Health alterations - Diarrhea
Clinical manifestations
***Fl/electro imbalance*** abdo cramping boborygmus anorexia thirst tenesmus painful anal spasms fever
Secretory
- High volume diarrhea - Increased production and increased secretion of water/electrolytes from mucosa in intestines - Happens with certain infectious (E.Coli/Cholera) (rectal cancer) - from endogenous mediators (bacterial toxins/neoplasms)
Pedi considerations
- SERIOUS - usually infectious (Rota virus) --> VACCINATE - Chronic causes - lactose intol, celiac, IBD - in bbys - congenital or metabolic anomaly - pathophysiology same as adults
Osmotic Diarrhea
- Water is pulled into intestines by osmotic pressure - Slows reabsorption of water by undissolved particles - Common w/Lactose Intolerance, Blood in Intestines, Enteral Nutrition, pancreatic dysfxn, ,intestinal hemorrhage
Skin integrity w/ diarrhea/ incontinence
- briefs certainly don't help - barrier cream + top notch skin care - Q2 turns - rectal tubes w/ order (can be contraindicated, being phased out, not a great solution)
Fluid/Electro imbalances
- hypokalemia (muscle weakness, arrythmia, dec. peristalsis) - pt taking Digoxin have higher risk of tox. w/ hypokalemia - metabolic acidosis (bicarb loss and K+ loss)
C. Diff :)
- most common nosocomial inf. - bacterial dysentery - r/t: LT hospitalization + ICU large dose abx >7 days abx post pyloric tube fed pts - Leads to: DEATH, sepsis, peritonitis
Nurses role: assess + Monitor
-patterns/characteristics of diarrhea -amount * - current meds - med/surg hx - diet - I&O - recent illness? - travel? - abdo assessment - V/S - check S+S dehydration - bed rest + fl - BRAT, no caffeine or bubbles - antidiarrheal meds - LR (IV fl) - electrolytes
3 anatomic causes of diarrhea
1. increased secretions 2. decreased mucosal absorption 3. altered motility
Oral rehydration soln recipe
5 cups clean drinking water 8 tbs suga 1 tbs salt *90ish% effective * 2-4 L a day
AIDS
60-90% ppl have diarrhea w/ aids
Normal Stool Composition
75% fl. 25% stool - undigested food/inorganic material/h2o/bacteria
Acute diarrhea
< 2 weeks
Chronic Diarrhea
> 4 weeks
Diarrhea classic definition
>3/day >200 g/day increase urgency perianal discomfort ~liquid~ incontinence
C.Diff Risk factors
>65 y.o. immunocompromised chrn. abx chemo LT hospitalization ICU exposure surgery drugs that suppress gastric acid (PPIs)
When to call the doc
>three days severe abdo pain >102 temp bloody/tarry stool S+S dehydration <5 y.o >70 y.o. and other high riskers
Imodium (#1)
NURSES LOVE THIS SHIT decreases gastric activity not for infectious diarrhea
Dx tests
CBC Electrolytes Urinalysis Stool spec. (1 inch of poop) Endoscopy Barium Enema
Metabolic causes
Diabetes - nocturnal diarrhea (diabetic neuropathy) Addisons
Viral/Baterial/protozoal Causes
E. Coli Staph Aureus Campylobacter Cholerae salmonella norwalk virus giardia Ova + Parasites
Pt teaching
Mon. urine color (hydration) Avoid milk/fat/whole grains/fried/spicy ( low residue diet) Watch for bloody stool traveling precautions encourage fl. proper food storage avoid sugar subs
Bright Red poop
Lower GI bleed/ meds/ food coloring
pediatric dehydration mgmt
ORT ESSENTIAL IV fl. for mod-sev. Strict I&O Promote Skin integrity Promote nutrition reduce fear/anxiety
Narrow/ribbon poop
Spastic Colon or obstruction
Med causes
Stool Softeners broad spec. Abx Chemo drugs antiarrythmics/ anti-hypertensives Thyroid Hormone Replacement Drugs Milk of Magnesia Liquid Meds that contain SORBITOL
Mgmt of C.Diff
abx. - Metrodinazole(Flagyl) + Vanco (2nd line) partial colon resection IV fl./ electrolytes Encourage PO hydration Monitor hypovolemia Record I&O FMT CONTACT PREC. (WASH HANDS)
C. Diff S+S
watery diarrhea, mucus-y, loss of appetite, abd cramping, N/V, Fever
~Mixed Inc motility diarrhea
inc. peristalsis inc secretion dec. absorption
Blood/mucus
inflam. bowel, chrons, colitis
blood +puss poop
inflamed bowel from bacterial inf.
voluminous greasy stools
intestinal malabsorption
Fatty pasty greasy poop
intestinal malabsorption, pancreatic disease, cystic fibrosis
Tan Clay-y poop
liver gallblader
Oil droplets in poop
pancreatic insufficiency
Lactobacillus
preventative replaces flora of GI tract probiotics yogurt keeps ya regular
Yellow/green
severe/prolonged diarrhea
Lomotil
slight sedative effect Central opiate efx not your first choice avoid in febrile dysentery
watery stools vs semisolid loose stools
small intestine vs lg intestine
S+S Severe dehydration in bbys
sunken eyes / fontanels loss of skin turgor dry mucous membr. delay cap refill rapid thready pulse tachypnea cyanosis lethargy LOC change wt loss
Tarry/black stool
upper GI bleed / iron supplements
Intestinal obs
water/fl seep around blockage causing psuedodiarrhea
