Nurse's Pocket Guide

DIARRHEA
• Adjust strength/rate of enteral tube feedings; change formula,
as indicated, when diarrhea is associated with tube feedings.
• Assess for/remove fecal impaction, especially in an elderly
client where impaction may be accompanied by diarrhea.
(Refer to NDs Constipation; Bowel Incontinence.)
• Recommend change in drug therapy, as appropriate (e.g.,
choice of antibiotic).
• Assist in treatment of underlying conditions (e.g., infections,
malabsorption syndrome, cancer) and complications of diarrhea.
Therapies can include treatment of fever, pain, and
infectious/toxic agents; rehydration; oral refeeding, etc.
• Promote use of relaxation techniques (e.g., progressive relaxation
exercise, visualization techniques) to decrease
stress/anxiety.
NURSING PRIORITY NO. 3.To maintain hydration/electrolyte balance:
• Assess for presence of postural hypotension, tachycardia, skin
hydration/turgor, and condition of mucous membranes indicating
dehydration.
• Weigh infant’s diapers to determine amount of output and
fluid replacement needs.
• Review laboratory studies for abnormalities.
• Administer antidiarrheal medications, as indicated, to
decrease gastrointestinal motility and minimize fluid
losses.
• Encourage oral intake of fluids containing electrolytes, such as
juices, bouillon, or commercial preparations, as appropriate.
• Administer enteral and IV fluids, as indicated.
NURSING PRIORITY NO.4.To maintain skin integrity:
• Assist, as needed, with pericare after each bowel movement.
• Provide prompt diaper change and gentle cleansing, because
skin breakdown can occur quickly when diarrhea is present.
• Apply lotion/ointment as skin barrier, as needed.
• Provide dry linen, as necessary.
• Expose perineum/buttocks to air; use heat lamp with caution,
if needed to keep area dry.
• Refer to ND impaired Skin Integrity.
NURSING PRIORITY NO. 5.To promote return to normal bowel
functioning:
• Increase oral fluid intake and return to normal diet, as
tolerated.
• Encourage intake of nonirritating liquids.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
262 Cultural Collaborative Community/Home Care