PANNA DHAI MAA SUBHARTI

NURSING COLLEGE, MEERUT

CASE PRESENTATION
ON
DIARRHEA

SUBMITTED TO: SUBMITTED BY:

Mr. Anandh Sam Perera Riya Singh

Asso. Professor M.Sc. Nursing I Year

Dept. of Medical Dept. of OBG

Surgical Nursing Batch 2019

PDMSNC PDMSNC

SUBMITTED ON:
 IDENTIFICATION DATA

PATIENT NAME: Mr. Vivek verma

AGE: 24 years

GENDER: Male

M.R. No.: 21002863

WARD: MICU

ADDRESS: Begum bridge, Meerut

EDUCATION: Doing Graduation

OCCUPATION: Student

MARITAL STATUS: Unmarried

RELIGION: Hindu

DATE OF ADDMISSION: 5/04/2021

DIAGNOSIS: Diarrhea
CHIEF COMPLAINS:

Patient came with the complain of loose motions 5 to 6 times a day since last 4 days. He was
taking treatment from a doctor in his area. Once taken medicine it is relieved but again the same
takes place after 4 to 5 hours. He was not satisfied with the treatment so decided to take
treatment from hospital.

PRESENT MEDICAL HISTORY:

Treatment for diarrhea.

PAST MEDICAL HISTORY:

Taking treatment for loose motions from a doctor of his area.

PRESENT SURGICAL HISTORY:

No significant history.

PAST SURGICAL HISTORY:

No significant history.

SOCIO-ECONOMIC HISTORY:
Patient is living in a pucca house. Electricity facility is available. Source of water is tap water.
He also gave history of good sanitation in his house. There is proper satiation facility available.
All are using a common washroom.

PERSONAL HISTORY:

DIET: Vegetarian

SMOKING: Non smoker

ALCOHOL: Non alcoholic

BOWEL &BLADDER: Disturbed

FAMILY HISTORY:

Patient belongs to middle class family. There are 5 members in her family, patient, his mother,
his father and 2 sisters. Children are not yet married.

S.NO NAME OF AGE/SEX EDUCATION OCCUPATION HEALTH

THE STATUS
FAMILY
MEMBERS
1. Ravinder 45y/M Graduate Teacher Healthy
Singh
2. Pushpa Devi 42y/F 12th passed Housewife Healthy
3. Vivek verma 24y/M Doing Student Unhealthy
graduation
4. Pooja 27y/F Graduate Employee Healthy
5. Reetu 23y/F Graduation Student Healthy

FAMILY MEDICAL HISTORY

There is no significant family medical history of the family members.

PHYSICAL EXAMINATION

General Appearance

Look- Anxious

Posture- Normal

Health- Unhealthy

Nourishment- Nourished

Consciousness- Conscious

Anthropometric Measurement

Height- 150 cm

Weight- 50 kg

BMI- 22.2

Vital signs

Temperature- 98.4°F

Pulse- 82 beats/min

Respiration- 20 breaths/min

BP- 130/90 mm of Hg
HEAD TO TOE EXAMINATION

Head

Skull- No nodules or masses

Scalp- Clear

Shape- Normal

Size- Normal

Hair- Normally distributed

Eyes

Eyebrows- Evenly distributed

Eyelashes- Equally distributed

Eyelids- Symmetrical

Vision- Normal

Ears

External Ear- Normal

Symmetry- Symmetrical

Hearing- Normal
Nose

Symmetry- Symmetrical

Discharge- Absent

Mouth

Lips- Pink

Teeth- No discoloration

Gums- No retraction

Neck

Lymph Nodes- Not enlarged

Movement- Normal

Chest

Symmetry- Symmetrical

Chest wall- Intact

Abdomen

Inspection- No scars

Palpation- No tenderness, no masses

Percussion- Bowel sounds

Auscultation- Bowel and bladder disturbed

Upper Extremities

Symmetry- Symmetrical

Movement- Normal

Lower Extremities

Symmetry- Symmetrical

Movement- Normal
 INVESTIGATION

INVESTIGATION PATIENT NORMAL REMARKS

VALUE VALUE

Hemoglobin 11.2 gm/dl 12-15 gm/dl Decreased

Platelet 230x103 mm3 150-410x103 mm3 Normal
WBC 9.3x103 mm3 4-10x103 mm3 Normal
Hematocrit 38.0 % 36-46 % Normal
MCV 94 fl 83-99 fl Normal
Neutrophil 80 % 40-70 % Increased
Lymphocyte 18 % 20-40 % Decreased
Urea 28.7 mg/dl 15-36 mg/dl Normal
Creatinine 0.4 mg/dl 0.5-1.0 mg/dl Decreased
Na+ 128 mmol/L 137-145 m/L Decreased
K+ 4.5 mmol/L 3.5-5.0 m/L Normal
Bilirubin 0.4 mg/dl 0.3-1.3 mg/dl Normal
Glucose 89 mg/dl <200 mg/dl Normal
 MEDICATIONS

MEDICATION DOSE/ ROUTE INDICATIONS SIDE EFFECTS

NAME FREQUENCY

Tab. Loperamide 4 mg/ TDS Oral Chronic Diarrhea Dry mouth

Traveler’s Diarrhea Somnolence
Abdominal Discomfort
Rash and Itching

Tab. Pansec 40 mg/ OD Oral Erosive esophagitis Diarrhea

Hypersecretory conditions Headache
Dizziness
Rash

Inj. Cefixime 250 mg/ BD IV Bacterial infection Dry mouth

Abdominal Discomfort
Rash
DISEASE CONDITION

DIARRHEA

Diarrhea is derived from Greek word, meaning ‘flowing through’. It is the leading cause of death
in children under 5 years of age.

DEFINITION

According to WHO, Diarrhea is defined as ‘passage of 3 or more loose stools per day or passing
more stools than normal for the age’.

INDICATION

Every year there are about 1.5 to 2 billion death of diarrheal diseases occurs. Diarrhea is the
second leading cause of child mortality and morbidity in the world.

One in 5* children die of diarrhea every year in India.

It mostly due to contaminated food and water sources.

CLASSIFICATION

1. On the basis of duration

 Acute diarrhea
 Chronic Diarrhea
2. On the basis of clinical presentation
 Acute watery diarrhea
 Acute bloody diarrhea
3. On the basis of physiology
 Secretory Diarrhea
 Osmotic Diarrhea
  Exudative Diarrhea
 Motility Diarrhea
 Inflammatory Diarrhea

ETIOLOGY

The causes of diarrhea are as follows:

1) Infection
2) Drugs
3) Dietary causes
4) Surgical conditions
5) Miscellaneous causes

CLINICAL FEATURE AND ASSESSMENT

Clinical feature of diarrhea depends on its severity:

1) Mild diarrhea (2-5 loose stool)

2) Moderate diarrhea (10 or more loose stool)
3) Severe diarrhea (100 loose stool within 24 hours)

DIAGNOSTIC EVALUATION

1. History taking
2. Physical examination
3. Stool examination
4. Stool culture
5. Blood tests
MANAGEMENT

Management of infants and young children with diarrhea and dehydration focus on:

1) Replacement of the fluids

2) Administration of prescribed drugs
3) Maintenance of nutritional status
4) Educate the mother regarding prevention of diarrhea.

 REHYDRATION THERAPY

The first step to treating acute diarrhea is rehydration, preferably oral rehydration.1 The
accumulated fluid deficit (calculated roughly as the difference between the patient's normal
weight and his or her weight at presentation with diarrheal illness) must first be addressed. Next,
the focus should turn to the replacement of ongoing losses and the continuation of maintenance
fluids. An oral rehydration solution (ORS) must contain a mixture of salt and glucose in
combination with water to best use the intestine's sodium-glucose coupled cellular transport
mechanism.

 FEEDING

Early refeeding decreases intestinal permeability caused by infections, reduces illness duration,
and improves nutritional outcomes. This is particularly important in developing countries where
underlying pre-existing malnutrition is often a factor. Although the BRAT diet (bananas, rice,
applesauce, and toast) and the avoidance of dairy are commonly recommended, supporting data
for these interventions are limited. Instructing patients to refrain from eating solid food for 24
hours also does not appear useful.

 ANTIDIARRHEAL MEDICATIONS

The antimotility agent loperamide (Imodium) may reduce the duration of diarrhea by as much as
one day and increase the likelihood of clinical cure at 24 and 48 hours when given with
antibiotics for traveler's diarrhea.
NURSING DIAGNOSIS

 Loose motions related to disease condition as evidenced by verbalization.

 Anxiety related to disease condition as evidenced by verbalization.

 Malabsorption related to disease condition as evidenced by loose motions.

 Risk of infection related to hospitalization as evidenced by observation.

 Knowledge deficit related to disease condition as evidenced by verbalization.

ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Loose motions To relieve To assess the patient’s To make Patient’s condition Loose motions
DATA: related to from condition. baseline for assessed. has been
Patient says, “ I disease loose care. relieved to much
am having loose condition as motions. To educate to take Patient educated to extent.
motions.” evidenced by fiber diet. To relieve from take fiber diet.
verbalization. motions.
To record the no. of No. of motions has
OBJECTIVE motions being passed. To inform the been recorded.
DATA: doctor and to
I observed that To take medications see Medications has been
patient is having on time as prescribed improvement. taken as per doctor’s
loose motions. by the doctor. prescription.

To get well
soon.
ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Anxiety related To reduce To assess the patient’s To make Patient’s condition Anxiety has
DATA: to disease the condition. baseline for assessed. been reduced.
Patient says, “I condition as anxiety. care.
am very anxious evidenced by To give psychological Psychological support
about my verbalization. support to patient. To support him given to the patient.
disease.” mentally.
To allow him to Patient allowed to
OBJECTIVE ventilate his feelings. To make him ventilate his feelings.
DATA: feel relieved.
I observed that To educate him for Patient educated for
patient is having intake of good and To get well intake of good and
anxiety. healthy diet. soon. healthy diet.

To educate to take Patient educated to

medication on time as For proper take medications on
per prescription. treatment. time as per
prescription.
ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Malabsorption To To assess patient’s To make Patient’s condition Malabsorption
DATA: related to improve condition. baseline for assessed. has been
Patient says, “I disease malabsor- care. reduced to much
am having loose condition as -ption. To assess for the Patient assessed for extent.
motions.” evidenced by motions of the patient. To make out the motions.
loose motions. the level of
Assess for abdominal care to be Assessed for
OBJECTIVE discomfort, frequency, provided. abdominal
DATA: urgency. discomfort, frequency
I observed that These and urgency.
patient is having Evaluate pattern of assessment
malabsorption. defecation. findings are Evaluated pattern of
linked with defecation.
Ask about tolerance of diarrhea.
milk and other dairy Asked about tolerance
products. Will help in of milk and other
treatment. dairy products.
 HEALTH EDUCATION
 Medications

 Diarrhea medicine is an over-the-counter medicine that helps slow or stop your diarrhea. 

 Antibiotics may be given to help treat an infection caused by bacteria.

 Antiparasitic may be given to treat an infection caused by parasites.

 Take your medicine as directed. Contact the healthcare provider if you think your medicine
is not helping or if you have side effects. Tell him of her if you are allergic to any medicine.
Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when
and why you take them. Bring the list or the pill bottles to follow-up visits.

 Self-care:

 Drink liquids as directed. Liquids will help prevent dehydration caused by diarrhea.

You may need to drink an oral rehydration solution (ORS). An ORS has the right
amounts of water, salts, and sugar you need to replace body fluids

 Eat foods that are easy to digest. Examples include rice, lentils, cereal, bananas,
potatoes, and bread. It also includes some fruits (bananas, melon), well-cooked
vegetables, and lean meats. Do not eat foods high in fiber, fat, and sugar. Do not drink
alcohol until your diarrhea is gone.

 Prevent acute diarrhea:

 Wash your hands often. Use soap and water. Wash your hands before you eat or
prepare food.

 Keep bathroom surfaces clean. 

 Wash fruits and vegetables well before you eat them. 
 Cook meat and poultry as directed. 
 BIBLIOGRAPHY

1. Lewis SM, Heitkemper MM. Medical Surgical Nursing, 7 th edition, Mosby publications,
Philadelphia,2007: 544-549.
2. Smeltzers Cs, Bare GB, Hinkle LH, Cheever HK. Brunner & Suddarths Text Book of
Medical Surgical Nursing. 10th ed. Williams &Willkins publications New Delhi:342-349.
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Delhi, Elsevier India Pvt ltd2003: 676-678.
5. https://www.drugs.com/cg/acute-diarrhea-aftercare-instructions.html
6. https://medlineplus.gov/diarrhea.html