COMMUNICABLE DISEASE

1. DIARRHEA
DONA JOSE

2. DIARRHEA
• Diarrhea is defined as, "An increase in the
frequency, volume and fluid content of the
stool".
• According to World Health Organization
(WHO), Diarrhea is defined as, "The passage
of three or more loose or liquid stools per
day".

3. Etiology
• 1. Diarrhea is usually a symptom of
gastroenteritis (a bowel infection). It is caused by
the following:
• a. Virus, such as Norovirus or Rotavirus.
• b. Parasite, such as Giardia intestinalis.
• c. Bacteria such as Clostridium difficile,
Salmonella and Shigella.

4. • 2. Others:
a. Diabetes
b. Laxative abuse
c. Alcohol abuse
d. Crohn's disease
e. Radiation therapy
f. Hyperthyroidism.

5. Risk Factors
• 1. Malnutrition
• 2. Exposure to unsanitary conditions.
• 3. Poor maternal education.
• 4. Measles
• 5. Drinking contaminated water.

6. PATHOPHYSILOGY

8. Clinical Manifestations
• 1. Watery stools
• 2. Abdominal cramps
• 3. Nausea and vomiting.
• 4. Thin or loose stools.
• 5. Sense of urgency to have bowel movement

9. Diagnostic Evaluation
• Diagnostic tests that may be order to help identify the
cause of diarrhea.
• 1. Stool sample: To know the exact cause of infection.
• 2. Serum electrolytes, serum osmolality and arterial
blood gases:
• a. They are ordered to assess for adverse effects of
diarrhea.
• b. Increased serum osmolality indicates water loss and
dehydration.

10. • 3. Sigmoidoscopy: It may be conducted to
visualize the bowel mucosa.
• 4. Colonoscopy: It is performed to examine
large intestine.

11. Management
• Medical Management
• 1. Over the counter drug: Pepto-Bismol (Bismuth
subsalicylate).
• 2 Anti-motility drug: Imodium plus (Loperamide
hydrochloride with simethicone).
• 3 Oral Rehydration Solution (ORS) should be used to
prevent dehydration
• 4. Anticholinergics such as atropine, belladonna
alkaloids (donnatal).

12. Nursing Management
• 1. Monitor the frequency and characteristics of
bowel movements
• 2. Monitor vital signs of patient
• 3. Record intake and output,
• 4. Measure abdominal girth and auscultate bowel
sounds every 8 hours as indicated.

13. • 5 Instruct patient to wash his/her hands thoroughly
before eating or preparing food and after going to
toilet.
• 6. Avoid sharing towels, or utensils with other
household members.
• 7. Provide fluid and electrolytic replacement solutions
as indicated.
• 8. Assist with cleaning the perianal area as needed.

14. • 9. Apply protective ointment to perianal area
• 10. Administer medicines as prescribed by
physician.
• 11. Instruct patient to avoid food high in fibre,
milk products and caffeine

15. Nursing Diagnosis with Acute Infection
Diarrhea
• 1. Diarrhea related to acute infection-
frequency loose, liquid stools.
• 2. Deficient fluid volume related to excessive
fluid loss and decrease intake.

16. Nursing Goals
• 1. To resume normal bowel pattern.
• 2. To maintain fluid and electrolyte balance.

17. Nursing Interventions
• 1. Collect stool for culture and continue
appropriate to treatment.
• 2. Nil per oral, liquid diet as per instruction.
• 3. Record intake and output- the pattern of
stool and urine.
• 4. Observe for dehydration.
• 5. Monitor vital signs.
• 6. Monitor weight and height
• 7. Encourage oral fluids.
• 8. Maintain a steady I/V effusion flow rate.

18. Patient Education and Health
Maintenance
• 1. Teach patient that stomach flu can be prevented with
good hand washing.
• 2. Avoid drinks that contain caffeine and milk.
• 3. Advice patient to drink plenty of fluids, including water,
juices and soups and eating fruits to prevent dehydration.
• 4. Avoid certain foods, such as high fibre foods or highly
seasoned foods for few days.
• 5. Instruct patient to take medicines as ordered by
physician

19. • 6. Instruct patient and family to contact health care
provider, if they notice the following:
• a. Bloody or black stools.
• b. Severe abdominal pain.
• c. Severe diarrhea that lasts more than 2 days.
• d. Yellowish color to skin or whites of patient's

20. Evaluation: Expected Outcomes
• 1. Normal bowel pattern is resumed.
• 2. Fluid and electrolyte balance is maintained.