1. Diarrhea is caused by infections that imbalance the intestines' fluid and electrolyte processes, commonly from rotavirus in children. It can lead to dehydration, malnutrition, and death. 2. Nursing management of diarrhea involves monitoring for complications, maintaining hydration through oral rehydration and continued feeding, and treating any underlying infections. 3. Treatment plans include oral rehydration with zinc at home, or intravenous rehydration in clinic for severe cases along with continued feeding and antibiotics if needed.

1. MUHIMBILI UNIVERSITY
HEALTH AND ALLIED
SCIENCE
SCHOOL OF NURSING
PAEDETRIC NURSING
PRESENTATION: DIARRHEA
DWASI MASUNGA(2009-04-01524)

2. INTRODUCTION
DEFINATION OF DIARRHOEA
DIARRHOEA Is the passage of unusually
loose or watery stools ,usually at least
three times in 24hours period .
Frequent passing of formed stools is not
diarrhea ,nor is the passing of
loose, pasty stools by breastfed babies

3. cont
• Diarrhoea is usually a symptom of an infection
in the intestinal infection which is caused by
variety of bacteria,viral,parasitic organism.
Infection is spread through contaminated food
or drinking –water or from person –to- person
as a result of a result of poor hygiene
• Diarrhoea disease is a leading cause of child
mortality and morbidity .Diarrhoea disease kills
1.5 million children every year . Globally, there
are 2million cases disease every year. Diarrhoea
is leading cause of malnutrition in children
under five year five years old

4. • Loss of fluid and electrolytes via stools
is net result of imbalance between
secretory and absorptive processes in
small & large intestine. Electrolytes
have a critical role in the regulation of
water absorption and secretion across
the intestine

5. CLINICAL TYPES OF
DIARRHOEAL DISEASES
 Four clinical types of diarrhoea can be recognize each
reflecting the basic underlying pathology and altered
pathology
 ACUTE WATERY DIARRHOEA(Including cholera) :which
lasts several hours or day : the main danger is
dehydration and malnutrion if feeding is not continued.
 COMMON CAUSES ARE:
-Rotavirus,
-Enterotoxigenic E.coli (ETEC),
-Shigella,
-Salmonella,
-Vibrio cholerae

6. BLOOD DIARRHOEA
 BLOOD DIARRHOEA which is called
Dysentery, the main dangers are
damage of intestinal mucosa,sepsi, and
malnutrion. Other complication including
dehydration may also occur
MAIN CAUSE OF ACUTE DYSENTERY
– SHIGELLA, CAMPLYLOBACTER
JEJUNI, Enteroinvasive E.coli
(EIEC), SALMONELLA

7. cont
 PERSISTENT DIARRHOEA: last for 14
days or longer ,the main danger is
malnutrion and serious non-intestinal
infections, dehydration may also occur
 DIRRHOEA AND SEVERE
MANUTRITION(marasmus and
kwashiorkor) : The main danger are severe
systemic infection ,dehydration, heart
failure, vitamin and mineral deficiency

8. CONT
• NOTE: most common cause of diarrhea
in children is ROTA virus(70%),the
remaining is bacteria
e.g:E.coli,Salmonella,Shigella

9. Nursing diagnosis
• Fluid volume deficit related to active
loss from gastro intestinal tract
• Altered nutrition less than body
requirement related to poor assimilation
of nutrition's
• Family anxiety related to changes in
child health status
• Acute pain related to
hiperperistaltik, irritation perirektal
fissure

10. Management diarrhoea
Management of diarrhoea in children.
Over 90% of deaths from diarrhoea in under-
fives would be prevented by:
• Continuing breast feeding and other feeding
throughout the attack of diarrhoea
(prevent malnutrition);
• Making sure mothers know when to take the
child to a health facility;
• Correct assessment, treatment and continued
feeding at the health facility level

11. cont
• Treatment of invasive diarrhoea (bloody stool)
with antibiotics;
• Treating or prevent dehydration and electrolyte
imbalance with ORS ( New osmolarity
ORS)
• Reduce the duration and severity of diarrhoea
and occurrence of future episodes by
giving supplemental Zinc
• investigation and treatment for severe
malnutrition and
persistent diarrhoea (lasting>14 days

12. Nursing management
• Observation of complication by checking vital
signs, behavior and consciousness
• Monitor fluid input and fluid out to know body
fluid balance
• Weighing the child on admission.
• Isolation
• Maintain hydration by:-
a-Increase oral feeding. b-giving fluid. c-check
intake and out put.

13. CONT
• Assess progress of hydration (weighing
the child daily).
• The nurse is responsible for collecting
stool sample for laboratory examination.
NOTE: avoid rectal thermometer
because it stimulate the bowel.

14. Medical treatment
Zinc
The use of Zinc during diarrhoea has been
shown to reduce frequency, stool volume
and recurrence of diarrhoea episode. All
children with diarrhoea should be
given Zinc, 10-20mg every day for
10-14 days. Zinc treatment should be
continued even after diarrhoea has
stopped

15. cont
• Low osmolarity ORS (245mmol/lt) has
been observed to be more effective
than the Standard ORS in especially
preventing dehydration

16. Low osmolarity ORS
(245mmol/lt)
• Sodium choride 2.6
• Sodium 75
• Trisodium citrate
• dihydrate2.9
• Citrate 10
• Potassium chloride 1.5 Potassium 20
• Glucose, anhydrous 13.5
Glucose, unhydrous 75
• Chloride 65

17. cont
• Use antimicrobial effective for Shigela.
At the moment it is Co-
trimoxazole, Ciprofloxacin

18. Treatment plans A, B and C
• Plan A: Treat Diarrhoea at Home
• Counsel the mother on the 3 Rules of Home
Treatment..
• Give Extra Fluid, Continue Feeding
(including Breast feeding), When to Return
• 1. GIVE EXTRA FLUID (As much as the
child will take)
• TELL THE MOTHER:
• Breastfeed frequently and longer.

19. cont
• If the child is exclusively breastfed give
ORS or clean water in addition to breast
• milk.
• If the child is not exclusively breastfed
give one or more of the following: ORS
• solution, food-based fl uids (such as soup.
plain porridge, .fresh fruit juice, green
• coconut juice and yoghurt drinks), or clean
water

20. cont
• 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 FLUI
D TO GIVE IN ADDITION TO
• THE USUAL FUID INTAKE:
• Up to 2 years 50 to 100 ml after each
loose stool
• 2 years or more 100 to 200 ml after each
loose stool

21. PLAN B
• Give in clinic recommended amount of
ORS over 4-hour period
• For infants under 6 months who are not
breastfed, also give 100-200 ml clean
water during this period
• Give Zinc, 10-20mg every day for 10-14
days. Zinc treatment should be continued
even after the diarrhoea has stopped

22. Plan C:
Treat severe dehydration quickly
• Start with IV fluid immediately. If the
child can drink, give ORS by mouth while
the drip is set up. Give 100 ml/kg
Ringer’s Lactate Solution (or, if not
available, normal saline
• Infants (under 12 months) First give30
ml/kg in hour Then give 70 ml/kg in: 5
hours

23. REFERENCE
• Hockenberry M.J,Wilson D. Winkelstein
M. L, Kline N.E. nursing care of infant
and children
• Standard treatment guideline and then
national medicine list for mainland
Tanzania