Wednesday, August 20, 2014

Nursing Care Plan - Diarrhea : Assessment and Diagnosis

Nursing Care Plan for Diarrhea
Nursing Care Plan for Diarrhea

Diarrhea is a disease characterized by increased frequency of defecation more than usual (more than 3 times / day) accompanied by a change in stool consistency (a liquid), with / without blood and / or mucus (Suraatmaja, 2007).

Around the world there are approximately 500 million children suffer from diarrhea each year, and 20% of all deaths in children living in developing countries associated with diarrhea and dehydration. Diarrheal disorders can involve the stomach and intestines (gastroenteritis), small intestine (enteritis), colon (colitis) or colon and intestines (enterocolitis). Diarrhea is usually classified as acute and chronic diarrhea (Wong, 2009).

Diarrhea is a condition of increased fecal weight (more than 200 mg / day) which can be attributed to increased fluid, the frequency of bowel movement, not feeling the perianal, and a sense of urgency for bowel movements with or without fecal incontinence. Diarrhea is divided into Acute and Chronic diarrhea. Acute diarrhea lasts 2 weeks or less, while chronic diarrhea duration of more than 2 weeks. Further discussion regarding devoted chronic diarrhea (Hooward, 1995 cit Sutadi 2003).


Classification

According to WHO (2005) diarrhea can be classified to:
  • Acute diarrhea, ie diarrhea lasting less than 14 days.
  • Dysentery, the diarrhea is accompanied by blood.
  • Persistent diarrhea, the diarrhea that lasts more than 14 days.
  • Diarrhea accompanied by severe malnutrition.

According to Ahlquist and Camilleri (2005), diarrhea divided into:
  • Acute, if less than 2 weeks, persistent if it lasts for 2-4 weeks. More than 90% of the causes of acute diarrhea are the causative agents of infectious and will be accompanied by vomiting, fever and abdominal pain. 10% were caused by the treatment, intoxication, ischemia and other conditions.
  • Chronic, if it lasts more than 4 weeks. In contrast to acute diarrhea, a common cause of chronic diarrhea caused by non-infectious causes such as allergic and others.
According Kliegman, Marcdante and Jenson (2006), states that based on the amount of loss of fluid and electrolytes from the body, diarrhea can be divided into:
  • Diarrhea without dehydration: At this rate of diarrhea sufferers do not become dehydrated because of diarrhea frequency is still within tolerable limits and there are no signs of dehydration.
  • Diarrhea with mild dehydration (3% -5%): At this level patients with diarrhea 3 times or more, sometimes vomiting, thirsty, have decreased urination, decreased appetite, activity has begun to decline, the pressure pulse is normal or tachycardia minimum and a physical examination within normal limits.
  • Diarrhea with moderate dehydration (5% -10%): In this situation, the patient will experience tachycardia, urinating less or no, irritability or lethargy, eye and large fontanel becomes concave, reduced skin turgor, mucous membranes of the lips and mouth and the skin appears dry, reduced tear and the elongated capillary refill (greater or equal to 2 seconds) with skin cold and pale.
  • Diarrhea with severe dehydration (10% -15%): In this situation, the patient has lost a lot of fluid from the body and is usually in a state of patients experienced tachycardia with weak pulse, hypotension and pulse pressure spreads, no urine output, eyes and large fontanel becomes very concave, no tear production, not being able to drink and the situation began to apathy, decreased consciousness and also the very elongated capillary refill (greater or equal to 3 seconds) with a cold and pale skin.


Nursing Care Plan for Diarrhea

Assessment

1. Identity
Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. Highest incidence is 6-11 months age group. Most bacteria stimulate gut immunity against infection, it helps explain the decline insidence disease in older children. At the age of 2 years or more of active immunity begins to form. Most cases are due to intestinal infection and asymptomatic enteric bacteria spread mainly clients are not aware of the infection. Economic status also influential, especially from the diet and treatment.

2 The main complaint
Defecate more than 3 times, vomiting, diarrhea, bloating, fever.

3. History of present illness
Defecating yellow-green color, mixed with mucus and blood or mucus only. Watery consistency, frequency is more than 3 times, spending time: 3-5 days (acute diarrhea), more than 7 days (prolonged diarrhea), more than 14 days (chronic diarrhea).

4. Past medical history
Never before have diarrhea, use of antibiotics or corticosteroids long term (candida albicans changes from saprophyte become parasites), food allergies, respiratory infections, UTI, OMA measles.

5. History of nutrition
At toddler age children are given food as in adults, the portion given 3 times per day with additional fruit and milk. Malnutrition in children toddler age are particularly vulnerable. The way good food management, food hygiene and sanitation, hand washing habits.

6. Family health history
There is one family that is experiencing diarrhea.

7 History of environmental health
Food storage at room temperature, less hygiene, neighborhood.


Nursing Diagnosis for Diarrhea
  1. Diarrhea
  2. Hyperthermia
  3. Deficient Fluid Volume
  4. Anxiety: parents
  5. Deficient Knowledge : on diarrheal disease
  6. Decreased cardiac output
  7. Ineffective breathing pattern
  8. Activity intolerance
 

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