NURSING CARE PLAN

ASSESSMENT

Subjective: “Madalas akong dumumi ngayon kaysa kahapon” as verbalized by patient.

Objective:

 Increased peristalsis.
 Frequent watery stools.
 Abdominal pain.
 V/S taken as follows: T: 36.6 P: 80 R: 18 Bp: 110/90

Nursing Diagnosis: Diarrhea related to presence of toxins.

Inference:

Diarrhea is the passage of loose and watery stools (more than 3 bowel movements per day) often associated with gassiness, bloating, and
abdominal pain. It may also be accompanied by nausea, vomiting, and fever. Diarrhea results to loss of body fluids and salts leading to dehydration
of varying severity. Severe dehydration may cause death especially in children

Nursing Objectives: After 4 hours of nursing interventions, the patient will report reduction in frequency of stools.

Nursing Interventions:

Independent:

 Observe and record stool frequency, characteristics, amount and precipitating factors.
Helps differentiate individual disease and assesses severity of episode.
 Promote bed rest. Rest decreases intestinal motility and reduces metabolic rate.
 Provide bedside commode. Urge to defecate may occur without warning and uncontrollable, increasing risk of incontinence or falls if
facilities are not close at hand.
 Identify foods and fluids that precipitate diarrhea. Avoiding intestinal irritants promotes intestinal rest.
• Restart oral fluid intake gradually. Offer clear liquids hourly, and avoid cold fluids. Provides colon rest by omitting or decreasing stimulus
of foods or fluids. Gradual consumption of liquids may prevent cramping and recurrence of diarrhea. Cold fluids can increase intestinal
motility.

 Helps differentiate individual disease and assesses severity of episode.

 Encourage to eat foods like banana and apple. Fruits that are stool former.
 Avoid foods that are oily, spicy and caffeine. Foods that may precipitate gastric cramping.

Collaborative:

•Administer anti-diarrheals as prescribed by the physician. Decreases G.I motility or peristalsis and diminishes digestive secretions to relieve
cramping and diarrhea.

Evaluation: After 4 hours of nursing interventions, the patient was able to report reduction in frequency of stools.

NURSING CARE PLAN

ASSESSMENT
SUBJECTIVE:
“Sumasakit ang tiyan ko at madalas akong dumumi” (I have been having severe diarrhea and abdominal pain) as verbalized by the patient.

OBJECTIVE:
¨ Restlessness
¨ Irritability
¨ Facial grimace
¨ Dry skin
¨ V/S taken as follows:
T: 37.4
P: 79
R: 19
BP: 110/70
DIAGNOSIS
¨ Risk for deficient fluid volume related to excessive losses through frequent diarrhea.
INFERENCE
¨ Amoebiasis is ainfectious disease caused by the parasite Entamoeba histolytica. It is a parasitic infection of the large intestine and characterized
by non specific diarrhea with loose, semi formed, foul smelling stools, or dysentery with mucous, traces of blood and small quantities of stools
passed repeatedly. Often there is an ineffectual urge to defecate again and again, with very little stool actually being passed. There is much
flatulence with abdominal cramps. In severe cases ,the liver and other organs may get affected, causing specific conditions related to organ, e.g.,
hepatitis, cysts, abscess, etc. The most common symptoms of amoebiasis are diarrhea (which may contain blood), stomach cramps and fever.

PLANNING
After 8 hours of nursing interventions, the patient will maintain adequate fluid volume as evidenced by good skin turgor and balance intake and
output.

INTERVENTION/ RATIONALE
INDEPENDENT:
 Monitor intake and output, character, and amount of stools; estimate insensible fluid losses. Measure urine specific gravity and observe
for oliguria. Provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid
replacement.

 Assess vital signs (BP, pulse, temperature). Hypotension (including postural), tachycardia, fever can indicate response to or effect of fluid
loss.

 Observe for excessively dry skin and mucous membranes, decreased skin turgor, slowed capillary refill. Indicates excessive fluid loss or
resultant of dehydration.

 Weigh daily. Indicator of overall fluid and nutritional status.

 Maintain oral restrictions, bed rest and avoidance of exertion. Colon is placed at rest for healing and to decrease intestinal fluid losses.

 Observe for overt bleeding and test stool daily for occult blood. Inadequate diet and decreased absorption may lead to vitamin K
deficiency and defects in coagulation, potentiating risk for hemorrhage.

 Note generalized muscle weakness or cardiac dysrhythmias. Excessive intestinal loss may lead to electrolyte imbalance.

 COLLABORATIVE:
 Administer parenteral fluids as indicated. Maintenance of bowel rest requires alternative fluid replacement to correct losses.

 Administer medications as indicated: Antidiarrheal and antibiotics. To reduces fluid losses in the intestine and to prevent further spread
of the bacteria.

EVALUATION
After 8 hours of nursing interventions, the patient was able to maintain adequate fluid volume as evidenced by good skin turgor and balance intake
and output.

Prevention for gastroenteritis:

 General suggestions on how to reduce the risk of gastroenteritis include:

 Wash hands thoroughly with soap and water after going to the toilet or changing nappies, after smoking,after using a handkerchief or
tissue, or after handling animals.
 Wash your hands thoroughly with soap and water before preparing food or eating.
 Use disposable paper towels to dry your hands rather than cloth towels, since the bacteria can survive for some time on objects.
 Keep cold food cold (below 5°C) and hot foot hot (above 60°C) to discourage the growth of bacteria.
 Make sure foods are thoroughly cooked.
 Clean the toilet and bathroom regularly, especially the toilet seat, door handles and taps.
 Clean baby change tables regularly.
 When travelling overseas to countries where sanitation is suspect, only drink bottled water. Don't forget to brush your teeth in bottled
water too. Avoid food buffets, uncooked foods or peeled fruits and vegetables

Diet for Gastroenteritis

n order to relieve symptoms of gastroenteritis, initially a liquid diet is recommended. A healthy option would be to drink plenty of fluids as diarrhea
causes dehydration. Excessive vomiting and frequent stools reduce the quantity of water and electrolytes in the body. So it is essential to increase
the fluid intake, to compensate for what has been lost. Restrict your diet to clear liquids (water and juices) throughout the day. Fluids that contain
high amounts of sugar and electrolytes (potassium, sodium) can also help reduce diarrhea.

Drinking clear fruit juices or other beverages such as flat soda or tea, can help relieve the patient's pain. The next day, if you are feeling better, you
can eat foods like white rice, apple sauce, white bread and bananas. Drinking large amounts of liquids quickly, causes an expansion of the stomach
and may cause nausea. Try to avoid greasy and citrus foods, as they can aggravate the condition. After vomiting, do not immediately consume
fluids. Wait for at least half an hour and then have fluids in small amounts (frequent sips).

Dairy products such as ice cream, must not be eaten as it can aggravate diarrhea. Consumption of alcohol or caffeinated beverages such as coffee,
should be avoided as they can make matters worse. After the symptoms subside, one may include solid foods (white toasts, dry cereal) in their diet.
The symptoms of gastroenteritis generally subside in 2 days. Prefer home cooked food and avoid eating outside. Having large meals during this
period is not recommended, as the stomach is not in a position to properly digest solid foods. It is important to have frequent small meals that are
spaced evenly throughout the day. After 10-15 days, the patient can start eating cooked vegetables, fruits and low fat milk products in small
amounts.