CHAPTER 1.

PREFACE

1.1 Background of the problem

Diarrhea is defecation with the liquid feces or semi liquid, the moisture content of fecal
matter more than usual, more than 200 g or 200 ml/24 hours and defecation more than 3 times in a
day. The feces may be diluted or without mucus and blood.
Acute diarrhea is diarrhea that combatting less than 14 days, while a chronic diarrhea is
diarrhea that combatting more than 14 days. Diarrhea can be caused by infectious and non
infectious. Diarrhea infections is the most happened in the sociality. Infectious diarrhea can be
caused by viruses, Bacteria, and parasites.
Acute diarrhea still be a health problem, not only in developing countries but also in
developed countries. Diarrheal diseases are still often give rise to KLB (Unusual) with many
sufferers within a short time.
In Indonesia, the accute diarrhea is caused by Shigella spp, Salmonella spp, V.
parahaemoliticus, Salmonella typhi, Campylobacter Jejuni, V. cholera non-01, and Salmonella
paratyphi A. But, the bacteria which often infections to human are Shigella, Salmonela,
Campylobacter jejuni, Escherichia coli, dan Entamoeba histolytica.
From the report, we get the information about number of patient that combatting diarrhea. In
puskesmas, we get number of patients are 13.3%, while in hosspital we get there are 0.45%
people who get diarrhea that must be hospitalization and there are 0.05% who must be cure at
home.
Because of that, we as a candidate of nurse must be know about this disease and the best
problem solving. So, in this paper i will discuss about diarrhea and the problem
solving/intervention of nursing.
1.2 The formulation of the problem

1.
2.
3.
4.

what is definition and the cause of diarrhea?

what is the characteristic of people who had diarrhea?
how to cure the people who had a diarrhea?
what is the intervention of nursing for this problem?

1.2 The aim of this paper

1. to know about definition, cause, characteristics and the cure of diarrhea;
2. to know about the problem solving from nursing side.
1.3 The benefit of this paper
The candidate of nurse will know well about diarrhea, so they can give the good nursery
nursing (askep) for the patients.

CHAPTER 2. THE RESULT AND DISCUSSION

2.1 Definition, characteristics and pathologics of diarrhea
a. Definition and characteristic of diarrhea
1

Diarrhea is defecation with the liquid feces or semi liquid, the moisture content of
fecal matter more than usual, more than 200 g or 200 ml/24 hours and defecation more
than 3 times in a day. The feces may be diluted or without mucus and blood.
In Indonesia diarrhea is caused by Shigella spp, Salmonela, Campylobacter jejuni,
Escherichia coli, and Entamoeba histolytica.
Some important epidemiological factor was seen to approach acute diarrhea patients
due to infection. Contaminated food or drink, travel, the use of antibiotics, HIV positive
or AIDS, an important clues in identifying patients at risk for diarrhea infections.
There are many characteristics of people who had diarrhea, that are abdominal
complaints such as heartburn pain such as colic, to nausea, vomiting, fever, tenesmus, as
well as the symptoms and signs of dehydration. Sometimes, in the feces there are mucus
and blood.
b. Pathologics
The germ shigella do the invasion of through membranes basolateral an epithelial
cell the intestines. Inside the cell of occurring multiplication of in fagosom and spreading
to the an epithelial cell surrounding. The invasion of and multiplication of intraselluler
inflict inflammatory reaction as well as the death of an epithelial cell. Inflammatory
reaction occurring due to he sent forth a mediator as leukotrien, interleukin, kinin, and
another astringent vasoaktif. The germ shigella also producing a toxin shiga that raises
breakdown of cells. The pathological process this is going to that were actually causing
symptoms systemic as a fever, abdominal pain, a sense of weak, and symptoms
dysentery. Another bacteria that can spatially invasive is Salmonella.

2.2 Diagnose
The general approach to diagnose of acute bacterial infection diarrhea are needed to
required systematic and meticulous examination. The patient should be asked about
disease history, background and environment of the patient, drug consumption history
mainly antibiotics, travel history, physical examination and ancillary inspections.
Diarrhea that lasts some time without medical countermeasure adekuat can cause
death due to lack of fluid in the body that lead to renjatan hipovolemik or biokimiawi in
the form of disruption due to metabolic acidosis which is next. Due to the loss of fluid a
person feel thirst, weight is reduced, the eyes become sunken, dry tongue, cheek bone

protrudes, decreased skin turgor pressure and the sound become hoarse. Complaints and
symptoms due to water depletion isotonic sculpting.
Laboratory Examination
The laboratory examination of patients suspected of infection diarrhea starts from
examination of the stool of leukocytes. Feces usually contains no leukocytes, if anything
it is considered a marker of inflammation or infection of the colon are either noninfection. The characteristics that

more consistant to inflammatory intestinal is

lactoferrin. Lactoferrin is a glycoprotein that is released netrofil with iron, its existence in
the stool suggests an inflammatory colonic.
Patients with severe diarrhea, fever, abdominal pain, or loss of liquids should be
checked: blood chemistry, sodium, potassium, chloride, ureum, creatinine, blood gas
analysis and examination of blood. Radiological examinations such as silver, 14
sigmoidoskopi, colonoscopy and other generally unhelpful to the evaluation of acute
infectious diarrhea.
The principle of TATALAKSANA DIARRHEA SUFFERERS are:
a)
Prevent dehydration, pevented occured his dehidasi can be done from home
by providing drinking more fluids are recommended as household water
tajin, gravy vegetables, water soup. Kinds of liquid that can be used will
depend on: local customs in treating diarrhea; the availability of a suitable
liquid cider food; health service coverage; the availability of oral rehydration
therapy when it is not possible given the liquid household submitted, provide
b)

water that had been cooking;

Treat dehydration if there is a dehydration (especially in children), the
patient must be immediately taken to the attendant or health facility to get
treatment quickly and appropriately, i.e. with oral rehydration therapy. When
dehydrated, the sufferer should be immediately given fluids intravenously

c)

with ringer lactate before continued terapioral;

Gave food for food Provided to provide nutritional diarrhea in patients
mainly on children remains strong and is growing as well as prevent the
reduced weight. Give liquids including oral rehydration therapy and
appropriate diet is recommended. Children who still have to be more often
mimun ASI was given breast milk. Children who drank milk formula given
more frequently than usual. Children aged 6 months or more, including a
baby who has got a solid food should be given an easily digested food a little
bit but often. After diarrhea stops feeding extra continued for two weeks to

d)

help the recovery of the child's weight;

Treat the other problems If found people with diarrhea is
complicated by other illnesses, then given appropriate
treatment indications, while prioritising rehydration. There
3

are no drugs that are safe and effective way to stop the
diarrhea.
2.3 Curing
Anti diarrhea drugs
Group antisekresi the latest Breakthrough in selective Millennium this is
starting to become widely useful racecadotril once as a barrier to the enzyme
enkephalinase so enkephalin can work back up to par. Repair function will
normalize the secretion of electrolytes and fluid balance is refundable up to
par. In Indonesia, is currently available under the name hidrasec as the first
generation of a new type of drug that anti diarrhea can also be used more
safely in children 14.
Opiat Group
In this group, belongs to codeine phosphate, loperamid HCl, and the
combination of difenoksilat and atropin sulfate (lomotil). Use of codeine is
15-3 x a day loperamid 60mg, 2% u2013 4 mg/3% u2013 4 x a day and
lomotil 5mg 3% u2013 4 x a day. The effect of drug groups include
inhibition of increased absorption of liquid propulsion, so as to improve
consistency and reduce diarrheal stool frequency. When given the right way
the drug is quite safe and dap.
Hydrophilic substances
Extracts derived from Plantago Psyllium, oveta, Karaya (Strerculia),
Ispraghulla, Coptidis and Catechu can form kolloid with liquid. in the
intestinal lumen and will reduce the frequency and consistency of stool but
were unable to reduce the loss of fluids and electrolytes. Its use is 5-10 cc/2 x
a day dissolved in water or granted in the form of capsules or tablets.
2.4 Intervention of nursing
There are ten basic steps in the treatment of children diarrhea with KEP
(child Health Dialoque 1996), Dana diarrhea is one important factor:
1. Mario Hypoglycemia;
2. Lionel Hypothermia;
3. Overcome Dehydration;
4. Correction of electrolyte disorders;
5. infection therapy;
6. Correction of less micronutrients (Vitamins & amp; minera;);
7. start feeding carefully;
8. Pursue growth of ;
9. Stimulation of play and orphanage for love;
10. Preparation of follow up.
After the patient home, ninth and tenth Step is an important step that is often
forgotten in the service of Medic, who determine the quality of life of
children.
Nutrition
4

Nutrition as well as persistent diarrhea, tatalaksana the end goal is to ensure

the optimal flower growing in the sense that children can consume a diet that
is prevalent in accordance with the age based on the condition of a normal
step clinic nutrition diet therapy can be used as a persistent underlying
nutritional therapy on heavy diarrhoea KEP, in which case the provision of
micronutrients supplementation becomes a necessity, therapeutic measures
refers to the tatalaksana the case of persistent diarrhea. It should be
remembered that the intestinal mucosa regeneration efforts more difficult and
long because we are dealing with the mucosa has been atropik. So we have
to anticipate the adjustment effort that feeding more gradual and longer,
followed by attempts to restore the much longer anyway.
Stulasi play and affection On KEP's case the delay in the development of
attitudes and behaviors since the beginning of the nursing care give
orphanage: lovingly Provide games and physical activities as soon as the
child is able to do so. Provide a fun and upbeat atmosphere environment
Encouraging involvement of mothers in care that allows such as bathing the
feed dan bermain.

CHAPTER 3. CLOSING
3.1 Conclusion
Acute diarrhea is a common problem in both the developing countries and developed countries.
Most are self limiting so that only need to watch out for the balance of fluids and electrolytes. When
there are signs and symptoms of acute diarrhea due to bacterial infection can be given empirically,
therapeutic peptides that can then be followed by specific therapy according to the results of the
culture. Treatment of simtomatik can be given as effective and safe enough if given in accordance
with the rules. Prognosis of acute bacterial infection diarrhea, with morbidity and mortality are
minimal. With the hygiene and sanitation are good for prevention of transmission of diarrhea is
bacterial infection. Intervention of nursing is important for healing process. So, the nurses must know
well about this disease moreover can give the best servis.
3.2 Sugestion
For the sociality, must be keep the environment clean, so there are no people who had diarrhea
because of their food/drink are contaminated by the waste.
For the goverment, should be controlling the sociality, escpecially for the cleaning. Goverment
should be adding the cleaning facilities, so the sociality are not lazy to keep the environment clean.

Reference

Pedoman Pemberantasan Penyakit Diare. Mentri Kesehatan Republik Indonesia. Available

from : http://www.depkes.go.id/downloads/SK1216-01.pdf [29 Desember 2011].
Tatalaksana Penderita Diare. Available from : http://www.depkes.go.id/downloads/diare.pdf.
[29 Desember 2011].