Diarrhea is a common symptom of many gastrointestinal tract diseases and can be caused by viral, bacterial, fungal, or parasitic infections. It is a common medical condition in the world today. It’s estimated that approximately one billion people are affected by diarrhea each year, and over 100,000 die from the complications of dehydration.
The condition may take different forms depending on the patient’s age, diet, environment, and other factors. This blog post will help you understand what diarrhea is and diagnose and care for patients with this disease. It includes resources for nurses as well as examples of nursing interventions when caring for these patients.
This post aims to inform nursing students about the different causes and treatments for diarrhea so that they have a better understanding of how to prevent future occurrences.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Diarrhea?
Diarrhea is a condition caused by increased intestinal motility or movement of the large intestine. The primary symptom of diarrhea is loose, watery/ liquid stools (a bowel movement). It is not uncommon to have some blood in your stool when you have diarrhea. Diarrhea can cause problems if it lasts for more than two days because of the loss of fluids.
There are three types of this disorder: acute watery diarrhea (AWD), chronic non-bloody diarrhea (CND), and bloody diarrhea (BD). AWD episodes may last from one day up to two weeks with symptoms lasting less than 24 hours; CND typically lasts longer than six months with intermittent symptoms; BD episodes usually last from 12-24 hours but could persist for several days.
There are many causes of diarrhea. They include infections, viruses, bacteria, and parasites. In addition to these causes, other factors can cause diarrhea, such as medication reactions or drug overdose, certain dietary products, allergies (i.e., protein intolerance), food poisoning, and other medical conditions (i.e., irritable bowel syndrome).
A viral or bacterial infection can be treated with antibiotics. Other common causes include cancer, lactose intolerance, celiac disease, small intestine bacterial overgrowth (SIBO).
The signs and symptoms of diarrhea are usually clear
- Frequent or urgent need to pass stool.
- Loose, watery stools that contain blood or mucus.
- Abdominal cramps and pain,
- Hyperactive bowel sounds
- Nausea and vomiting,
In severe cases of diarrhea, you may also experience chills, a high fever, and excessive sweating.
Pregnant women are at higher risk for developing this symptom in their second trimester due to hormonal changes during pregnancy, causing increased sensitivity to certain foods such as dairy products which may trigger diarrhea because they contain lactose or milk sugar, which when ingested, cannot always be properly digested by the human.
Acute diarrhea is uncomfortable but rarely dangerous in healthy adults and children. However, diarrheal stools may contain viruses and bacteria that spread infections. For example, the bacterium Escherichia coli causes about 9% of all foodborne infections in the United States. If there is severe diarrhea with vomiting, dehydration can occur. This occurs when there is excessive water loss from your body due to diarrhea and/or vomiting. Severe dehydration (also known as hypovolemic shock) may be life-threatening.
- Avoid eating contaminated food- If food poisoning is suspected to be a cause of your diarrhea, contact a local health department or call your doctor for instructions.
- Maintain hygiene -Keep hands clean by washing with soap and warm water for 20 seconds.
Follow these steps to prevent dehydration:
1. Drink plenty of water and other liquids. Water is important because your body loses water when you have diarrhea. Fluids that contain electrolytes (e.g., Pedialyte, a commercial product for children with diarrhea) are also helpful.
2. Avoid coffee and tea while you have diarrhea because they may worsen the problem by irritating the bowel wall, causing pain and inflammation, and increasing fluid loss.
Many nursing diagnoses could apply to someone experiencing diarrhea, such as;
- Imbalanced nutrition: less than body requirements
- Nutritional deficiency
- Decreased fluid volume
- Acute pain
- Anxiety-related to health status or prognosis of the condition
- Diarrhea X 10 days in the past year with at least three of the following: fluid loss >500 ml/day, cramping/abdominal pain, nausea, fever (>38°C), and unintentional weight loss >5%. Type: chronic or acute (i.e., watery, bloody, or inflammatory)
- Chronic diarrhea: symptoms have been present for >8 weeks. Specify type: (e.g., Crohn’s disease, ulcerative colitis, irritable bowel syndrome)
- Acute diarrhea: symptoms <8 weeks or no time frame given. Specify type: (e.g., infectious, foodborne, parasitic)
- Nonspecific diarrhea: symptom complex that does not meet the criteria for any of the above types.
- Other: (e.g., pregnancy, lactation, age <5 years or >85 years, specific medical cause such as cancer, coronary artery disease, or intestinal surgery). Specify the type of acute diarrhea: infectious (e.g., viral), foodborne (i.e., bacterial), or parasitic
- Inadequate fluid intake. Specify type: oral, enteral, intravenous, or maintenance. /define hydration failure as actual body weight loss >5% in the past 2 weeks.
A registered nurse should prepare a nursing care plan for diarrhea. The care plans include administering medication as prescribed and monitoring the patient’s hydration status by checking weight, urine output, skin turgor, and mucous membranes. Nursing care also involves monitoring the frequency and consistency of stools.
You may need to supplement the patient’s diet with extra fluids or try a BRAT diet (bananas, rice, applesauce, and toast). The patient should also avoid eating foods high in sugar, such as fruit juices or sugary sodas, until they feel better because it will worsen diarrhea.
The patient should instead drink clear liquids like water or broth to keep them from becoming dehydrated. Dehydration could lead to serious health issues, including heart failure, if not treated early enough. Keeping the patient hydrated will also maintain a good skin turgor.
Preventive measures to help patients avoid diarrhea are good eating habits and sufficient fluid intake. Meals should include fruits, whole grains, and lots of vegetables with additions of lean meat, poultry, or fish. This diet should also be supplemented with additional vitamins and minerals. A good fluid intake is necessary for the digestive system to work effectively. Eight glasses of water a day is recommended, along with 4-8 ounces of fruit juice each day and a sufficient amount of milk, tea, or coffee in moderation.
The patient may also be given meds to replace electrolytes that they lost. These meds can help prevent dehydration and shock, which are two common complications of diarrhea. The meds will also relax the bowel muscles so they can rest and heal. They may also be given pain relievers like Tylenol for the cramping that they experience with diarrhea.
- Nursing interventions for diarrhea may include fluid replacement therapy with oral rehydration solutions to counteract dehydration;
- Dietary modifications that provide more fluids and fibre to help ease constipation; using medication when necessary to treat bacterial infections or inflammation of the bowel or colon (enteritis);
- Decreasing intake of fatty foods that are difficult to digest, slowing down intestinal motility, and giving time for intestinal healing.
- The nurse should check for dehydration by checking the weight, urine output, and skin turgor of a patient. A weight loss of 5% is considered to be a major dehydration indicator. The skin turgor test helps you determine whether or not the patient is dehydrated because it will show if they do indeed have adequate fluid and electrolyte content in their cells by snapping back into place within 2-3 seconds when gently pressed with a finger. If the skin stays indented for 4-5 seconds or longer, this is a sign of dehydration.
Complications of diarrhea may include:
Dehydration: If you don’t drink enough fluids to replace what you lose each day, become dehydrated. Your heart has to work harder to pump blood to your body and circulate blood through the vessels in your arms and legs. Also, your brain doesn’t receive enough blood, so it doesn’t work as well. Severe dehydration can put you into shock and may cause death.
Electrolyte imbalances: Your body needs a balance of sodium (salt), potassium, calcium, magnesium, and phosphorus to work properly. Diarrhea can affect the levels of these minerals in your blood. An imbalance of electrolytes may affect how well your heart, nerves, and muscles work.
Watery stools can cause excessive or prolonged loss of thiamine [vitamin B1]. Thiamine deficiency may be especially common among alcohol abusers, the elderly, and those with malabsorption syndromes.
Diarrhea in children is one of the most important causes of malnutrition in developing countries. It reduces the absorption of water and nutrients from food and leads to wasting (unintentional weight loss). Diarrhea may also reduce the absorption of water and electrolytes from oral rehydration solutions.
Watery stools result in increased stool frequency, which may lead to an infection (colitis). The extra work required to eliminate diarrhea-caused toxins and fluid loss increase heart rate, blood pressure, breathing rate, and oxygen consumption. Therefore, people with severe acute diarrhea may experience dyspnea (difficulty breathing) and fatigue.
Treatment Options include;
Medications: Some medications may be prescribed to reduce fever, facilitate bowel movements, treat nausea and vomiting, and decrease abdominal pain associated with diarrhea.
Oral Rehydration: Oral rehydration therapy may be recommended. This procedure uses fluid and electrolyte solutions to replace fluids and minerals lost as a result of diarrhea.
Rest: Diarrhea can cause severe fatigue, so it’s important to rest if you are not feeling well.
Increase fluid intake– Drink LOTS of water or clear liquids, such as broth, to prevent dehydration. – Avoid greasy and fatty foods. These are hard for your body to digest and may cause more diarrhea.
Don’t use antacids until you check with your health care provider about the amount of phosphate in them. Phosphate can worsen diarrhea by binding with the water in your body. If you take antacids, ask about phosphate-free varieties.
Prevention: Other steps to help prevent dehydration caused by diarrhea include eating foods that are easy to digest and avoiding fatty, spicy, or greasy foods.
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Diarrhea is a common condition that causes frequent and loose bowel movements. It’s usually caused by viruses or bacteria, but it can also be triggered by food allergies, medications, and other health problems. Severe diarrhea can lead to dehydration, which is a serious condition that may require medical treatment.