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- 2. DIARRHEA PRESENTED BY MR KAPILDEVSAHOO NURSING TUTOR VIMSAR,BURLA
- 3. DEFINITION OF DIARRHEA •Diarrhea is an increased frequency of bowel movements (more than 3 per day), an increased amount of stool (more than200g / day) and altered consistency(i,e ,increased liquidity ) . • DEFINITION OF DIARRHEA:- According to WHO • Diarrhea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual.
- 4. TYPES OF DIARRHEALDISEASE:- • 1.NON INFLAMMATORY DIARRHEA :- Intestinal infection ,such as cholera and Giardia ,are caused by an alteration in intestinal absorption of fluids .these type of infections result in large volumes of watery diarrhea, accompanied by cramps and bloating with mild or no fever . • 2.INFLAMMMATORY DIARRHEA:- Also known as dysentery, this kind of disease is characterized by smaller volumes of bloody diarrhea, accompanied with fever and pain . • It is caused by microbes, such as shigella and Entamoeba histolytica that invade the colon and trigger an inflammatory immune response .
- 5. DIARRHEA IS GENERALLY CLASSIFIEDBASEDON DURATION:- • Acute diarrhea- Acute diarrhea is most often associated with infection and usually self limiting, lasting up to 7 to 14 days . • Chronic diarrhea- Chronic diarrhea persist for more than 2 to 3 weeks and may return sporadically .
- 6. PATHOPHYSIOLOGY OF DIARRHEA •Secretory diarrhea is usually high volume of diarrhea .Often associated with bacterial toxins and neoplasm’s , It is caused by increased production and secretions of water and electrolytes by the intestinal mucosa into the intestinal lumen . • Osmotic diarrhea occurs when water is pulled in to the intestine by the osmotic pressure of unabsorbed particles, slowing the reabsorption of water .It can be caused by lactase deficiency , pancreatic dysfunction , or intestinal hemorrhage • Malabsorptive diarrhea combines mechanical and biochemical actions, inhibiting effective absorption of nutrients manifested by markers of malnutrition that include hypoalbuminemia . Low serum albumin levels lead to intestinal mucosa swelling and liquid stool . • Infectious diarrhea results from infectious agents invading the intestinal mucosa. • Clostridium difficile is the most commonly identified agent in antibiotics associated diarrhea in the hospital. • Exudative diarrhea is caused by changes in mucosal integrity, epithelial loss or tissue destruction by radiation or chemotherapy. • Notably , other causes of diarrhea also include laxative misuse
- 7. CAUSES OF DIARRHEA:- •CAUSES OF ACUTE INFECTIOUS DIARRHEA • VIRAL-Rota virus, • SYMPTOMS- • Fever, vomiting ,profuse watery diarrhea, last 3-8 days • SYMPTOMS • Norovirus • Nausea , vomiting ,diarrhea, stomach cramping. Rapid onset .Last 1-2 days • CONTINUEES……
- 8. • BACTERIA- E.coli •Nausea , vomiting, fever, Mean duration -.>60 hr • Shigella • Diarrhea (some times bloody),fever ,stomach cramps, • Usually lasts 5-7 days .post infections arthritis may occur . • Samonella • Diarrhea, fever, abdominal cramps, Last- 4 -7 days • Staphylococcus • Nausea , vomiting, abdominal cramps, diarrhea usually mild • Clostridium difficile • Watery Diarrhea ,fever, anorexia, nausea ,abdominal pain • Campylobacter jejuni • Diarrhea, abdominal cramps ,nausea , vomiting, Last about 7 days . • Clostridium perfringens • Diarrhea, abdominal cramps , nausea , vomiting, Occurs 8-12 hrs after eating contaminated food and lasts approximately 24 hr . • CONTINUEES………………
- 9. • PARASITIC- Giardialamblia • Abdominal cramps, nausea, diarrhea may interfere with nutrient absorption . • Entamoeba histolytica • Diarrhea ,abdominal cramping ,only 10-20 % are ill and symptoms are usually mild . • Cryptosporidium • Abdominal cramps, nausea, fever, dehydration, weight loss , some time no symptoms .Long lasting and may be fatal in those who are immunocompromised , (eg. AIDS)
- 10. OTHER CAUSES:- • Foodintolerances and sensitivities –Some people have difficulty digesting certain ingredients , such as lactose, the sugar found in milk and milk products . some people may have diarrhea if they eat certains types of sugar substitutes in excessive quantities . • Reactions to medicine- Antibiotics ,cancer drugs, and antacids can all cause diarrheas . • Stomach surgery
- 11. MODE OF TRANSMISSION:- •It is mainly feco –oral route .it is water borne ,food –borne disease or may transmit via fingers,fomites, flies or dirt.
- 12. RISK FACTORS :- •Food poisoning . • Eating foods that upset digestive system • Allergies to certain foods • Radiation therapy • Malabsorption • Hyperthyroidism • Some cancers • Laxative abuse • Alcohol abuse • Digestive tract surgery • Diabetes • Competitive running
- 13. CLINICAL MANIFESTATIONS • Frequent,loose watery stools • Loss of appetite. • Nausea and vomiting • Fever • Abdominal pains • Abdominal cramps • Dehydration (dry mouth or skin, excessive thirst, severe weakness, dark-colored urine and dizziness) • Pricking sensation • Some times bacterial or parasitic infections some time cause bloody stools • Bloating • Urgent need to have a bowel movement
- 14. DIAGNOSTIC EVALUATIONS:- • A.MEDICAL HISTORY & PHYSICAL EXAMINATION • The doctors will ask about eating habits and medication use and will perform a physical examination to look for signs of illness . • B .STOOL TESTS • Culture : A bacteria culture is used to identify bacterial species responsible for your infection . • Gram-stain: These stains can distinguish between two major classes (gram positive or gram negative ) bacteria and narrowing down what kind of infection you have . • Ova +Parasites testings: A stool sample is examine for the presence of parasites and / their Eggs . . • Fecal Leukocytes : Identification of WBC in your stools will inform your doctor that you have an inflammatory disease . • Toxin and Antigen Assay : Some infecations can be detected through these substances . • Continue……………
- 15. • C. BLOODTESTS • Serology: This method consist of drawing a blood sample and evaluating antibodies to identify microbes with which you have recently been infected . • Culture : A Blood sample is used to culture bacteria that may be responsible for infections . • D.SIGMOIDOSCOPY OR COLONOSCOPY • These tests may be used to look for sign of intestinal diseases that cause chronic diarrhea. • For sigmoidoscopy ,The doctors uses a thin ,flexible ,lighted tube with lens on the end to look at the inside of the rectum and lower part of the colon • Colonoscopy is similar to the sigmoidoscopy , but it allow the doctors to view the entire colon . •
- 16. MANAGEMENT OF DIARRHEA •Medical management : • (ORS) solution. Mechanisam- ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces. • Rehydration: with intravenous fluids in case of severe dehydration or shock. (RL,NS) • SPOROLAC POWDER (LACTIC ACID BACILLUS): s It works by maintaining a healthy balance of microflora in the intestine • CONTINUES………
- 17. • Antidiarrheal drugs: •1.:Bismuth subsalicylate : Taken as suspension (60ml - 6hrly) .Mechanism action-Decrease secretion & has weak antibacterial activity .used to prevent traveler diarrhea • 2. Loperamide: 4mg followed by 2 mg after each motion (max. 10 mg in a day ) 2mg BD for chronic diarrhea . Mechanism action- Inhibits peristalsis, Increases absorption of fluid from stools . • 3. Diphenoxylate : (2.5 mg) + atropine (0.025 mg) ,Dose- 5- 10 mg, followed by 2.5-5 mg 6 hourly . Mechanism action- Opoid and anticholinergic .decreases peristalsis and intestinal motility . • 4. Racecadotril : It is indicated in short term treatment of acute secretory diarrhoeas . • Dose-100mg (children 1.5mg /kg ) TDS for more than 7 days . •
- 18. SOME ANTIBIOTICS USE OFDIARRHEA: • • TAB .Metronindazole:- DOSE-250-500 mg t.id ,10-14 days .(Toxigenic clostridium difficile) • INJ .CEFTRIXONE :- DOSE -1gm b.d 5-7 Days ( sigella species) • Tab. Ofloxacin 200 mg and Ornidazole- 500mg . b.d • Inj.Amikacin 500 mg b.d
- 19. NURSING MANAGEMENT:• • NURSINGASSESSMENT:- • • Subjective Data:- • Important health information; - Past health history-Recent travel, infection, stress , malabsorption , metabolic disorders ,inflammatory bowel disease, irritable bowel syndrome . • Medications –Laxatives or enemas, magnesium containing antacids etc . • Surgery or other treatment;-Stomach or bowel surgery, radiation . • Functional health patterns: • Health perception-Health management: chronic laxative abuse , malaise . • Nutritional –metabolic : Ingestion of fatty & spicy foods ,food intolerances, anorexia ,nausea, vomiting, weight loss, thirst . • Elimition : Increased stool frequency ,volume ,and looseness ,change in color and character of stools ,steatorrhea, abdominal bloating ,decreased urine output . • Cognitive –perceptual : Abdominal tenderness ,abdominal pain • CONTINUEES………….
- 20. • Objective Data:- • General • Lethargy , sunken eyeballs, fever ,malnutrition . • • Integumentary; • Pallor ,dry mucous membranes, poor skin turgor, perianal irrition . • Gastrointestinal : • Frequent soft to liquid stools that may alternate with constipation altered stool color, abdominal distention ,hyperactive bowel sounds ,pus , blood ,mucus, or fat in stools ,fecal impaction . • Urinary : • Decreased output ,concentrated urine .
- 21. THE IMPORTANT NURSING DIAGNOSIS •Diarrhea related to acute infectious process • Deficient fluid volume related to excessive fluid loss and decreased fluid intake . • Impaired nutritional status ,less than body requirement related to malabsorption and poor oral intake . • Risk for cross infection related to infective loose motion . • Potential to Impaired skin integrity related to frequent passage of stools . • Fear and anxiety related to illness and hospital procedures. • Knowledge deficit related to causes of diarrhea and its prevention
- 22. • Nursing Intervention:- •Nursing diagnosis - 1 - Diarrhea related to acute infectious process • Nursing intervention – 1 • Wash your hands before and after contact with each patient & when handling body fluids of any kind . • Flush vomitus and stool & in the toilet. • Teach the patient and care giver to wash contaminated clothing immediately with soap and water • Teach the patient principle of hygiene , Infection control precautions, . • Discuss proper food handling ,cooking, & storage with the patient and care giver .
- 23. • Nursing diagnosis2- Deficient fluid volume related to excessive fluid loss and decreased fluid intake • Nursing intervention-2 • Encourages bed rest and intake of liquids and foods . • Give oral rehydration salts (ORS) solution. • Avoid caffeine, Carbonated beverages & very hot and very cold foods . • Administers antidiarrheal medications such as diphenoxylate, loperamide , as prescribed . • Administer RL Fluid for rapid rehydration
- 24. • Nursing diagnosis– 3- Risk for cross infection related to infective loose motion . • Nursing intervention- 3- • Prevention of infection by good hand washing practice . • Hygienic disposal of stools . • Maintain general cleanliness and universal precautions . • Provide private rooms patient with C.difficile infection and ensure that visitors and HCP wear gloves and gowns . • Infected patients must be given their own disposable stethoscopes and their mometers .
- 25. PREVENTION OF DIARRHEA •Key measures to prevent diarrhea include: • access to safe drinking-water . • use of improved sanitation . • hand washing with soap . • good personal and food hygiene . • health education about how infections spread ..
- 26. COMPLICATIONS • Dysrhythmias -(because of significant fluids and electrolytes loss especially loss of potassium . • Oliguria -Urinary output of less than 30 ml per hour for 2 to 3 consecutive hours • Muscle weakness • Paresthesia (prickling sensation) • Hypotension • Anorexia • Irritant Dermatitis
- 27. The "Simple Solution"- Home made Oral Rehydration Salts (ORS) Recipe Six (6) level teaspoons of Sugar. Half (1/2) level teaspoon of Salt. One Litre of clean drinking or boiled water and then cooled - 5 glass (each glass about 200 ml.)