Rabu, 11 Mei 2011

Nursing care in patients with diarrhea

| Rabu, 11 Mei 2011 | 0 komentar

DIARRHEA

courtesy by e d u
UNDERSTANDING
Diarrhea is the number of bowel movements with stools more than normal (normal 100-200 ml per hour) with the form of liquid or semi-liquid feces, can also be accompanied by an increased frequency defecation.
According to WHO diarrhea is watery bowel movements and more than 3 times a day.
Acute diarrhea is a sudden diarrhea and short duration, within a few hours to 7 days or until 14 days.
Chronic diarrhea is diarrhea that lasts more than 3 weeks.

ETIOLOGY
The cause is a bacterial diarrhea, parasites, or viruses (E.colli, V. cholerae, Aeromonas.SP.)
Another cause is a toxin, drug, food, chemotherapy, fecal impaction and other conditions.

CLINICAL MANIFESTATIONS
Patients with infections often experience diarrhea nausea, vomiting, abdominal pain to stomach cramps, fever and defecation increases with increasing fluid content in feces. spasmodic contraction of the pain and stretching is not effective in anal (tenesmus) can happen every defecation. lack of fluid causes the patient to feel thirsty, tongue dry, and decreased skin elasticity.
hypovolemic cause rapid pulse, decreased blood pressure, nervous, pale, cyanosis, in certain circumstances cause hypokalemia which which will lead to cardiac arrhythmia.

PATHOPHYSIOLOGY
Infectious diarrhea is usually transmitted through the fecal oral because of contaminated food or beverages feces excretion bad plus, the food is not cooked or undercooked. Transmission is person to person via aerosolization or contaminated hands.
Non-invasive bacteria produce a toxin that bound to the intestinal mucosa and increase levels of cyclic AMP in the cell causes active secretion of chloride anions into the intestinal lumen at follow water, carbonate ions, sodium and potassium cations.
Entero-invasive bacteria cause damage to the intestinal wall in the form of necrosis and ulceration, are secretory eksudatif. The liquid can be mixed with mucus and diarrhea with blood.

EXAMINATION SUPPORT
  • Laboratory tests are complete
  • Examination of blood gas analysis
  • Examination of urine and feces

MANAGEMENT
  • Rehydration as a priority treatment. on acute diarrhea can be given ORS, RL fluid or an isotonic Nacl plus 1 ampoule of 7.5% Sodium bicarbonate 50 ml.
  • Identify causes of diarrhea
  • Symptomatic therapy. anti-intestinal motility and secretion (loperamide / Imodium), anti-emetic (metokloperamide).
  • Definitive therapy. cotrimoxazol, cloramphenicol, metronidazole, Ampisillin.

NURSING MANAGEMENT
  1. Measures to control diarrhea by resting in bed, eating and drinking low-fiber to reduce the acute period, limit drinking caffeine and carbonates which stimulates intestinal motility.
  2. Maintaining fluid balance and encourage oral rehydration such as water, juice and broth.
  3. Reduce anxiety by supporting individual coping.
  4. perianal skin care to maintain cleanliness and humidity.
  5. Prevent infections that may occur and prevent the spread of disease through the hands, clothing, bed sheets and other objects.
  6. Monitoring and management of potential complications with the examination of serum electrolyte levels, vital signs and general condition.

COMPLICATIONS
  • Metabolic acidosis
  • Hypovolemic shock
  • Cardiac arrhythmias
  • Acute renal tubular necrosis

NURSING
  1. Physical examination: Patient's general condition: the objective data: body weakness, nausea, vomiting, abdominal pain. Subjective Data: decreased skin elasticity, cyanosis, pale, cold ektrimitas, anuria.
  2. Abdomen: abdominal cramps, hyper peristalsis.
  3. Skin: cold sweat, moisture, changes in skin elasticity.
  4. Neurological: decreased consciousness, seizures.
  5. Psychological: anxiety.
  6. Cardiovascular: Tachicardi, cardiac arrhythmia, shock.

NURSING DIAGNOSIS
  1. Diarrhea associated with the infection process
  2. Imbalance nutrition: less than the needs of biological factors associated with nausea and vomiting
  3. Fluid deficit associated with loss of fluid volume excess
  4. Anxiety associated with changes in health status
  5. Acute pain related to biological factors increasing intestinal motility

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