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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Diarrhea - Loose Stools, Clostridium difficile (C. difficile)
Audrey Klopp, RN, PhD, ET, CS, NHA

NANDA: The state in which an individual experiences a change in normal bowel habits characterized by the frequent passage of loose, unformed stools

Diarrhea may result from a variety of factors, including intestinal absorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. Problems associated with diarrhea, which may be acute or chronic, include fluid and electrolyte imbalance and altered skin integrity. In the elderly, or those with chronic disease (such as acquired immunodeficiency syndrome [AIDS]), diarrhea can be life-threatening. Diarrhea may result from infectious (viral, bacterial, or parasitic) processes, primary bowel diseases (such as Crohn's disease), drug therapies (e.g., antibiotics), increased osmotic loads (e.g., tube feedings), radiation, or increased intestinal motility such as irritable bowel disease. Treatment is based on addressing the cause of the diarrhea, replacing fluids and electrolytes, providing nutrition (if diarrhea is prolonged and/or severe), and maintaining skin integrity. Health care workers and other caregivers must take precautions (e.g., diligent handwashing between patients) to avoid spreading diarrhea from person to person, including self.

Related Factors

Defining Characteristics

Expected Outcome

Patient passes soft, formed stool no more than three times per day.

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Assess for abdominal pain, cramping, frequency, urgency, loose or liquid stools, and hyperactive bowel sensations.
(c) Culture stool
To identify causative organisms.
(i) Inquire about the following:
(i) Check for history of the following:
(i) Assess impact of therapeutic or diagnostic regimens on diarrhea.
Preparation for radiography or surgery, and radiation or chemotherapy predisposes to diarrhea by altering mucosal surface and transit time through bowel.
(i) Assess hydration status, as in the following:
(i) Assess condition of perianal skin.
Diarrheal stools may be highly corrosive, as a result of increased enzyme content.
(i) Explore emotional impact of illness, hospitalization, and/or soiling accidents by providing privacy and opportunity for verbalization.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Give antidiarrheal drugs as ordered.
Most antidiarrheal drugs suppress GI motility, thus allowing for more fluid absorption.
(i) Provide the following dietary alterations as allowed:
(i) Check for fecal impaction by digital examination.
Liquid stool (apparent diarrhea) may seep past a fecal impaction.
(i) Encourage fluids; consider nutritional support
To compensate for malabsorption and loss of nutrients.
(i) Evaluate appropriateness of physician's radiograph protocols for bowel preparation on basis of age, weight, condition, disease, and other therapies.
Elderly, frail, or those patients already depleted may require less bowel preparation or additional intravenous (IV) fluid therapy during preparation.
(i) Assist with or administer perianal care after each bowel movement (BM)
To prevent perianal skin excoriation.
(i) For patients with enteral tube feeding, employ the following:

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Teach patient or caregiver the following dietary factors that can be controlled:
(i) Encourage reporting of diarrhea that occurs with prescription drugs.
There are usually several antibiotics with which the patient can be treated; if the one prescribed causes diarrhea, this should be reported promptly.
(i) Teach patient or caregiver the following measures that control diarrhea:
(i) Teach patient or caregiver the importance of fluid replacement during diarrheal episodes
To prevent dehydration.
(i) Teach patient or caregiver the importance of good perianal hygiene after each BM.
To control perianal skin excoriation and minimize risk of spread of infectious diarrhea.

NIC

Diarrhea Management; Enteral Tube Feeding; Teaching: Prescribed Medication

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