DIARRHEA

Reference: Hinkle, J. L., & KH, C. (2014). Brunner & suddarths textbook of medical surgical nursing: LWW. Thirteenth, North American Edition eddition.
Diarrhea is increased frequency of bowel movements (more than

three per day), increased amount of stool (more than 200 g per day),
.
and altered consistency (ie, looseness) of stool. It is usually

associated with urgency, perianal discomfort, incontinence, or a

combination of these factors. Any condition that causes increased

intestinal secretions, decreased mucosal absorption, or altered

motility can produce diarrhea

is most often associated with infection and is
.
self-limiting

persists for a longer period and may return

sporadically
• Medications

(eg, thyroid hormone replacement, stool softeners and

.

laxatives ,antibiotics, chemotherapy, antacids),

• certain tube feeding formulas

• Metabolic and endocrine disorders (e.g diabetes, Addison’

s diseas, thyrotoxicosis),
• Nutritional and malabsorptive disorders (eg, celiac disease)

• Anal sphincter defect,

.

• Zollinger-Ellison syndrome,

• Paralytic ileus

• Intestinal obstruction

• Acquired immunodeficiency syndrome (AIDS).

PATHOPHYSIOLOGY
Mixed Diarrhea
Is caused by increased
peristalsis (usually from IBD)
and a combination of increased
secretion and decreased
absorption in the bowel.
Diarrhea by infection
Diarrhea can have viral, bacterial, and
parasitic causal agents.
Rotavirus is the common viral cause of
diarrhea in young children
Common causes of bacterial infection
include Escherichia coli and Salmonella,
Shigella, Campylobacter, and Yersinia
species.
Parasitic infections of importance
include Giardia and Cryptosporidium
species and Entamoeba histolytica
Secretory Diarrhea
Is usually high-volume diarrhea
and is caused by increased
MD SD production and secretion of
water and electrolytes by the
intestinal mucosa into the
intestinal lumen
Osmotic Diarrhea
I OD
occurs when water is pulled into
the intestines by the osmotic
pressure of unabsorbed particle,
slowing the reabsorption of
water.
Clinical manifestation
01 Increased frequency and fluid content of stools

02 Abdominal cramps

Distention, intestinal rumbling

03 (ie, borborygmus)

04 Anorexia, and thirst

Painful spasmodic contractions of the anus and in

05 effectual straining (ie, tenesmus) may occur with
defecation.
ASSESSMENT & DIAGNOSTIC FINDINGS

Complete blood cell count

Urinalysis

Routine stool examination

Stool examinations for infectious or parasitic

organisms, bacterial toxins, blood, fat, and
electrolytes.
Endoscopy or barium enema
MEDICAL MANAGEMENT

• Controlling symptoms, preventing

complications, and eliminating or
treating the underlying disease.
• Medications such as antibiotics &
anti-inflammatory agents may reduce
the severity of the diarrhea and treat the
underlying disease.
COMPLICATIONS

Complications of diarrhea include:

• cardiac dysrhythmias because of significant fluid and
electrolyte loss (especially loss of potassium).
• Less urinary output ( <30 ml/2-3 hrs)
• muscle weakness, paresthesia, hypotension, anorexia,
and drowsiness with a potassium level of less than 3.0
mEq/L (3 mmol/L).
• Decreased potassium levels cause cardiac dysrhythmias

that can lead to death.

NURSING MANAGEMENT
Encourage bed rest and intake of liquids
and foods low in bulk until the acute
01 attack subsides. Rehydrate with
electrolyte balanced fluids

Recommend a bland diet of semisolid

02 and solid foods for patients that can
tolerate food intake

Advise patient to avoid caffeine, carbonated

03 beverages, and very hot and very cold food,
because they stimulate intestinal motility.
NURSING MANAGEMENT

Administers antidiarrheal medications

04 such as diphenoxylate (Lomotil) and
loperamide (Imodium) as prescribed.

05 Monitor serum electrolyte levels.

06 Immediately reports evidence of dysrhythmias

or a change in the level of consciousness.
PHARMACOLOGICAL MANAGEMENT

Antimotility agents:, :Diphenoxylate with Atropine,

(Lomotil), and Loperamide (Imodium)

Antisecretory drugs: Racecadotril and Diosmectite

Antibiotics: Erythromycin, Ciprofloxacin, Vancomycin, Doxycycline,

Metronidazole, Albendazole, Azithromycin

Probiotics: Bacillus clausii

Oral rehydration solution: ORESOL (homemade solution composed of 1 teaspoon

of salt, 4 teaspoons of sugar mixed in 1 liter of water)