DIARRES (Gastro Entritis)
Definition
Diarrhea is an excessive loss of fluid and
electrolytes that occur because of the frequency of one or more bowel movements
with a watery or liquid stool.
Pathophysiology
Ø
Increased
motility and rapid discharge on the Intestinal is the result of impaired
absorption and excretion of fluid and electrolyte.
Ø Liquids, sodium, potassium and bicarbonate are
enhanced from the extracellular space into the stool, resulting in dehydration
of electrolyte deficiency, and metabolic acidosis may occur.
Diarrhea is a process of;
Ø Active transport due to stimulation of
bacterial toxin against electrolytes into the small intestine. Cells
in the intestinal mucosa are irritated and increased secretion of fluid and
electrolytes. Incoming
microorganisms will damage intestinal mucosal cells to decrease intestinal
surface area, intestinal capacity change and fluid and electrolyte absorption
occur.
Ø Inflammation will decrease the intestinal
ability to absorb fluids and electrolytes and food ingredients. This occurs in
malabsorption syndrome.
Ø Increased intestinal motility may lead to
impaired intestinal absorption.
Complications:
Ø
Dehydration
Ø Hypokalemi
Ø Hypocalcemia
Ø Cardiac dysrhythmias due to hypokalemi and
hypocalcemia
Ø Hyponatremia
Ø Hypovolemic shock
Ø Acidosis
Etiology:
Infection Factors:
Ø
Bacteria;
Enteropathogenic
escherichia coli, salmonella, shigella, yersinia enterocolitica
Ø
Viruses;
Enterovirus
- echoviruses, adenovirus, human retrovirua - such as agent, rotavirus.
Ø
Mushrooms;
Candida enteritis
Ø
Parasites;
Clambian
giardia, crytosporidium
Ø
Protozoa
Not Fakror Infection:
Ø Food allergy; Milk, protein
Ø Metabolic or malabsorptive disorders; Celiac
disease, cystic fibrosis in the pancreas
Ø Direct irritation of the digestive tract
by food
Ø Medicines; antibiotics,
Ø Intestinal disease; Colitis
ulcerative, crohn disease, enterocolitis
Ø Emotional or stressful
Ø Intestinal obstruction
The kilini sign
Ø Frequent bowel movements with the
consistency of liquid or dilute stools
Ø There are signs and symptoms of
dehydration; Bad
skin turgor (decreased skin elasticity), crown and sunken eyes, dry mucous
membranes
Ø Abdominal abdominal
Ø Fever
Ø Nausea and vomiting
Ø Anorexia
Ø WeakPale
Ø Changes in vital signs; Pulse and rapid breathing
Ø Decrease or no urine expenditure
Diagnostic Checkup
Ø History of allergy to drugs or food
Ø Fecal culture
Ø Electrolyte examination; Ureum, creatinine, and glucose
Ø Stool examination; PH, leukocytes,
glucose, and the presence of blood
Therapeutic Management
Ø Handling focus on causes
Ø Giving of fluids and electrolytes; Oral
(such as pedialyte or oralite) or parenteral therapy
Ø In infants, breastfeeding is continued if
the cause is not from breast milk
Nursing Management
Assessment
Ø Assess diarrhea history
Ø Assess hydration status; Crown,
skin turgor, eyes, mucous membrane mouth
Ø Assess the stools; Amount,
color, odor, consistency and time to defecate
Ø Assess intake and output (income and
expenditure)
Ø Assess weight
Ø Assess child's activity level
Ø Assess vital signs
Nursing diagnoses
1.
Lack
of fluid volume is associated with frequent bowel movements and caesare
2.
The
risk of impaired skin integrity is associated with frequent bowel movements
3.
The
risk of infection in people associated with infected diarrheal germs or lack of
knowledge about prevention of disease spread
4.
Changes
in nutrients less than the body needs associated with decreased intake
(inclusion) and decreased absorption of food and fluids
5.
Lack
of knowledge related to child care
6.
Anxiety
and fear of children / parents related to hospitalization and illness
Implementation
1.
Increases
hydration and electrolyte balance
§ Assess hydration status ,; Crown, eye,
skin turgor and mucous membranes
§ Assess urine expenditure; Gravity
of urine or specific gravity of urine (1.005-1.020) or corresponding to urine
clearance age of 1-2 ml / kg per hourAssess fluid intake and discharge
§ Monitor vital signs
§ Laboratory inspection according to
program; Electrolytes,
Ht, pH, and serum albumin
§ Provision of fluids and electrolytes
according to protocol (with oralit, and parenteral fluid when indicated)
§ Provision of anti-diarrhea drugs and
antibiotics according to the program
§ The child is rested
2.
Maintaining
the integrity of the skin
§
Assess
skin damage or irritation of any bowel movements
§
Use a
damp cotton and baby soap (or normal pH) to clean the anus of any large water
vessel
§
Avoid
from humid bed clothing and bedding
§
Change the diaper / cloth when moist or wet
§
Use a
cream medicine if necessary for perineal treatment
3.
Reduce
and prevent the spread of infection
§
Teach
you how to wash your hands properly for parents and visitors
§
Immediately
clean and remove the former large baung water and place in a special place
§
Use
unive prevention standards
§
Place
in a special room
4.
Increase
the optimum nutritional requirements
§ Weigh the child's weight every day
§ Monitor intake and output (inclusion and
expenditure)
§ After rehydration, give frequent oral
drinks and meals appropriate to diet and age and / or body weight
§ Avoid fruit drinks
§ Perform oral hygiene after every meal
§ For babies, breast milk continues
§ If
the infant is intolerant with breast milk give a low lactose formula
5.
Increase
knowledge of parents
§ Assess the level of parental understanding
§ Teach about diit and diarrhea control
principles
§ Teach parents about the importance of
washing hands to avoid contamination
§ Explain about illness, care and treatment
§ Explain the importance of cleanliness
6.
Decrease
fear / anxiety in children and parents
§ Teach parents to express feelings of fear
and anxiety; Listen
to parental complaints and be empathetic, and touch therapeutic
§ Use therapeutic communication; Eye contact, body
posture and touch
§ Explain each procedure that will be
performed on the child and parents
§ Involve parents in child care
§ Describe the child's condition, the reason
for the treatment and care
Planning for Returns
ü
Explain
the cause of diarrhea
ü
Teach
to recognize diarrhea complications
ü
Teach
to prevent diarrhea and transmission of diseases; Teach about prevention
standards
ü
Teach
child care; Feeding and drinking (eg, Sugar and salt
solution)
ü
Teach
recognize signs of dehydration, crown and sunken eyes, skin turgor is not
elastic, dry mucous membranes
Describe the medicines given; Side effects and their usefulness
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