blood cells Scanty red blood cells with
trophozoite or cyst
Treatment Antibiotics Antiamoebic drugs
Sign and symptoms
1) Frequently have high fever and seizure the temperature is abnormally low, especially
in the most serious cases.
2) Nauseas and vomiting
3) Mucus and blood in the stool
4) Large watery or frequent small stool
5) Child appears irritable
6) Abdominal pain and cramps
7) If acute, severe dehydration
8) If chronic malnutrition
Diagnosis
1) History taking
2) Physical examination
3) Stool microscopic appearance
4) Stool macroscopic appearance
5) Stool culture and sensitivity
Prevention
a. Washing hand before and after using toilet, before and after having meals, before
handling, cooking food, handling babies or regularly throughout the days.
b. Keep contact with someone known to have dysentery to a minimum.
c. Avoiding sharing items such as towels and face cloths.
d. Drink water from reliable sources.
e. Use purified water to clean teeth
Management
1) Administration of ORS, continuation of oral diet or breastfeeding, zinc
supplementation and antibiotics are the components of treatment.
2) Stool culture and sensitivity should be sent for before starting empirical antibiotics.
Antimicrobial agents are the mainstay of therapy of all cases of shigellosis.
3) Based on safety, low cost and efficacy, ciprofloxacin (15 mg/kg/day in two divided
doses for 3 days) has been recommended by World Health Organization (WHO) as
the first line antibiotic for shigellosis.
4) However, antimicrobial resistance to fluoroquinolones had increased significantly
from 2002 to 2011 and only ceftriaxone has been shown to be uniformly effective.
5) Intravenous ceftriaxone (50-100 mg/kg/ day for 3-5 days) should be the first line of
treatment in a sick child.
6) In a stable child, either ciprofloxacin or oral cefixime may be given, but the patient
should be monitored for clinical improvement within 48 hr (decrease in fever, stool
frequency and blood in stools).

3. 7) If no improvement is seen at 48 hr, antibiotics should be changed appropriately.
8) Oral azithromycin (10 mg/kg/ day for 3 days) can be used for shigellosis but the
experience is limited.
9) Amoebic dysentery is less common among children. The onset is insidious.
Tinidazole or metronidazole is the drug of choice.
10) Any young child presenting with blood in stools and persistent abdominal pain should
be suspected to have intussusception and evaluated accordingly.
11) Treatment any sign of malnutrition
Nursing management
Assessment
 Assess the general condition of the child.
 Assess the eyes, tear, mouth and respiratory rate.
 Monitor urine output, thirst, diarrhea and vomiting.
 Observe skin pinch and pulse rate.
Nursing Diagnosis:
 Imbalanced Nutrition: less than body requirements related to: inadequate intake and
output
 Imbalanced Body Temperature related to: the impact of infection secondary to
diarrhea.
 Risk for Impaired Skin Integrity: perianal related to: increased frequency of bowel
movements (diarrhea)
Nursing Interventions for Dysentery:
a. Imbalanced Nutrition: less than body requirements related to: inadequate intake and output
1. Discuss and explain about the diet restrictions of patients (high fiber foods, fatty and water
is too hot or cold) (Rational high fiber, fat, water is too hot / cold can stimulate irritate the
stomach and intestinal tract.)
2. Create a clean environment, away from the smell of the odour or litter, serve food in a
warm state. (Rational situation comfortable, relaxed to stimulate appetite.)
3. Provide hours of rest (sleep) and reduce excessive activity. (Rational Reducing energy
consumption is excessive)
4. Monitor intake and output within 24 hours. (Rational Knowing the amount of output )
5. Collaboration with other health care team:
a. Nutritional therapy: A diet high in calories and high in protein, low in fiber, milk.
b. medications or vitamins (A)
(Rational Containing substances necessary for the growth process.)
b. Imbalanced Body Temperature related to: the impact of infection secondary to
diarrhea
1. Monitor body temperature every 2 hours.
Rational :- Early detection of abnormal changes in body function (an infection)
2. Give warm compresses.
Rational:- stimulate heat regulating center to reduce the production of body heat
3. Provide antipyretic
Rational:- Stimulate the heat regulating center in the brain.
c. Risk for Impaired Skin Integrity: perianal related to: increased frequency of bowel
movements (diarrhea)
1. Discuss and explain the importance of keeping the beds.
Rational:- Hygiene prevent the proliferation of germs.

4. 2. Encourage family to remove the wet clothing and replace the bottom as well as the
base
Rational:- Preventing skin irritation
3. Adjust the position of sleep or sit with an interval of 2-3 hours.
Rational:- Smooth vascularisation, reducing the emphasis that long so did not happen
ischemia and irritation.
COMPLICATION
1. Dehydration
2. Electrolyte imbalance
3. Malnutrition
4. Renal failure
5. Organ failure
References of dysentery
 Uprety K, Child Health Nursing, fourth Edition (2071 Bhadra), Tara Books and
Stationery, Chhetrapati, Kathmandu, pg 324- 329
 Shrestha T. Essential Child Health Nursing. first Edition 2015,August. Medhavi
Publication; Jamal, Kathmandu Page no.193-203
 Dahal K, Community Health Nursing –II. 5th
edition Makalu Publication House
Dillibajar, Kathmandu, Page no 80-90
 Paul VK, Bagga A, Ghai Essential Pediatrics, eight edition, CBS Publisher and
Distributors Pvt Ltd page 293 to 296
 https://pubmed.ncbi.nlm.nih.gov/1421937/