This document provides an overview of diarrhea including its definition, incidence, types, causes, signs and symptoms, diagnosis, prevention, treatment, nursing management, and complications. It notes that diarrhea is a leading cause of death in children under five in Nepal. The document discusses acute vs chronic diarrhea and predisposing factors. Signs of dehydration and its classification and management according to WHO plans A, B, and C are outlined. Nursing interventions for diarrhea and associated dehydration are also summarized.

1. Presented by:-
Sushmita Bajagain

4. Content
Diarrhea
 Definition, Incidence
 Type , Causes
 Predisposing factors, Pathophysiology
 Sign and symptom, Diagnosis ,Prevention
 Treatment , Nursing management
 Complication

5. Content
 Dehydration
 Definition , Causes
 Sign and symptoms
 Classification
 Treatment
 Nursing management

6. Diarrhea
DEFINITION
 Diarrhea is defined as the passage of loose liquid or
watery stool more than 3times in 24 hours. There is
change in amount of stool >200gram per day.

7. INCIDENCE
 According to international journal of environmental
research and public health article (diarrhea in under
five year old children in Nepal) published on 23 march
2020 .

8. Incidence
The mortality rate of children under five years old was
still high
 Nepal (i.e., 32 deaths per 1000 live births in 2018),
 the United States of America (i.e., 6 deaths per 1000
live births in 2018).

9. Incidence
 Diarrhoea remains the leading cause of morbidity and
mortality of children under five years old.
 According to the WHO, there were 1193 deaths under
five caused by diarrhoea in Nepal in 2017.
Source ( file:///C:/Users/HP/Downloads/ijerph-17-
02140-v2.pdf )

10. Types

11. TYPES OF DIARRHEA
1). Acute Diarrhea:
 An attack of sudden onset which usually lasts 3-7 days
and may last up to 10-14 days.
 Acute diarrhea is defined as a sudden increase in
frequency and a change in consistency of stools, often
caused by an infectious agent in the GI tract.

12. Types of diarrhea
2). Chronic Diarrhea:
 It is defined as an increase in stool frequency and
increased water content with duration of more than
fourteen days.
 It is often caused by chronic conditions such as
malabsorption syndrome, inflammatory bowel
disease, lactose intolerance, etc.

13. Causes

14. PREDISPOSING FACTOR
Factors responsible to increase the risk of diarrhea in
children;
1. Poor environmental sanitation such as unsafe
drinking water, unsafe excreta disposal, unhygienic
environment, etc.
2. Solid foods introduced too early
3. Unhygienic food

15. Predisposing factor…
4. Age: more common in child between 6months to
2years,it is also common among child below
6months with formula feeding.
5. Season (more common in pre-monsoon and
monsoon.
6. Worm infestation.
7. Low immunity.

16. Pathophysiology

17. Clinical features
 Frequent Loose stool
 Thirsty , Abnormalities of the pulse

19. Diagnosis
 Physical assessment
 Blood examination can
be performed to detect
electrolyte imbalance,
acid- base disturbances,
TC, DC,ESR etc

20. Prevention of diarrhea
 Exclusive breast feeding for the first 6 months of life
and timely weaning.
 Giving freshly prepared foods and clean safe drinking
water to child.
 Follow proper hand washing technique and teach child
accordingly.
 Proper disposal of human excreta and use of toilet.

21. Principle of diarrhea management
 Assessment of the children’s condition.
 Identify the level of dehydration
 Correction of dehydration
 Proper nutritional care

22. Principle of diarrhea management
 Treatment of underlying causes and associated
problems
 Treatment of complications
 Prevention of diarrhea.

23. Nursing management for diarrhea
 Assess the complete health history to identify the
character and pattern of diarrhea.
 Perform a complete physical assessment.
 Inspect mucous membrane and skin

24. Nursing management..
 Restoring fluid and electrolyte balance by ORS and IV
therapy.
 Encourage rest, liquids and foods low in bulk until
acute period subsides.
 Administer anti diarrheal drugs as prescribed.

25. Complication of diarrhea
 Dehydration
 Electrolyte imbalance
 Kidney failure

26. DEHYDRATION
Definition:
 Loss of abnormal amount of water and salts from the
body is called dehydration. It occurs when the output
of water and salt is greater than the input in the body.

27. Causes of dehydration:
 Decreased water or fluid intake.
 Diarrhea
 Vomiting
 Excessive heat
 Excessive sweating
 Fever
 Excessive urination

29. Sign and Symptom of dehydration
 Restless, irritable, lethargic or unconsciousness.
 Tears absent.
 Dry mouth with coated tongue.
 Thirsty, drinks poorly or not able to drink.

30. Sign and symptom
 Uncoated tongue

31. Classification of dehydration
Parameter No dehydration Some dehydration Severe
dehydration
Fluid loss Less than 5% of
total body weight
7-10% of total body
weight
More than 10% of
total body weight
Appearance Well, alert Restless , irritable Lethargic or
unconscious, floppy
Eyes Normal Sunken Very sunken
Thirst Drinks normally,
not thirsty
Thirsty, drinks
eagerly
Drinks poorly or
not able to drink
Skin pinch Goes back quickly Goes back slowly Goes back very
slowly

33. Refreshment

34. Refreshment

35. Management
 Treatment plan for dehydration according to CB-
IMNCI guideline.
 No dehydration : Plan A
 Some dehydration: Plan B
 Severe dehydration: Plan C

36. No signs of dehydration (Plan A):
 Such children may be treated at home after
explanation of feeding and the danger signs to the
mother/ caregiver.
 Danger signs requiring medical attention are those of
continuing diarrhoea beyond 3 days, increased
volume/ frequency of stools, repeated vomiting,
increasing thirst, refusal to feed, fever or blood in
stools.

37. Plan A continue
 Counsel the mother on the four rules of home
treatment:
1. Give Extra Fluids,
2. Give Zinc Supplements,
3. Continue Feeding,
4. When to Return

38. Give extra fluids
 Tell the mother:
 To breastfeed frequently and for longer at each feed.
 If the child is exclusively breastfed, give ORS in
addition to breast-milk.
 If the child is not exclusively breastfed, give one or
more of the following: ORS solution, food-based fluids
(such as soup), or clean water.

39. Give extra fluids continue..
 Teach the mother how to mix and give ORS.
 Give the mother 2 packets of ORS to use at home.
 Show the mother how much fluid to give in addition
to the usual fluid intake

40. Give extra fluid
Age Amount of
ORS per stool
Amount of
ORS per day
Up to 2 years 50-100ml 500ml/day
Up to 10 years 100-200ml 1000ml/day
More than 10
years
As much as
child want
2000ml/day

41. Give extra fluids
2. Tell the mother to:
Give frequent small sips from a cup.
If the child vomits, wait 10 minutes. Then continue,
but more slowly.

42. Give extra fluid
3. Continue giving extra fluid until the diarrhea stops.
4. Follow up: If the child doesn't get better in 3 days or
develops any of the following; many stools, more
vomiting, marked thirst, fever and blood in stool.

43. Give zinc supplements:
●Tell the mother how much zinc to give:
Up to 6 months 10mg/ 1/2 tablet for 10 days
6 months or more 20mg/1 tablet for 10 days
● Show the mother how to give Zinc supplements
– Infants=dissolve tablet in a small amount of expressed
breast-milk, ORS or clean water in a cup;

44. Give zinc supplements
 – Older children= tablets can be chewed or dissolved
in a small amount of clean water in a cup.
 - If the child vomits after half an hour of tablet
administered, re-administer the tablet.

45. Some dehydration (Plan B):
 Treat with oral rehydration
 Give recommended amount of ORS over 4-hour period
 Determine amount of ORS to give during first 4 hours

46. Plan B
Age <4mo
nths
4-11
month
s
12-
23mon
ths
2-4
years
Weight <5kg 5-8kg 8-11kg 11-
16kg
ORS,
ml
200-
400
400-
600
600-
800
800-
1200
Numbe
r of
glasses
1-2 2-3 3-4 4-6

47. Plan B
 For infants less than 6 months who are not breastfed,
also give 100–200 ml clean water during this period.
 Show the mother how to give ORS solution.
 After 4 hours reassess the general condition of
baby.

48. Plan B
IF THE MOTHER MUST LEAVE BEFORE
COMPLETING TREATMENT:
● Show her how to prepare ORS solution at home.
● Show her how much ORS to give to finish 4-hour
treatment at home.
● Give her enough ORS packets to complete rehydration.
Also give her a box of 10 packets of ORS as
recommended in Plan A.

49. Plan B continue..
 Explain the 4 Rules of Home Treatment; these are:
 Give extra fluids
 Give zinc supplementation
 Continue feeding
 When to return

50. Plan C: Treat Severe Dehydration
 Start IV fluid immediately.
 If the child can drink, give ORS by mouth while the
drip is setup.
 Give 100ml/kg Ringer's lactate Solution (or if normal
saline), divide as follows:

51. Plan C
Age First give 30
ml/kg in:
Then give 70ml
/kg in:
<12 months 1 hours 5 hrs
>12 months to
<60 months
30 min 2 hr and 30 min

52. Plan C
 Reassess the child every 1-2 hourly.
 Give ORS (about 5 ml/kg/hrs as soon the child can
drink)
 If IV line is not available, start rehydration by tube or
mouth with ORS solution 120 ml/kg for 6 hr.
 Reassess the child every 1-2 hrs: if there is repeated
vomiting or increasing abdominal distension, .

53. Management of dehydration
 Reassess the child, classify dehydration and choose the
appropriate plan (A, Band C) to continue treatment.
 Besides rehydration therapy, antimicrobial therapy
may also be needed for treatment of associated
consequences such as dysentery, persistent diarrhoea,
etc.

54. Management continue
 Advise mother to continue breastfeeding.
 Follow up in 5 days.
 In case of dysentery, treat with oral antibiotic for 5days
and ask for follow up in 2 days.

55. Nursing Management
Assessment :
 Assess the general condition of the child.
 Assess the eyes, mouth and respiratory rate.
 Monitor urine output, thirst, diarrhea and vomiting.

56. Nursing Diagnosis
 Risk for ineffective tissue perfusion related to
decreased blood flow.
 Risk for impaired skin integrity related to decreased
skin turgor.
 Activity intolerance related to physical weakness.

57. Intervention
Risk for ineffective tissue perfusion
 Assess change in the level of consciousness
 Assess , the skin against the cold , pale , sweating
 Record output and urine specific gravity
 Change positions frequently
 Give IV fluids as indicated

58. Intervention
Risk for impaired skin integrity related to
decreased skin turgor
 Use skin cream
 Discuss the importance of changes in position it is
necessary to maintain the activity
 Emphasize the importance of nutrient input/adequate
fluid.

59. Intervention
Activity intolerance related to physical weakness
 Assess the patient’s nutritional status
 Observe and monitor the patient’s sleep pattern and
the amount of sleep achieved over the past few days

60. Intervention
 Determine the patient’s daily routine .
 Assess the need for ambulation aids for ADLS
 Observe and document response to activity

62. References of diarrhea
 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
 file:///C:/Users/HP/Downloads/ijerph-17-02140-v2.pdf
 http://dohs.gov.np/wp-content/uploads/2020/11/DoHS-Annual-
Report-FY-075-76-.pdf