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748 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems

Diagnostic Tests
TABLE 34.3 DIARRHEA SUMMARY The diagnosis of diarrhea is determined by the onset and pro-
gression of the condition, presence of fe ver, laboratory ex-
Signs and Frequent, watery stools aminations, and visual inspection of the stool for bacteria,
Symptoms Abdominal cramping pus, or blood. Diarrhea mix ed with red blood cells (RBCs)
Distention and mucus is associated with cholera, typhoid, typhus, large-
Anorexia bowel cancer, or amebiasis. Diarrhea mixed with white blood
Intestinal rumbling cells (WBCs) and mucus is associated with shigellosis, intes-
Causes Inflammatory diseases such as Crohn’s tinal tuberculosis, salmonellosis, regional enteritis, or ulcer-
disease and ulcerative colitis ative colitis. Bulky, frothy stool is seen in celiac disease. Pasty
Infectious organisms stools usually have a high fat content and may be associated
Recent antibiotic use with common bile duct obstruction and celiac disease.
Surgical procedures such as bowel
Therapeutic Measures
resection
Laxatives Replacing fluids and electrolytes is the first priority. This can
Enteral tube feedings be done by increasing oral fluid intak e and using solutions
Radiation therapy with glucose and electrolytes if ordered by the health care
provider (HCP). Intravenous (IV) fluid replacement may be
Diagnostic History necessary for rapid hydration, especially in the v ery young
Tests Laboratory examinations of stool or very old. An elimination diet can be tried to identify foods
Therapeutic Replacement of fluids and electrolytes that may contribute to diarrhea. Foods known to cause diar-
Measures Antidiarrheal medications rhea are eliminated to see if a change in bo wel function oc-
Antimicrobials curs. Each food item is then added back into the diet, one at
Lactinex a time, to see which ones cause diarrhea.
If the patient has three or more w atery stools per day ,
Priority Diarrhea motility of the intestines can be decreased with the use of
Nursing Deficient Fluid Volume drugs, such as diphenoxylate (Lomotil), difenoxin HCl
Diagnoses Deficient Knowledge (Motofen), and loperamide (Imodium). If diarrhea is thought
to be caused by antibiotics that change the normal flora of
the bowel, a Lactobacillus granule probiotic supplement
(Lactinex) may be used to help restore the normal flora. Fecal
transplant can restore the normal intestinal flora in those who
are ill (Chapter 32). Antimicrobial agents are prescribed if in-
fectious agents have been identified.
Gerontological Issues
Nursing Process for the Patient With Diarrhea
Dehydration and Hypokalemia DATA COLLECTION. Observation of the patient’s behaviors
Diarrhea can cause older people to quickly become dehy- and symptoms assists in identifying the cause of diarrhea.
drated and hypokalemic because both fluid and potassium Ask the patient to describe any symptoms, when they started,
are lost in stools. The signs and symptoms of hypokalemia and how long they have been present. Questions should in-
include muscle weakness, hypotension, anore xia, pares- clude “Is there any abdominal pain, urgency, or cramping?”
thesia, and drowsiness. It can also cause cardiac dysrhyth- and “What time of the day does it happen?” Stool consis-
mias, such as atrial and ventricular tachycardia, premature tency, color, odor, and frequency are documented.
ventricular contraction, and ventricular fibrillation, which Observe for symptoms of dehydration, such as tachycar -
can be fatal. dia, hypotension, decreased skin tur gor, weakness, thready
If the older person has decreased mobility , quick pulse, dry mucous membranes, and oliguria. Obtain the pa-
access to the bathroom is important. Because of poor tient’s height and weight to establish a baseline. Abnormal
muscle control, older patients may be incontinent. This laboratory studies that may indicate dehydration include in-
might embarrass patients or cause them to hurry, which creased serum osmolality, increased specific gravity of urine,
increases chances of patients f alling and causing other and increased hematocrit. Decreased serum potassium may
problems such as fracture, dislocation, or hematoma. result from intestinal loss of potassium.
Also, because older patients’ skin is more sensiti ve re- Inspect the abdomen for distention. The patient’s usual di-
sulting from poor turgor and a reduction in subcutaneous etary habits and any changes or recent exposure to contaminated
fat layers, perirectal skin excoriation can occur second-
ary to the acidity and digestive enzyme content of diar-
rheal stools. • WORD • BUILDING •
enteritis: entero—intestine + itis—inflammation