MEDICAL SURGICAL NURSING

UNIT NO:XII
NURSING MANAGEMENT OF PATIENT
WITH COMMUNICABLE DISEASE
TOPIC: DIARRHOEAL DISEASES

MRS.S.TAMIL SELVI MSC(N),

PROFESSOR.
 Objectives

• At the end of the class students can able to

- Describe the definition, incidence and epidemiology of diarrhoea

-List down the etiology ,classification and mechanism of diarrhoea

-Understand the pathophysiology and clinical manifestation of diarrhoea

-State down the classification and complications of diarrhoea

- Enumerate the laboratory diagnoses of diarrhoea

- List down the treatment, nursing management and preventive measures

 INTRODUCTION

• Diarrhoeal disease is the second leading cause of death in

children under five years old, and is responsible for killing
around 525000 children every year.
• Diarrhoea can last several days, and can leave the body
without the water and salts that are necessary for survival.
• In the past, for most people, severe dehydration and fluid
loss were the main causes of diarrhoea deaths.
• Now, other causes such as septic bacterial infections are
likely to account for an increasing proportion of all diarrhoea-
associated deaths.
 DEFINITION

• Diarrhoea is defined as the passage of three or more loose or

liquid stools per day (or more frequent passage than is normal
for the individual). Frequent passing of formed stools is
not diarrhoea, nor is the passing of loose, "pasty" stools by
breastfed babies.-WHO
 CAUSES OF DIARRHOEA

• Diarrhoeal infections are caused by ingestion of

contaminated food and water, contamination by dirty
hands or exposure to faecal matter. Some common
germs that cause gastro-enteritis and subsequently
diarrhoea are:
• Bacteria. E.g. Salmonella or Escherichia (E. coli)
• Viruses. E.g. Notovirus or rotavirus
• Parasites. E.g. Giardia intestinalis
Causes of diarrhoea
 OTHER CAUSES

• Usually, diarrhea happens because of a virus that gets into your

gut. Some people call it "intestinal flu" or "stomach flu."
• Other causes include:
• Alcohol abuse
• Allergies to certain foods
• Diabetes
• Diseases of the intestines (such as Crohn's disease or ulcerative
colitis)
• Eating foods that upset the digestive system
• Infection by bacteria (the cause of most types of food poisoning)
or other organisms
 OTHER CAUSES

• Laxative abuse
• Medications
• Overactive thyroid (hyperthyroidism)
• Radiation therapy
• Some cancers
• Surgery on your digestive system
• Trouble absorbing certain nutrients, also called “malabsorption”
• Diarrhea may also follow constipation, especially for people who
have irritable bowel syndrome.
 DIARRHOEA CLASSIFICATION

• According to pathogens
• According to duration
• According to mechanism of diarrhoea
• According to clinical types of diarrhoea
 TYPES OF DIARRHOEA

Three clinical types of diarrhoea

Acute watery diarrhoea – lasts several hours or days, and
includes cholera
Acute bloody diarrhoea – also called dysentery
Persistent diarrhoea – lasts 14 days or longer.
CHARACTERISTICS OF STOOL
PROCESS OF DIARRHOEA
 SIGNS AND SYMPTOMS

• Loose, watery stools

• Abdominal cramps
• Abdominal pain
• Fever
• Blood in the stool
• Mucus in the stool
• Bloating
• Nausea
• Urgent need to have a bowel movement
 CLINICAL ASSESSMENT

Physiological measurements of six parameters

Respiratory rate
Oxygen saturation
Temperature
Systolic blood pressure
Pulse rate
Level of consciousness.
The score indicates whether an urgent medical referral is required.
The Malnutrition Universal Screening Tool (MUST) is useful to assess
rehydration and nutrition requirements (Todorovic et al, 2003).
 ANTIDIARRHOEAL MEDICATION

• Loperamide, or Imodium, is an antimotility drug that

reduces stool passage.
Loperamide and Imodium are both available to purchase
over-the-counter or online.
Bismuth subsalicylate, for example, Pepto-Bismol,
reduces diarrheal stool output in adults and children.
 MANAGEMENT OF DIARRHOEA

Diarrhoea stop fast

• A diet known as BRAT may also quickly relieve diarrhea.
• BRAT stands for bananas, rice, applesauce, and toast.
• This diet is effective due to the bland nature of these
foods, and the fact that they're starchy, low-fiber foods.
• These foods have a binding effect in the digestive tract
to make stools bulkier.
ORS preparation
 COMPLICATIONS OF DIARRHOEA

• Fluid loss with consequent dehydration,

• Electrolyte loss (sodium, potassium, magnesium, chloride)

• Hypotension (vascular collapse) sometimes occur. Collapse

can develop rapidly in patients who have severe diarrhea
(eg, patients with cholera) or are very young, very old, or
debilitated.
 PREVENTIVE MEASURES

• Access to safe drinking-water

• Use of improved sanitation
• Hand washing with soap
• Exclusive breastfeeding for the first six months of life
• Good personal and food hygiene
• Health education about how infections spread
• Rotavirus vaccination.
 REFERENCES

• NSW Ministry of Health (2012) Gastroenteritis in an

institution: Control Guideline for Public Health
Units, NSW Ministry of Health, Sydney

• Furyk, J.S,. Meek, R.A., Egerton-Warburton D.

(2015) Medicines in the treatment of emergency
department nausea and vomiting. The Cochrane
Collaboration, London.