Diarrhea Nursing Diagnosis Care Plan: Comprehensive Guide for Nurses

What is Diarrhea?

Diarrhea is characterized by an increase in the frequency of bowel movements, accompanied by stools that are loose or watery in consistency and increased in volume. This common condition can stem from a multitude of underlying causes, ranging from disruptions in intestinal absorption and secretion to motility issues. Specifically, diarrhea may arise due to malabsorption syndromes, where the intestine fails to properly absorb nutrients, or it can be triggered by an elevated secretion of fluids from the intestinal mucosa. Hypermotility of the intestine, meaning overly rapid movement of intestinal contents, is another significant factor.

Beyond these physiological mechanisms, diarrhea can also be a symptom of various health issues. Infections, whether viral, bacterial, or parasitic, are frequent culprits. Inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis, medication side effects, increased osmotic loads in the intestine, and radiation therapy can all induce diarrhea. Furthermore, conditions that accelerate intestinal motility, like certain neurological disorders or irritable bowel syndrome (IBS), can also lead to this condition.

Diarrhea exists on a spectrum of severity. Mild cases are often self-limiting, resolving within a few days with simple home care. However, severe diarrhea poses significant health risks, primarily dehydration and malnutrition. The complications associated with diarrhea extend beyond just fluid loss. Patients may experience fluid and electrolyte imbalances, which can disrupt vital bodily functions. Nutritional deficits can occur due to malabsorption and increased nutrient loss. Additionally, frequent bowel movements and watery stools can compromise skin integrity in the perianal area, leading to discomfort and potential infection. Crucially, in cases of infectious diarrhea, meticulous hygiene and infection control measures are paramount to prevent the spread of pathogens to both healthcare providers and other patients.

Causes of Diarrhea

Diarrhea can be triggered by a wide array of factors. Understanding these causes is crucial for effective diagnosis and management. Here’s a detailed list of common causes:

Anxiety: Psychological stress and anxiety can significantly impact the gastrointestinal system, leading to increased bowel motility and diarrhea.
Alcohol Abuse: Chronic alcohol consumption can irritate the gastrointestinal tract, disrupt normal bowel function, and result in diarrhea.
Chemotherapy: Many chemotherapy drugs have diarrhea as a common side effect, as they can damage the rapidly dividing cells of the intestinal lining.
Dietary Factors: Certain dietary choices can provoke diarrhea.
- Disagreeable Dietary Intake: Food intolerances or sensitivities, as well as consumption of spoiled or contaminated food, can lead to diarrhea.
Enteric Infections: Infections of the gastrointestinal tract are a major cause of diarrhea globally.
- Viral Infections: Viruses like norovirus and rotavirus are common causes of acute infectious diarrhea, often referred to as “viral gastroenteritis” or “stomach flu.”
- Bacterial Infections: Bacteria such as Salmonella, Campylobacter, E. coli, and C. difficile can cause diarrhea, often through food poisoning or contaminated water.
- Parasitic Infections: Parasites like Giardia lamblia and Cryptosporidium can infect the intestines and cause persistent diarrhea, particularly in areas with poor sanitation.
Gastrointestinal Disorders: Underlying conditions affecting the digestive system can manifest with diarrhea.
- Inflammatory Bowel Disease (IBD): Crohn’s disease and ulcerative colitis are chronic inflammatory conditions that frequently cause diarrhea, abdominal pain, and other gastrointestinal symptoms.
- Irritable Bowel Syndrome (IBS): While IBS is characterized by a range of bowel symptoms, diarrhea-predominant IBS (IBS-D) is a common subtype.
Increased Secretion: Certain conditions can cause the intestines to secrete excessive fluids, leading to diarrhea.
Laxative Abuse: Overuse or misuse of laxatives can disrupt normal bowel function and induce chronic diarrhea.
Malabsorption: Conditions that impair nutrient absorption can result in diarrhea.
- Lactase Deficiency (Lactose Intolerance): Inability to digest lactose, the sugar in milk, leads to diarrhea after consuming dairy products.
- Celiac Disease: An autoimmune reaction to gluten damages the small intestine and can cause malabsorption and diarrhea.
- Short Bowel Syndrome: Occurs after surgical removal of a significant portion of the small intestine, leading to reduced absorption capacity and diarrhea.
Motor Disorders: Disruptions in the normal muscle contractions of the intestines can cause diarrhea.
- Irritable Bowel Syndrome (IBS): As mentioned earlier, IBS can involve motility disturbances.
Mucosal Inflammation: Inflammation of the intestinal lining, as seen in IBD, directly contributes to diarrhea.
- Crohn’s Disease: Causes chronic inflammation throughout the digestive tract.
- Ulcerative Colitis: Inflammation primarily affects the colon and rectum.
Radiation Therapy: Radiation to the abdominal or pelvic area can damage the intestinal lining, leading to radiation-induced diarrhea.
Side Effects of Medication Use: Many medications can cause diarrhea as a side effect.
- Antibiotics: Disrupt the normal balance of gut bacteria, often leading to antibiotic-associated diarrhea.
- Metformin: A common diabetes medication that can cause gastrointestinal side effects, including diarrhea.
- Laxatives: As mentioned under laxative abuse, even prescribed laxatives, if not managed properly, can contribute to diarrhea.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Can irritate the gastrointestinal lining.
- Certain Antihypertensives and Antiarrhythmics: Some medications for blood pressure and heart rhythm disorders can have diarrhea as a side effect.
- Magnesium-based Antacids: Magnesium citrate and magnesium hydroxide, common in antacids, can have a laxative effect.
Stress: Similar to anxiety, general stress can impact bowel function and contribute to diarrhea in some individuals.
Surgical Procedures: Certain surgeries can disrupt normal bowel function.
- Bowel Resection: Removal of a portion of the intestine can alter digestion and absorption, leading to diarrhea.
- Gastrectomy: Partial or complete removal of the stomach can affect digestion and gastric emptying, potentially causing diarrhea.
Tube Feedings (Enteral Nutrition): Diarrhea is a potential complication of tube feeding.
- Hyperosmolar Feedings: Formulas with high osmolality can draw water into the intestine, causing diarrhea.
- Formula Composition: Certain components of formulas may be poorly tolerated by some patients.
- Bacterial Contamination: Improper handling or storage of feeding formulas can lead to bacterial contamination and infectious diarrhea.

Signs and Symptoms of Diarrhea

Patients experiencing diarrhea may present with a variety of signs and symptoms. Recognizing these is essential for prompt assessment and intervention. Common symptoms include:

Abdominal Pain: Discomfort in the abdomen, which can range from mild to severe.
Cramping: Spasmodic pains in the abdomen, often associated with bowel contractions.
Frequency of Stools (more than 3/day): An increase in the number of bowel movements beyond what is normal for the individual, typically defined as more than three per day.
Hyperactive Bowel Sounds (borborygmi) or Sensations: Increased rumbling or gurgling sounds from the abdomen due to increased intestinal activity. Patients may also report a heightened awareness of bowel movements.
Loose or Liquid Stools: The hallmark symptom of diarrhea is a change in stool consistency, becoming watery, mushy, or liquid.
Urgency: A sudden and compelling need to defecate, often difficult to control.

Nursing Diagnosis for Diarrhea

Following a comprehensive nursing assessment, formulating accurate nursing diagnoses is crucial for developing an effective care plan. These diagnoses are based on the nurse’s clinical judgment and understanding of the patient’s specific condition and needs related to diarrhea. While standardized nursing diagnoses provide a framework for care, their application should always be individualized to the patient and the clinical setting. The nurse’s expertise is paramount in prioritizing diagnoses and tailoring the care plan to best meet the patient’s needs.

Here are primary nursing diagnoses commonly associated with diarrhea:

Diarrhea: This is the primary diagnosis when the patient is experiencing frequent, loose, watery stools. It is crucial to specify the characteristics of the diarrhea and contributing factors if known.
Risk for Deficient Fluid Volume: Diarrhea significantly increases the risk of dehydration due to excessive fluid loss. This diagnosis is applicable to all patients with diarrhea, but especially those with severe diarrhea, infants, young children, and the elderly.
Deficient Fluid Volume: This diagnosis is used when the patient exhibits signs and symptoms of dehydration, such as dry mucous membranes, decreased skin turgor, decreased urine output, and changes in vital signs.
Impaired Skin Integrity: Frequent, loose stools, especially if acidic, can irritate and damage the perianal skin. This diagnosis is relevant for patients experiencing frequent diarrhea and showing signs of skin breakdown in the perianal area.
Imbalanced Nutrition: Less Than Body Requirements: Chronic or severe diarrhea can lead to malabsorption and nutrient loss, increasing the risk of nutritional deficits. This diagnosis is considered for patients with prolonged diarrhea, significant weight loss, or evidence of malnutrition.
Risk for Electrolyte Imbalance: Diarrhea can lead to significant losses of electrolytes, such as sodium, potassium, and bicarbonate. This diagnosis is relevant for patients with severe or prolonged diarrhea, particularly those with pre-existing electrolyte imbalances or underlying medical conditions.
Anxiety: The unpredictable nature of diarrhea, especially fecal incontinence, can cause significant anxiety and distress for patients. This diagnosis is appropriate when the patient expresses or demonstrates anxiety related to diarrhea or bowel control.
Social Isolation: Fear of incontinence and embarrassment associated with diarrhea can lead to social withdrawal and isolation. This diagnosis may be considered for patients who are limiting their social activities due to diarrhea.
Knowledge Deficit: Patients may lack knowledge about the causes of diarrhea, self-management strategies, and when to seek medical attention. This diagnosis is pertinent when patient education is a key component of the care plan.

Goals and Expected Outcomes for Diarrhea

The overarching goals for nursing care related to diarrhea are focused on resolving the diarrhea, preventing complications, and promoting patient comfort and well-being. Specific goals and expected outcomes include:

Patient will experience a decrease in the frequency of bowel movements to their normal pattern within [specify time frame, e.g., 24-48 hours]. This goal directly addresses the primary symptom of diarrhea and aims to restore normal bowel function.
Patient will have formed stools of normal consistency within [specify time frame, e.g., 24-48 hours]. This outcome focuses on improving stool consistency, moving away from liquid or loose stools towards a more solid form.
Patient will maintain adequate fluid balance, as evidenced by moist mucous membranes, good skin turgor, stable vital signs, and urine output within normal limits. This goal addresses the risk of dehydration and ensures the patient remains adequately hydrated throughout the episode of diarrhea.
Patient will demonstrate balanced electrolytes, as evidenced by laboratory values within normal limits and absence of signs and symptoms of electrolyte imbalance. This outcome focuses on preventing or correcting electrolyte imbalances that can arise from fluid and electrolyte losses due to diarrhea.
Patient will maintain perianal skin integrity, free from redness, irritation, or breakdown. This goal aims to prevent skin complications associated with frequent bowel movements and watery stools by implementing appropriate skin care measures.
Patient will verbalize relief or decrease in abdominal discomfort and cramping. This outcome focuses on symptom management and improving patient comfort by addressing abdominal pain and cramping.
Patient will demonstrate understanding of the causes of diarrhea, appropriate dietary modifications, medication management, and self-care measures to prevent recurrence. This goal emphasizes patient education and empowerment, enabling them to actively participate in their care and prevent future episodes of diarrhea.
Patient will express reduced anxiety and improved comfort related to bowel elimination. This outcome addresses the psychological impact of diarrhea and aims to improve the patient’s emotional well-being and confidence in managing their bowel function.
Patient will resume normal activities of daily living and social interactions without fear or embarrassment related to diarrhea or bowel incontinence. This goal focuses on restoring the patient’s quality of life and minimizing the social impact of diarrhea.

Nursing Assessment and Rationales for Diarrhea

A thorough nursing assessment is fundamental in understanding the patient’s diarrhea, identifying potential underlying causes, and guiding the development of an individualized care plan. Each assessment parameter has a specific rationale, providing valuable insights into the patient’s condition.

1. Assess for abdominal discomfort, pain, cramping, frequency, urgency, loose or liquid stools, and hyperactive bowel sensations.

Rationale: These are the cardinal signs and symptoms of diarrhea. It’s crucial to understand the patient’s subjective experience of these symptoms. Patients may define diarrhea differently, focusing on stool consistency, frequency, urgency, or incontinence. Normal stool frequency varies widely, from three times a week to three times a day. Increased frequency and altered stool consistency are key diagnostic criteria for diarrhea, particularly acute diarrhea. Many patients with acute diarrhea, regardless of the cause, experience associated symptoms like gas, bloating, flatulence, nausea, vomiting, and abdominal pain. Abdominal pain can vary in character (cramp-like, achy, dull, sharp) and location. Rapid transit of intestinal contents, caused by excessively fast entry of chyme into the intestines, contributes to these symptoms.

2. Evaluate the pattern of defecation.

Rationale: Bowel habits are highly individual. What is “normal” varies from person to person. Establishing the patient’s baseline defecation pattern is essential for determining if diarrhea represents a deviation from their usual bowel function. A change from their typical pattern is a significant indicator.

3. Culture stool.

Rationale: Stool cultures are essential for identifying infectious agents (bacteria, parasites, viruses) that may be causing the diarrhea. Stool examinations can also detect bacterial toxins, blood, fat, electrolytes, white blood cells, and other components that help determine the etiology of diarrhea. Identifying the causative organism is crucial for guiding appropriate treatment, particularly in cases of infectious diarrhea.

4. Determine tolerance to milk and other dairy products.

Rationale: Lactose intolerance is a common cause of diarrhea. Lactose, the sugar in milk, requires the enzyme lactase for digestion. In lactose intolerance, lactase deficiency leads to undigested lactose in the intestines, increasing osmotic pressure and drawing water into the intestinal lumen, resulting in diarrhea. Lactose intolerance can be diagnosed through a lactose breath hydrogen test, which measures hydrogen levels in breath after lactose consumption.

5. Determine intolerances to food.

Rationale: Food intolerances, distinct from food allergies, can trigger diarrhea. Certain foods can irritate intestinal nerve fibers, increasing peristalsis and leading to diarrhea. Some foods increase intestinal osmotic pressure, drawing fluid into the intestinal lumen. Common culprits include spicy, fatty, or high-carbohydrate foods; caffeine; sugar-free foods with sorbitol; and contaminated tube feedings. A food and symptom diary can help identify specific food triggers. Food allergies, while also potentially causing diarrhea, involve an immune response and often present with other symptoms like hives, itching, congestion, and throat tightness.

6. Determine methods of food preparation.

Rationale: Improper food handling and preparation are significant risk factors for infectious diarrhea. Inadequately cooked food, food contaminated during preparation, foods not stored at appropriate temperatures, or contaminated tube feedings can all introduce bacteria and cause diarrhea. Food safety education interventions, particularly focusing on mothers and children, have demonstrated a significant reduction in diarrhea incidence by improving knowledge and practices related to safe food handling.

7. Review the medications the patient is or has been taking.

Rationale: Medications are a frequent cause of diarrhea. Many drug classes can induce diarrhea, including thyroid hormone replacement, stool softeners, laxatives, prokinetic agents, antibiotics, chemotherapy drugs, antiarrhythmics, antihypertensives, and magnesium-based antacids. Antibiotics are a particularly common cause of hospital-acquired diarrhea, affecting a significant percentage of patients receiving broad-spectrum antibiotics.

8. Assess changes in eating habits and behaviors.

Rationale: Eating habits significantly impact digestive function. Poor eating habits can disrupt normal bowel function and contribute to diarrhea. Specific habits to assess include:
- Eating too quickly: The stomach takes time to signal fullness to the brain. Eating rapidly can lead to overeating and digestive distress.
- Gulping down food: Swallowing air while eating can lead to trapped gas, bloating, and poor digestion.
- Eating big, heavy meals: Large meals require more digestive effort and can overwhelm the system.
- Eating late at night: Digestive processes are generally less efficient later in the day.

9. Review osmolality of tube feedings.

Rationale: Hyperosmolar tube feedings can draw excessive fluid into the gut, stimulating peristalsis and causing diarrhea. Other factors related to enteral nutrition, such as formula composition, administration method, and bacterial contamination, can also contribute. It’s essential to rule out other causes of diarrhea before altering or discontinuing tube feedings. Conditions like diabetes, malabsorption syndromes, infections, gastrointestinal complications, and concurrent medications should be considered.

10. Assess stress levels.

Rationale: Stress can significantly impact gastrointestinal function. In some individuals, stress triggers hyperactivity of the gastrointestinal tract. The “fight-or-flight” response to stress releases hormones that prepare the body for action. This response also signals the bowels to increase motility, potentially leading to diarrhea.

11. Assess for fecal impaction.

Rationale: Paradoxical diarrhea, also known as overflow diarrhea, can occur in the presence of fecal impaction. Liquid stool may seep around the impacted stool, mimicking diarrhea. It’s important to differentiate this from true diarrhea, as the management approach is different.

12. Determine hydration status by assessing input and output.

Rationale: Diarrhea leads to fluid loss, and prolonged or severe diarrhea can result in dehydration. Accurate monitoring of fluid intake and output is crucial for assessing the extent of fluid loss and guiding fluid replacement therapy. Dehydration occurs when fluid loss exceeds fluid intake, leading to insufficient fluid for normal bodily functions.

13. Assess moisture of mucous membranes.

Rationale: Dry mucous membranes are a classic sign of dehydration. Assessing the moisture of the oral mucosa (mouth and tongue) is a quick and readily accessible indicator of hydration status. Other signs of dehydration include dry mouth and tongue, absence of tears when crying, listlessness, sunken eyes or cheeks, sunken fontanel in infants, fever, and decreased skin turgor.

14. Assess skin turgor.

Rationale: Skin turgor, the elasticity of the skin, is another indicator of hydration. Decreased skin turgor, manifested as skin that tents or remains elevated after being pinched and released, suggests dehydration. This is assessed by gently pinching the skin on the back of the hand (adults) or abdomen (children).

15. Assess for other signs of dehydration.

Rationale: A comprehensive assessment for dehydration includes evaluating various signs and symptoms. These include thirst, decreased urination, dark urine, dry mouth and tongue, fatigue, sunken eyes or cheeks, lightheadedness, and decreased skin turgor. In children, additional signs include lack of energy, decreased wet diapers, listlessness, and absence of tears when crying.

16. Assess history for gastrointestinal diseases.

Rationale: Underlying gastrointestinal diseases are common causes of chronic diarrhea. Conditions like gastroenteritis and Crohn’s disease can lead to malabsorption and chronic diarrhea. The characteristics of the stool can provide clues to the location of the problem: watery stools are more common in small bowel disorders, while loose, semisolid stools are more associated with large bowel disorders. Voluminous, greasy stools suggest intestinal malabsorption, while blood, mucus, and pus in stools indicate inflammatory enteritis or colitis. Oil droplets in toilet water may point to pancreatic insufficiency. Nocturnal diarrhea can be a symptom of diabetic neuropathy.

17. Assess history for abdominal radiation therapy.

Rationale: Radiation therapy to the abdomen or pelvis can damage the intestinal mucosa, leading to decreased absorption capacity and diarrhea. Radiation-induced diarrhea, often exudative, results from mucosal damage, epithelial loss, and tissue destruction caused by radiation.

18. Use the Common Toxicity Criteria (CTC) to grade chemotherapy-related diarrhea.

Rationale: The CTC is a standardized grading system used to assess the severity of chemotherapy-related diarrhea. It provides a framework for consistent assessment and management. The grading system ranges from Grade 0 (no diarrhea) to Grade 4 (life-threatening consequences). It considers stool frequency, nocturnal stools, incontinence, need for parenteral support, and physiological consequences.

19. Assess history for previous gastrointestinal surgery.

Rationale: Gastrointestinal surgery can alter bowel function and lead to diarrhea. Diarrhea is common in the immediate postoperative period (1-3 weeks) after bowel resection. Patients undergoing gastric partitioning surgery for weight loss may experience diarrhea as they reintroduce food. Diarrhea can also be a manifestation of dumping syndrome, a condition that can occur after some gastric surgeries, where rapid gastric emptying leads to an osmotic shift of fluid into the small intestine.

20. Assess history of foreign travel, ingestion of unpasteurized dairy products, or drinking untreated water.

Rationale: These factors increase the risk of infectious diarrhea. Travelers’ diarrhea is a common ailment, particularly for those traveling to developing countries. Contaminated food and water are primary sources of infection. Enterotoxigenic E. coli is the most common cause of travelers’ diarrhea.

21. Determine the type of stools using the Bristol Stool Chart.

Rationale: The Bristol Stool Chart is a validated tool for classifying stool form. It categorizes stools into seven types, ranging from type 1 (separate hard lumps, indicating constipation) to type 7 (watery, no solid pieces, indicating diarrhea). Types 5, 6, and 7 on the chart are indicative of diarrhea. Using the Bristol Stool Chart provides a standardized and objective way to document and monitor stool consistency.

22. Assess the condition of the perianal skin.

Rationale: Diarrheal stools can be irritating and corrosive due to increased enzyme content and acidity. Frequent loose stools can cause perianal skin breakdown, especially in young children and older adults. Assessing for redness, irritation, excoriation, or breakdown is crucial for implementing preventive skin care measures.

23. Examine the emotional impact of illness, hospitalization, and soiling accidents.

Rationale: Diarrhea, particularly with fecal incontinence, can have a significant emotional and psychological impact. Loss of bowel control can lead to feelings of embarrassment, shame, anxiety, and decreased self-esteem. Patients may experience fear of incontinence in public and social isolation. Understanding the emotional impact of diarrhea is essential for providing holistic patient-centered care and addressing psychosocial needs.

Bristol Stool Chart: Types of Stool Consistency. This chart is used to classify the form of human feces into seven categories, ranging from constipation (types 1-2) to diarrhea (types 5-7). Nurses use this tool to assess and document patient’s bowel movements.

Nursing Interventions and Rationales for Diarrhea

Nursing interventions for diarrhea are aimed at managing symptoms, addressing the underlying cause if possible, preventing complications (especially dehydration and electrolyte imbalance), and promoting patient comfort and well-being.

1. Weigh daily and note decreased weight.

Rationale: Diarrhea leads to significant fluid loss, resulting in weight loss. Daily weight monitoring is a sensitive indicator of fluid balance. A decrease in weight can be an early sign of dehydration. While short-term weight loss is a consistent finding in diarrhea, the long-term impact on weight may be more variable and influenced by other factors.

2. Have the patient keep a diary of their bowel movements.

Rationale: A bowel movement diary provides valuable data for assessing stool consistency, frequency, timing, and associated symptoms. It helps track the pattern of diarrhea and evaluate the effectiveness of interventions. For patients with cancer-related diarrhea, a diary can help identify triggers and patterns. The diary should include details such as time of defecation, usual stimuli, stool consistency, amount, frequency, food and fluid intake, bowel habits, laxative use, diet, exercise, medical and surgical history, medications, perianal sensations, and current bowel regimen.

3. Avoid using medications that slow peristalsis if an infectious process is suspected.

Rationale: In cases of infectious diarrhea, such as Clostridium difficile infection or food poisoning, medications that slow down peristalsis (antimotility agents) are generally contraindicated. Slowing intestinal motility can prolong the exposure of the intestinal mucosa to pathogens and toxins, potentially worsening the infection and increasing the risk of complications like toxic megacolon, exacerbation of colitis, and systemic infection. Increased gut motility is a natural defense mechanism to eliminate the causative agent. Certain medications, such as opioids, antidepressants, NSAIDs, and anticholinergics, can exacerbate toxic megacolon and should be avoided.

4. Administer antidiarrheal drugs as ordered, when appropriate.

Rationale: Antidiarrheal medications can be used to manage symptomatic diarrhea, particularly when the cause is not infectious or when infection has been appropriately treated. Most antidiarrheal drugs work by suppressing gastrointestinal motility, allowing for more fluid absorption in the intestines. Probiotics or yogurt may be beneficial in re-establishing normal gut flora and reducing diarrhea symptoms. Antidiarrheal agents are broadly classified into those for mild to moderate diarrhea and those for severe secretory diarrheas. Opiates, commonly prescribed antidiarrheals, primarily reduce intestinal motility but lack antisecretory effects. Racecadotril, an enkephalinase inhibitor, reduces intestinal fluid secretion without affecting motility. Antidiarrheal agents for severe diarrhea often have more significant side effects.

5. Provide bulk fiber (e.g., cereal, grains, psyllium) in the diet.

Rationale: Bulk-forming agents and dietary fiber can help manage diarrhea by absorbing excess fluid in the stool, thereby increasing stool consistency and reducing liquidity. Psyllium, found in cereals, supplements, and bulk fiber laxatives, is an example of a bulk fiber. While often used for constipation, psyllium’s water-holding capacity can also help solidify watery stools in diarrhea and bind some toxins. It’s generally recommended to start with a small dose (e.g., one teaspoon twice daily) and avoid combining psyllium products with laxatives. Studies suggest psyllium husk has complex effects on gut motility, potentially both stimulating and inhibiting intestinal activity, which may contribute to its effectiveness in both constipation and diarrhea.

6. Provide “Natural” bulking agents (e.g., rice, apples, matzos, cheese) in the diet.

Rationale: Soluble fiber, found in foods like rice, apples, bananas, and certain vegetables, absorbs excess fluid in the digestive tract, helping to decrease diarrhea. Encouraging intake of soluble fiber-rich foods can aid in managing diarrhea symptoms. Soluble fiber slows down digestion, while insoluble fiber tends to speed it up, which is beneficial for constipation.

7. Explain the need to avoid stimulants (e.g., caffeine, carbonated beverages, artificial sweeteners).

Rationale: Certain substances can exacerbate diarrhea. Caffeine stimulates intestinal motility and should be avoided. Carbonated beverages, especially sugary sodas, may contain high-fructose corn syrup, which can lead to fructose malabsorption and diarrhea. Artificial sweeteners like sorbitol have a laxative effect by drawing water into the colon. Carbonation itself can also contribute to bloating, gas, and indigestion, potentially worsening diarrhea.

8. Record the number and consistency of stools per day; if desired, use a fecal incontinence collector for accurate measurement of output.

Rationale: Accurate documentation of stool frequency and consistency provides a baseline for monitoring the progression of diarrhea and evaluating the effectiveness of interventions. For patients with fecal incontinence, a fecal collection system can be used to accurately measure stool output, especially liquid or semi-liquid stool. These systems can also help protect perianal skin and prevent cross-infection in certain situations.

9. Evaluate dehydration by observing skin turgor over the sternum and inspecting for longitudinal furrows of the tongue. Monitor for excessive thirst, fever, dizziness, lightheadedness, palpitations, excessive cramping, bloody stools, hypotension, and symptoms of shock.

Rationale: Dehydration is a major complication of diarrhea, particularly severe diarrhea. Assessing for signs of dehydration is critical. Skin turgor and tongue furrows are physical indicators. Other signs include excessive thirst, fever, dizziness, lightheadedness, palpitations (rapid heart rate), severe cramping, bloody stools, hypotension (low blood pressure), and signs of shock (e.g., altered mental status, rapid and weak pulse, cool and clammy skin). Severe dehydration can lead to deficient fluid volume, profound weakness, and even death, especially in vulnerable populations like infants, the chronically ill, and the elderly. Malnutrition, acute diarrhea, and alcohol withdrawal can synergistically increase the risk of life-threatening complications like shock.

10. Encourage intake of fluids 1.5 to 2 L/24 hr plus 200 mL for each loose stool in adults unless contraindicated; consider nutritional support.

Rationale: Fluid replacement is paramount in managing diarrhea to prevent or treat dehydration. Increasing fluid intake is essential to replace fluid losses. Adults generally need to consume 1.5 to 2 liters of fluid per day, plus an additional 200 mL for each loose stool. In some cases, nutritional support may be necessary to address nutrient losses and maintain nutritional status.

11. Encourage to take oral rehydration solution (ORS).

Rationale: Water alone may not be sufficient for rehydration in diarrhea because it doesn’t replace lost electrolytes. ORS is specifically formulated to replenish both fluids and electrolytes lost through diarrhea.
- For adults: Adults can use commercially available ORS solutions, diluted juices, diluted sports drinks, clear broth, or decaffeinated tea. Sugary, carbonated, caffeinated, and alcoholic beverages should be avoided as they can worsen diarrhea.
- For children: Pediatric ORS solutions are crucial for children with diarrhea. They provide the appropriate balance of electrolytes and glucose for optimal rehydration.

12. Monitor and record intake and output (I&O); note oliguria and dark, concentrated urine. Measure the specific gravity of urine if possible.

Rationale: Accurate I&O monitoring is essential for assessing fluid balance and guiding fluid replacement therapy. Oliguria (decreased urine output) and dark, concentrated urine are indicators of dehydration and deficient fluid volume. Urine specific gravity, when measurable, provides a more objective assessment of urine concentration and hydration status. Meticulous recording of all fluid intake and output in milliliters on an I&O chart is crucial. Patient cooperation in recording intake and output should be encouraged whenever possible.

13. Evaluate the appropriateness of protocols for bowel preparation based on age, weight, condition, disease, and other therapies.

Rationale: Bowel preparation protocols, often used before procedures like colonoscopies, can induce diarrhea. It’s important to assess the patient’s individual risk factors and adjust bowel preparation protocols accordingly, especially for older, frail, or dehydrated patients. These patients may require less aggressive bowel preparation or additional intravenous fluid support during the preparation process to prevent dehydration.

14. Provide perianal care after each bowel movement.

Rationale: Perianal care is essential to prevent skin breakdown and promote comfort. Frequent, loose stools can irritate and inflame the perianal skin. Perianal care should include gentle cleansing with a mild cleansing agent (perineal skin cleanser), application of protective ointments or barrier creams, and, if skin breakdown is present, application of a wound hydrogel to promote healing.

15. Avoid the use of rectal Foley catheters.

Rationale: While rectal tubes may be used in some critically ill patients with diarrhea to manage fecal incontinence and prevent skin soiling, rectal Foley catheters are generally contraindicated due to the risk of serious complications. These risks include rectal necrosis, sphincter damage, and rectal rupture. The intensive care and meticulous management required for rectal Foley catheters may not always be feasible in busy clinical settings.

16. If diarrhea is associated with cancer or cancer treatment, once infectious causes are ruled out, administer medications as ordered to stop diarrhea.

Rationale: Cancer and cancer treatments, particularly chemotherapy and radiation therapy, can cause diarrhea. It’s essential to rule out infectious causes first. Cancer patients are often immunocompromised and more susceptible to infections. Diarrhea in cancer patients can lead to rapid deterioration due to protein, electrolyte, and water losses, potentially resulting in fatal dehydration. Prompt management of diarrhea in cancer patients is crucial.

17. For patients with enteral tube feeding, employ specific interventions to prevent or manage diarrhea.

Rationale: Diarrhea is a common complication of enteral tube feeding. Specific interventions are needed to address tube feeding-related diarrhea.

18. If diarrhea is chronic and there is an indication of malnutrition, discuss with the primary care practitioner for a dietary consult and possible use of a hydrolyzed formula to maintain nutrition while the gastrointestinal system heals.

Rationale: Chronic diarrhea can lead to malnutrition. In such cases, a dietary consultation is recommended to optimize nutritional intake. Hydrolyzed formulas, where proteins are broken down into smaller peptides, may be beneficial for patients with malabsorption or difficulty digesting standard formulas. These formulas are designed to be easier to digest and absorb, providing nutritional support while the gastrointestinal system recovers.

19. Encourage the patient to eat small, frequent meals and to consume foods that normally cause constipation and are easy to digest.

Rationale: Small, frequent meals are generally better tolerated than large meals during diarrhea. Bland, starchy foods are often recommended initially as they are easily digestible and can help solidify stools.

20. Educate patient not to eat only bland foods for prolonged periods.

Rationale: While the BRAT diet (bananas, rice, applesauce, toast) is commonly recommended for initial management of stomach upset, prolonged use is discouraged. The BRAT diet is low in fat and protein and does not provide adequate nutrition for recovery. Patients should be advised to return to their normal, balanced diet as soon as they can tolerate it.

21. Educate patient or caregiver about dietary measures to control diarrhea.

Rationale: Dietary modifications are a cornerstone of diarrhea management. Education should include:
- Avoiding spicy, fatty foods, alcohol, and caffeine: These substances can stimulate the gastrointestinal tract and worsen diarrhea.
- Broiling, baking, or boiling foods instead of frying: Lower-fat cooking methods are easier to digest.
- Avoiding foods that are known to trigger diarrhea for the individual.
- Limiting or avoiding carbonated drinks and dairy products: These can exacerbate diarrhea in some individuals.

22. Remind the patient of the importance of diet modification and electrolyte replacement.

Rationale: Diet modification is a key aspect of self-management for diarrhea. Patients should be advised to include foods rich in potassium (e.g., bananas, potatoes, fruit juices), sodium (e.g., pretzels, soup), and yogurt with active bacterial cultures to help replenish lost electrolytes and promote gut health. Even a small amount of fat in the diet can be beneficial as it slows down digestion and may reduce diarrhea.

23. Allow patient to communicate with nurse or caregiver if diarrhea occurs with prescription drugs.

Rationale: Medication-induced diarrhea is common. Patients should be instructed to report any new onset of diarrhea after starting a new medication. Prompt communication allows for timely assessment and potential medication adjustments to prevent worsening diarrhea. Numerous medications can cause diarrhea, including antibiotics, laxatives, certain cardiovascular drugs, and gastrointestinal medications.

24. Educate patient or caregiver on the proper use of antidiarrheal medications as ordered.

Rationale: If antidiarrheal medications are prescribed or recommended, patient education on their proper use is essential. This includes dosage, frequency, potential side effects, and when to take the medication. Proper use ensures effectiveness and minimizes potential adverse effects.

25. Discuss the importance of fluid replacement during diarrheal episodes.

Rationale: Fluid replacement is a primary treatment for diarrhea, alongside antidiarrheal agents, nutritional support, and antimicrobial therapy when indicated. Severely dehydrated patients may require intravenous rehydration with Ringer’s lactate or saline solution, with electrolyte supplementation as needed. Oral rehydration solutions are effective for mild to moderate dehydration and for maintaining hydration after initial rehydration. ORS solutions are beneficial due to their balanced content of sodium, sugars, and sometimes amino acids, which facilitate nutrient-dependent sodium and water uptake in the intestines. Oral rehydration is often as effective as intravenous hydration in less severe cases. Maintaining adequate fluid intake is crucial to prevent dehydration.

26. Impart to the patient the importance of good perianal hygiene.

Rationale: Perianal hygiene is essential for preventing perianal skin excoriation and promoting comfort. Proper hygiene reduces the risk of skin breakdown and secondary infections. Neglected diarrhea, leading to perianal excoriation and poor hygiene, has been linked to serious conditions like Fournier’s gangrene, a life-threatening necrotizing fasciitis of the perineal region. Good hygiene practices are crucial in preventing such complications.

27. Educate patient and significant other (SO) on preparing food properly and the importance of good food sanitation practices and handwashing.

Rationale: Education on food safety and hygiene is crucial for preventing infectious diarrhea, particularly fecal-oral transmission. Proper food preparation, storage, and handling, along with thorough handwashing, are fundamental in preventing the spread of foodborne pathogens and reducing the risk of diarrhea outbreaks.

28. Provide tips on how to manage stress.

Rationale: Stress can contribute to diarrhea in some individuals by affecting gastrointestinal motility. Stress management techniques can be helpful in reducing stress-related diarrhea. Deep breathing exercises are a simple and effective way to activate the body’s relaxation response and reduce stress.

29. Allow the patient to use free time to relax, meditate, read a book, or listen to music.

Rationale: Relaxation techniques can help manage stress and promote overall well-being. Activities like reading, meditation, and listening to music can provide distraction, reduce anxiety, and promote relaxation. Music, in particular, with a slower tempo, can have a calming effect on the mind and body, aiding in relaxation and stress management.

30. Provide emotional support for patients who have trouble controlling unpredictable episodes of diarrhea.

Rationale: The unpredictable nature of diarrhea, especially with fecal incontinence, can be emotionally distressing and embarrassing, particularly for older adults. It can lead to social isolation and feelings of powerlessness. Providing emotional support, empathy, and understanding is crucial in addressing the psychosocial needs of patients experiencing diarrhea and promoting their emotional well-being.

Recommended Resources

Disclosure: The following are affiliate links from Amazon.com. We may earn a small commission if you purchase through these links, at no extra cost to you.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care – An excellent resource for evidence-based nursing interventions and care planning.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) – A comprehensive guide with numerous care plans, including updated diagnoses and LGBTQ health topics.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales – A quick-reference tool for nursing diagnoses, interventions, and rationales, updated with the latest diagnoses.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care – A detailed manual for planning, individualizing, and documenting nursing care for a wide range of conditions.
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health – A comprehensive resource covering care plans across various nursing specialties.

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