2. DIARRHEA
• Increased in daily stool weight more than
200gm.
• Typically the patient may also describe an
increase in stool liquidity and frequency of
more than 3 times per day.
• Even one episode of liquid / semi formed
stool it is considered as diarrhea.
3. Mechanism of diarrhea
•Osmotic diarrhea : due to poorly absorbable osmotically
active solutes in the gut lumen.
•Secretory diarrhea : secretion of cl and water with or
without inhibition of normal active sodium and water
absorption.
•Inflammation : exudation of mucus, blood and protein into
bowel lumen.
•Abnormal intestinal motility : increased or decreased
contact between luminal contents and mucosal surface.
5. SN. FEATURES Large Bowel diarrhea
1 Volume of stool Small
2 Color of stool Dark
3 Smell of stool Foul
4 Nature of stool Mucinous / jelly like
5 Type of stool Mucoid
6 Blood in stool Common
7 WBCs in stool Common
8 PresentTenesmus
6. Patient complains:
•If child:
1. The child may have low grade fever, thirst, anorexia.
2. Behavioral changes like irritability, restlessness, weakness,
lethargy, sleepiness, delirium, stupor
3. Physical changes like loss of weight, poor skin turgor, dry
mucus membranes, dry lips, pallor, sunken eyes, depressed
fontanelles are also found.
7. Cont..
• Vital signs are changed as low blood pressure, tachycardia,
rapid respiration, cold limbs and collapse.
• Decreased or absent urinary output.
• Convulsions and loss of consciousness may also present in some
children with diarrheal diseases.
8. INVESTIGATION
1. Examination of the stool
• Presence& absence of WBC
• Occult or gross blood in the stool
• Bacteria and parasitic organisms in the stool
2. Sigmoidoscopy or colonoscopy
3. Electrolytes abnormalities
9. Examination
• Assessment of the degree of dehydration by
skin turgor , pulse , and BP measurement.
• Monitor urine output and ongoing stool
losses.
11. TREATMENT
Elimination of the cause
IV fluids and electrolytes
Medications(antidiarrheal
agents-Lomotil, Imodium,
Kaolin, Aluminum
hydroxide)
12. Rehydration therapy
The management of diarrhea is a vast majority of
children is best done with ORS solution and continued
feeding.
• ORT means drinking of solution of clean water, sugar and
mineral salt to replace the water and salt lost from the body
during diarrhea, especially when accompanied by vomitting,
i.e gastroenteritis.
13. Criteria for giving ORT
• The appropriate amount of ORS solution to be given in the first
4 hours are as follows:
Age less than 4 months or weight less than 5 kg- 200 to 400ml.
Age 4 to 11months or weight 5 to 7.9 kg – 400 to 600 ml.
Age 12 to 23 months or weight 8 to 10.9 kg – 600 to 800ml.
Age 2 to 4 years or weight 11 to 15.9 kg – 800 to 1200ml.
Age 5 to 14 years or weight 16 to 29.9 kg – 1200 to 2200 ml.
Age 15years or older or weight 30kg or more to 2200 to
4000ml.
14. • During ORS therapy ,if child is having puffy eyelids, then ORS
should be stopped and plain water and breastfeeding to be
given
1. REHYDRATION:
Sodium chloride 3.5g.
Potassium chloride 1.5g.
Tri sodium citrate 2.9g.
glucose anhydrous 20.0g.
16. Nursing diagnosis
• Fluid volume deficit related to diarrhea.
• Risk for cross-infection related to infective loose motion.
• Potential to altered skin integrity related to frequent passage of
stools.
• Altered nutritional status, less than body requirement related to
malabsorption and poor oral intake.
• Fear and anxiety related to illness and hospital procedures.
• Knowledge deficit related to causes of diarrhea and its
prevention.
17. NURSING CONSIDERATIONS
Assess client’s fluid I&O and weight.
Monitor for s/s of electrolyte disturbances and electrolyte
levels
Record exact time, amount and character of each stool.
Restrict client’s diet to clear liquids.
Reintroduce food and fluids slowly to observe for improvement
or worsening.
Client teaching that includes prevention of food contamination
with S. aureus and Salmonella.
26. PHARMACOLOGICAL MANAGEMENT OF
CONSTIPATION
Laxatives:
• promote a soft stool(eg: cellulose compound, saline products,
castor oil& dulcolax)
Cathartics
• Results in a soft to watery stool with some cramping
Purgative:
• is a harsh cathartic causing a watery stool with abdominal
cramping
27. Therapeutic Uses of enema
• Enemas can be used to provide a form of mechanical
stimulation
• useful only for stool in the rectum, not in the intestinal
tract.
• cleansing the colon in preparation with saline or soap
water enema
• Eg: proctoclysis enema
28. PRECAUTION
•Constipation with N/V may indicate appendicitis and
using laxatives could cause rupture
•Constipation in pt after surgery
•Rectal bleeding and sudden change in bowel habits may
indicate rectal cancer
29. NURSING CONSIDERATIONS
Warn client not to strain while defecating.
Client should quit worrying
Lots of fluids – drink prune juice
Increase dietary bulk(whole grains& green leafy vegetables)
Exercise
Regular schedule for defecation
