Health alterations - Diarrhea

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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


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