CASE STUDY

(GROUP C) RLE MCN

INTRODUCTION

The patient is a 10 year old female who complained of dizziness, body malaise and abdominal
pain after drinking cold chocolate and having 3 times watery stool. Upon bringing the patient to
the clinic the nurse took her vital signs with a blood pressure of 110/70 mmHg, respiratory rate
of 22 cpm, pulse rate of 75 bpm, and 36.4 C for her temperature. The patient was advised for
bed rest and advised to take an ORS or oral rehydration salts.

Diarrhea is when your bowel movements become loose or watery. The definition of diarrhea is
passing loose or watery bowel movements 3 or more times in a day (or more frequently than
usual). Diarrhea occurs when the lining of the intestine is unable to absorb fluid, or it actively
secretes fluid.

According to WHO, diarrhea is known as the second leading cause of death in children under 5
years old though it is preventable and curable.

NURSING HISTORY:

NAME OF PATIENT: PATIENT X

AGE: 10
INITIAL VITAL SIGNS ON ADMISSION: PATIENT WAS NOT ADMITTED.
VITAL SIGNS:
BP: 110/70 mmHg TEMP: 36.4 C PR: 75 bpm RR: 22 cpm

CHIEF COMPLAINT: Patient complained of dizziness, body malaise, and abdominal pain after
drinking cold chocolate having 3 times watery stool.

FINDINGS SIGNIFICANT TO NURSING CARE: Patient felt dizziness, body malaise and
abdominal pain followed by watery stools due to Diarrhea which was caused by drinking cold
chocolate drink. Take note of the symptoms, food intake, medications, defecation, and other
signs and symptoms related to diarrhea.

NURSING DIAGNOSIS: Impaired comfort related to diarrhea as evidenced by body malaise

and dizziness. Imbalanced Nutrition: Less than Body Requirements related to diarrhea as
evidenced by frequency of loose stools. Acute pain related to diarrhea as evidenced by
abdominal pain, and fluid volume deficit related to dehydration.

*for other information on the health history form, there was no data given for most of the
parts*
 PHYSICAL ASSESSMENT

Prior to physical examination, the patient’s blood pressure is 110/70 mmHg, with a
temperature of 36.4 C, pulse rate 75 bpm and respiratory rate of 22 cpm.

DIAGNOSIS: Diarrhea AGE: 10

PAIN SCALE:
VITAL SIGNS:
BP: 110/70 mmHg TEMP: 36.4 C PR: 75 bpm RR: 22 cpm

GENERAL SURVEY:
Patient has abdominal pain with body malaise and dizziness, and the patient appears to be
dehydrated due to defecation of watery stool three times.

NO DATA GIVEN FROM PHYSICAL EXAMINATION.

NURSING CARE PLAN

Cues Nursing Objectives Nursing Rationale Evaluation

Diagnosis Intervention

Subjective Objective

Patient Patient’s
complained of vital signs Impaired After 4 (Goal met)
abdominal that were comfort hours of
pain, body taken are related to nursing After 4
malaise and the diarrhea as intervention hours of
dizziness. following: evidenced s, the nursing
by body patient will intervention
BP: 110/70 malaise be able , the patient
mmHg and was able to
1. Note for the 1. To
RR: 22 dizziness. 1. To identify
location, scale, determine
cpm identify individual
intensity and the nursing
PR: 75 individual areas of
onset of pain care to be
bpm areas of weakness
given to the
Temperatur weakness and needs.
patient.
e: 36.4 o/c and needs

Patient also
had watery
stools 3
times.
2. To 2. Use 2. To After 4
verbalize relaxation promote hours the
that the techniques comfort patient
abdominal such as heat and states the
pain is no and cold relaxatio abdominal
longer application an n pain is no
present. deep more to be
breathing felt caused
exercise by diarrhea
( GOAL
MET )

3. After 3. 3. To After 1-2

1-2 days Administer decre days of
of nursing anti-diarrhe ase nursing
interventio a GI intervention
ns, the medication motilit s the
patient will s as y and patient
be free of indicated minim shall be
diarrhea. ize free of
fluid diarrhea as
losse evidenced
s. by
re-establish
ed and
maintain
normal
bowel
movement,
reduced in
frequen of
stools and
stool
returned to
its normal
consistency
.
 Cues Nursing Objectives Nursing Rationale Evaluation
Diagnosis Interventio
n
Subjective Objective

Patient The Imbalanced

complained of patient's Nutrition: After 4 hours
dizziness, vital signs Less than of nursing
body malaise were Body intervention,
and 110/70, RR Requireme the patient
abdominal 22, PR 75, nts related will be able
pain and a to diarrhea to:
temperatur as
e of 36.4o/c evidenced 1. To observe After 4
1.The nurse 1.To create a
throughout by the nutritional hours of
will explore baseline of
the frequency status of the nursing
the patient's the patient's
examinatio of loose patient intervention,
daily nutritional
n. stools nutritional status and the patient
intake and preferences was aware
food habits of her
nutritional
status
(GOAL
2. To be MET)
aware of
dietary
choices that Patient was
2. Assist the
cause 2. To relieve able to be
patient in
imbalanced abdominal free of
selecting
nutrition and pain, imbalanced
appropriate
loose stool alleviate nutrition,
dietary
diarrhea, and pain was
choices to
healthy food alleviated
reduce the
habits and
intake of milk
diarrhea
products,
was
chocolates,
stopped.
high fat
(GOAL
foods
MET)
3. To know 3. Discuss wi
what diet to the patient Patient was
3. To avoid
take while the B.R.A.T able to
aggravating
(banana, discuss what
 recovering rice, apple, the digestive B.R.A.T diet
from diarrhea toast) diet system and and its
and its to firm the purpose; the
purpose stool. B.R.A.T diet
took effect in
the patient.
(GOAL MET)

Cues Nursing Objectives Nursing Rationale Evaluation

Diagnosis Intervention

Subjective Objective

Patient Patient’s Acute pain After the 8

complained of vital signs related to hour nursing
abdominal that were diarrhea as intervention,
pain taken are evidenced the patient
the by will be able
following: abdominal to:
pain
BP: 110/70 1. To state 1. The nurse To promote After 3
mmHg relief of will apply comfort and hours, the
RR: 22 pain heating ease patient was
cpm from (warm) pads abdominal able to state
PR: 75 abdomin on the pain. relief of pain
bpm al pain patient's from
Temperatur after 3 abdomen. abdominal
e: 36.4 o/c hours. pain caused
by diarrhea.
Patient also (GOAL MET)
had watery 2. To 2. Monitor and To assess
stools 3 lessen document the status The patient
times. frequenc patient’s stool. of the was able to
y of Administer patient, defecate
 watery ORS and promote normal stool
defecatio advise bed rest and and
n after a rest as prevent frequency
day. ordered by the dehydration was
Physician. . lessened.
(GOAL MET)

Cues Nursing Objectives Nursing Rational Evaluation

Diagnosis Intervention e

Subjective Objective

Patient’s Fluid After the 8

Patient vital signs volume hour nursing
complained that were deficit intervention,
of taken are related to the patient
dizziness the diarrhea will be able
and body following: to:
malaise.
BP: 110/70 1. To return 1. Monitor Frequen The patient
mmHg to normal weight daily. t has signs of
RR: 22 hydration Assess intake assessm normal
cpm status and and output. ent of hydration.
PR: 75 will not Assess heart hydratio
bpm develop rate, postural n status
Temperatur hypovolemic blood pressure, facilitate
e: 36.4 o/c shock. skin turgor, s rapid
capillary refill intervent
Patient time and urine ion and
had a specific gravity evaluati
watery every 4 hours on of the
stool 3 or more effective
times. frequently as ness of
indicated. fluid
replace
ment.

2. To 2. Urge the
verbalize patient to drink Oral
awareness fluid
of causative the prescribed replace
factors and amount of fluid. ment is
behaviors indicate
essential to d for
correct fluid mild fluid
deficit. deficit
and is a
cost-effe
ctive
method
for
replace
ment
treatmen
3. To explain 3. Aid the t.
measures patient if they
that can be cannot eat Dehydra
taken to without ted
treat or assistance, patients
prevent fluid and may be
volume loss. encourage the weak
family or so to and
assist with unable
feedings as to meet
necessary. prescrib
ed
intake
4. To 4. Emphasize indepen
describe the dently.
symptoms importance of
that indicate oral hygiene.
the need to
consult with A fluid
a health care deficit
provider. can
cause a
dry,
sticky
mouth.
Attention
to mouth
care
promote
 s
interest
in
drinking
5. Provide a and
comfortable reduces
environment the
by covering discomf
the patient ort of dry
with light mucous
sheets. membra
nes.

Drop
situation
s where
patients
can
experien
ce
overheat
ing to
prevent
further
fluid
loss.
 DRUG STUDY

WHY IS YOUR
MEDICATION PATIENT MECHANISM SIDE EFFECTS/ NURSING
(GENERIC/ROUTE/ CLASSIFICATION TAKING THIS OF ADVERSE IMPLICATIONS/
DOSAGE) DRUG? ACTION EFFECTS RESPONSIBILITIES
Oral Rehydration In a class of To replace ORS works Too much salt: Inform physician if
Salts to be given medications fluids and because the condition
orally. called electrolyte minerals sodium and - Convulsions worsens or
oral (such as water (seizures) persists for more
TREATMENT PLAN A pharmacological sodium, absorption in - Dizziness; than 24 hours or if
For patients over 10 group used for potassium) the small -fast severe
years and adult: 200 oral replacement lost due to intestine is heartbeat; stomach/abdomina
to 400 mL after each of electrolytes diarrhea. increased by -high blood l pain, blood in the
loose stool and fluids in glucose pressure; stool/vomit, a
(approximately 2000 patients with To prevent (sugar). The -irritability; fever, or signs of
mL daily) dehydration or treat two are -muscle dehydration (such
associated with dehydration. carried across twitching; - as dizziness,
TREATMENT PLAN B diarrhea. the wall of the restlessness; - decreased
For moderate To small intestine Swelling of urination, severe
dehydration, over the accelerate together via a feet or lower thirst, very dry
first four hours give the right mechanism legs; mouth, seizures)
1200 mL to 2200 mL. amount of called the - Weakness have been
fluids and “sodium-gluco observed.
After 4 hours if there minerals se cotransport Too much
are no signs and which is mechanism.” fluids:
symptoms follow important for The toxins Assess severity of
treatment plan A. the normal which cause - Puffy eyelids dehydration and
functioning diarrheal - Vomiting supervise
If there are signs of of the body. diseases, prescribed oral
moderate such as from
rehydration
dehydration, repeat food
treatment plan B. poisoning, therapy
increase
secretion of Make sure to use
water into the the right amount of
small water to make up
intestine, but
the medicine.
don’t block
water uptake
by this If the eyelids
sodium-glucos become puffy
e transport during the
mechanism. treatment: stop
ORS does not
ORS, give plain
cure you
when you water then,
have diarrhea resume ORS
but it will according to
 rehydrate you. Treatment plan A
when the puffiness
is gone.

If vomiting, stop
ORS for 10 min
and then resume
at a slower rate
(very small,
frequent,
amounts); do not
stop rehydration.

HEALTH TEACHING

The following topics below will be discussed to the Mother and child for them to be
knowledgeable about their situation, including the definition of Diarrhea, causes, prevention,
signs and symptoms, foods to eat and not to eat, and when to bring the patient to the ER.

The student nurses will educate and discuss information about Diarrhea to the
Mother and patient.

What is Diarrhea?

Going to the bathroom, having a bowel movement, pooping – no matter what you call it, stool is
a regular part of your life.

However, sometimes this process of getting waste out of your body changes. When you have
loose or watery stool, that’s when we call it diarrhea.

When you have diarrhea, this can cause dehydration, which is why doctors often give ORS for
rehydration. When you have diarrhea, you lose water and electrolytes along with stool. You
need to drink plenty of fluids to replace what’s lost. Dehydration can become serious if it fails to
resolve (get better), worsens and is not addressed adequately.

What causes Diarrhea?

Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a
variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food
or drinking-water, or from person-to-person as a result of poor hygiene.

How to prevent Diarrhea?

First, the patient must practice proper hand hygiene, which is easy as the picture shows! This
should be done for 15 - 20 seconds. Implementation of proper hand washing will help eliminate
transmission of diseases such as Diarrhea.

Second, follow the Doctor’s order for the patient’s medication which is ORS. ORS is used to
treat dehydration caused by diarrhea. Unlike other fluids, the ratio of the ingredients in an ORS
matches what the body needs to recover from a diarrheal illness.

Third, increase fluid intake with safe drinking water. Water alone won’t be enough to replace the
essential fluids lost in your body.

Lastly, promote bed rest for the patient.

Signs and Symptoms to WATCH OUT FOR caused by Dehydration due to Diarrhea

● Thirst
● Less frequent urination than normal
● Dark-colored urine
● Dry skin
 ● Fatigue
● Light-headedness
● Inability to sweat

Foods to eat when having Diarrhea

When you have diarrhea, the foods that you eat and the foods that you avoid can be critical to
helping you recover quicker. This is where BRAT foods come in.

BRAT stands for “bananas, rice, apples, toast.” These foods are bland, so they won’t aggravate
the digestive system. They’re also binding, so they help firm up stool.

Other foods that are included in the BRAT diet include:

- Cooked cereal, like Cream of Wheat or farina (if available)

- Soda crackers (sky flakes, rebisco, etc)
- Applesauce and Apple juice (harvest fresh, del monte, etc.)

It is very important to increase fluid intake, aside from the ORS, you can also try the following
liquids to be taken in moderation:

● Clear broths, like chicken broth or beef broth, with any grease removed
● Electrolyte-enhanced water or coconut water with vitamins or electrolytes (try to avoid
ones high in sugar)
● Solutions like Pedialyte
● Weak, decaffeinated tea

Foods to AVOID

The following are foods that can trigger the digestive system and prolong diarrhea.

● Milk and dairy products (including milk-based protein drinks)

● Fried, fatty, greasy foods
● Spicy foods
● Processed foods, especially those with additives
● Pork and veal
● Sardines
● Raw vegetables
● Rhubarb
● Onions
 ● Corn
● All citrus fruits
● Other fruits, like pineapples, cherries, seeded berries, figs, currants, and grapes
● Alcohol
● Coffee, soda, and other caffeinated or carbonated drinks
● Artificial sweeteners, including sorbitol

But, it is always better to consult your doctor for foods to eat and not to eat.

When to Visit the ER for Diarrhea

You should seek medical attention as soon as possible for diarrhea with these symptoms:

● Diarrhea lasting more than two days

● Blood or pus in the stool
● Severe abdominal pain
● Black, tarry stools (a sign of bleeding from the digestive tract)
● High fever
● Signs of dehydration

Without following the precautions mentioned above, infections like diarrhea may occur, different
diseases are everywhere which is why we must keep in mind the things to do and to prevent
daily to have a healthy life.

As advised by the patient’s physician, if diarrhea still occurs, the patient can be brought to the
Emergency room or nearest hospital immediately.

Always consult your doctor.

References:

Boshell, P. (2016). What is the Correct Hand Washing Technique? Retrieved from
https://info.debgroup.com/blog/what-is-the-correct-hand-washing-technique

Cleveland Clinic (2020). Diarrhea. Retrieved from

https://my.clevelandclinic.org/health/diseases/4108-diarrhea

True Remedies (2019). 12 Do’s And Don’ts Of Diarrhea For Quick Relief. Retrieved from
https://trueremedies.com/dos-and-donts-of-diarrhea/

World Health Organization (2017). Diarrhoeal Disease. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

Jaret, P. (2011). Preventing dehydration when you have diarrhea or vomiting. WebMD.
Retrieved October 9, 2021, from
https://www.webmd.com/digestive-disorders/features/prevent-dehydration

Gotter, A. (2021, August 30). What to eat when you have diarrhea: Foods to eat and avoid.
Healthline. Retrieved October 9, 2021, from
https://www.healthline.com/health/what-to-eat-when-you-have-diarrhea#foods-to-avoid