Primary Nursing Diagnosis

Diarrhea related to increased intestinal motility

OUTCOMES. Bowel elimination; Electrolyte and acid/base balance; Fluid balance; Hydration; Infection status; Nutritional status: Food and fluid intake

INTERVENTIONS. Diarrhea management; Fluid/electrolyte management; Fluid monitoring; Perineal care; Skin surveillance; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

Many intestinal infections are short-lived (24 to 48 hours) and are adequately treated by resting the colon and with rehydration. The patient is instructed to take nothing by mouth until vomiting stops. Early fluid and electrolyte replacement is critical for debilitated, aged, and very young patients. Clear liquids are started slowly until tolerance is evaluated. Gatorade or other drinks with electrolytes are preferred to water. Oral rehydration therapy with products such as Resol may be used for elderly patients. The patient may advance to bland solids within 24 hours. When rapid dehydration occurs, the patient is admitted to the hospital for intravenous fluid replacement with solutions such as half-strength normal saline solution to prevent serious complications or possible death. Electrolytes such as potassium may be added to intravenous solutions, depending on the patient's blood chemistry results.

It is mandatory to notify the local health department for cases of shigellosis and in some areas mandatory to notify for Campylobacter enteritis. Check with the local and state health department guidelines for reporting gastroenteritis.

Antiemetics and anticholingerics are contraindicated because they slow the motility of the bowel, which interferes with evacuating the causative organism. The longer the infectious agent is in contact with the intestinal wall, the more severe the infection.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Antidiarrheal agents

Varies with drug

Kaolin-pectin (Kaopectate); bismuth subsalicylate (Pepto-Bismol)

Coat the intestinal wall and decrease intestinal secretions

Anti-infectives

Varies with drug

Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Combat Shigellosis enteritis

Antibiotics

Varies with drug

Ampicillin; tetracycline; hydrochloride; rifaximin

Combat infection if leukocytes are present in stools

Independent

Provide for periods of uninterrupted rest, which often helps decrease the patient's symptoms. The patient with gastroenteritis is anxious and weak from vomiting and diarrhea. Explain the rationale for the treatment regimen of having no oral intake, maintaining bedrest, and administering intravenous fluids. Measure all urine, emesis, and loose stools. Tell the patient to call for assistance to use the bathroom, and explain the use of the commode "hat" for the purpose of measuring output. Try to place the patient in a private room to decrease embarrassment about the frequent, foul-smelling stools and to limit cross-contamination. Encourage the patient to wash his or her hands carefully after each stool and after performing perianal care; make sure all staff use good hand-washing techniques and universal precautions when dealing with stool and vom-itus to prevent disease transmission.

To prevent excoriation, provide skin protective agents and creams (petroleum jelly, zinc oxide) to apply around the anal region. Teach the patient to cleanse with water or barrier cleanser spray, wipe with cotton pads, and apply the cream after each bowel movement. Inspect the perineal area daily for further breakdown. Sitz baths for 10 minutes two to three times per day are helpful for perianal discomfort.

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