Diarrhea Nursing Care Plan

Actual Nursing Care Plan example from Nursing for Life Organization

1. Nursing Care Plan
"Diarrhea"
Patient
Problem
( Actual )
Nursing diagnosis \ Diarrhea related to (contributing factor according to the
patient’s condition)
Subjective
Data
 According to the nurse’s observation.
Objective
Data
 According to the patient description.
Objectives

Short term


In 2 days, the patient will…

 Will explain cause of diarrhea and rationale for treatment.

 Report less diarrhea within 36 hours.

 Will consume at least 1500-2000 mL of clear liquids within 24 hours period.


Long term
In 2 weeks, the patient will…

 Patient maintains good skin turgor and weight at usual level.
 Patient maintains a rectal area free of irritation.
 Patient states relief from cramping and less or no diarrhea.
Nursing intervention

Assessment


 Assess for abdominal discomfort, pain, cramping, frequency, urgency,
loose or liquid stools, and hyperactive bowel sensations.
- Rationale: These assessment findings are usually linked with diarrhea.

 Evaluate pattern of defecation.
- Rationale: Assessment of defecation pattern will help direct treatment.

 Culture stool.
- Rationale: Testing will distinguish potential etiological organisms for the
diarrhea.

2.  Assess tolerance to milk and other dairy products.
- Rationale: Diarrhea is a typical indication of lactose intolerance. Patients
with lactose intolerance have insufficient lactase, the enzyme that digests
lactose. The presence of lactose in the intestines increases osmotic
pressure and draws water into the intestinal lumen.

 Assess food intolerances
- Rationale: Foods may trigger intestinal nerve fibers and cause increased
peristalsis. Some foods will increase intestinal osmotic pressure and draw
fluid into the intestinal lumen. Spicy, fatty, or high-carbohydrate foods;
caffeine; sugar-free foods with sorbitol; or contaminated tube feedings
may cause diarrhea.

 Assess medications the patient is or has been taking
- Rationale: Drugs such as laxatives and antibiotics usually cause diarrhea.
magnesium and calcium supplements can also cause diarrhea.

 Assess change in eating pattern
- Rationale: Alterations in eating schedule can cause changes in intestinal
function and can lead to diarrhea.

 Assess for fecal impaction
- Rationale: Liquid stool (apparent diarrhea) may seep past fecal impaction.

Interventions

 Weigh patient daily and note decreased weight.
- Rationale: An accurate daily weight is an important indicator of fluid
balance in the body.

 Have patient keep a diary that includes the following: time of day
defecation occurs; usual stimulus for defecation; consistency, amount,
and frequency of stool; type of, amount of, and time food consumed; fluid
intake; history of bowel habits and laxative use; diet; exercise patterns;
obstetrical/gynecological, medical, and surgical histories; medications;
alterations in perianal sensations; and present bowel regimen.
- Rationale: Evaluation of defecation pattern will help direct treatment.

 Avoid using medications that slow peristalsis. If an infectious process is
occurring, such as Clostridium difficile infection or food poisoning,
medication to slow down peristalsis should generally not be given.
- Rationale: The increase in gut motility helps eliminate the causative
factor, and use of antidiarrheal medication could result in a toxic
megacolon.

3.  Give antidiarrheal drugs as ordered.
- Rationale: Most antidiarrheal drugs suppress gastrointestinal motility,
thus allowing for more fluid absorption. Supplements of beneficial
bacteria (“probiotics”) or yogurt may reduce symptoms by reestablishing
normal flora in the intestine.

 Avoid the use of rectal Foley catheters.
- Rationale: Rectal Foley catheters can cause rectal necrosis, sphincter
damage, or rupture, and the nursing staff may not have the time to
properly follow the necessary and very time-consuming steps of their care.

 Record number and consistency of stools per day; if desired, use a fecal
incontinence collector for accurate measurement of output.
- Rationale: Documentation of output provides a baseline and helps direct
replacement fluid therapy.

 Evaluate dehydration by observing skin turgor over sternum and
inspecting for longitudinal furrows of the tongue. Watch for excessive
thirst, fever, dizziness, lightheadedness, palpitations, excessive cramping,
bloody stools, hypotension, and symptoms of shock.
- Rationale: Severe diarrhea can cause deficient fluid volume with extreme
weakness and cause death in the very young, the chronically ill, and the
elderly.

 Monitor and record intake and output; note oliguria and dark,
concentrated urine. Measure specific gravity of urine if possible.
- Rationale: Dark, concentrated urine, along with a high specific gravity of
urine, is an indication of deficient fluid volume.

 Provide perianal care after each bowel movement.
 Cleanse with a mild cleansing agent (perineal skin cleanser).
 Apply protective ointment prn.
 If skin is still excoriated and desquamated, apply a wound hydrogel.
- Rationale: Mild cleansing of the perianal skin after each bowel movement
will prevent excoriation. Barrier creams can be used to protect the skin.

Health Teac
hing

 Instruct the patient to have Bulk fiber (e.g., cereal, grains, Metamucil)
- Rationale: Bulking agents and dietary fibers absorb fluid from the stool
and help thicken the stool.

 Avoidance of stimulants (e.g., caffeine, carbonated beverages)
- Rationale: Stimulants may increase gastrointestinal motility and worsen
diarrhea.

4.  Encourage fluids 1.5 to 2 L/24 hr plus 200 mL for each loose stool in adults
unless contraindicated; consider nutritional support.
- Rationale: Increased fluid intake replaces fluid lost in the liquid stool.

 Encourage patient to eat small, frequent meals and to consume foods that
normally cause constipation and are easy to digest.
- Rationale: Bland, starchy foods are initially recommended when starting
to eat solid food again.

 Educate the patient or caregiver about the following dietary measures to
control diarrhea:
 Avoid spicy, fatty foods, alcohol, and caffeine.
 Broil, bake, or boil foods; avoid frying.
 Avoid foods that are disagreeable.
- Rationale: These dietary changes can slow the passage of stool through
the colon and reduce or eliminate diarrhea.

 Educate patient or caregiver the proper use of antidiarrheal medications
as ordered.
- Rationale: Appropriate use of antidiarrheal medications can promote
effective bowel elimination.

 Discuss the importance of fluid replacement during diarrheal episodes.
- Rationale: Fluid intake is necessary to prevent dehydration.

 Educate patient and SO on how to prepare food properly and the
importance of good food sanitation practices and handwashing.
- Rationale: These could prevent outbreaks and spread of infectious
diseases transmitted through fecal-oral route.


Evaluation

Achieved ( ) Partially achieved ( ) Not achieved ( )
Evidence by:


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