Diarrhea: passing of 3 or more watery or loose stool within 24 hours except in
breast fed baby.
Types of diarrhea:
1- Acute diarrhea: begins acutely and last less than 14 days.
2- Chronic diarrhea :last for more than one month.
3- Persistent diarrhea: last more than 14 days.
4- Dysentry:visible blood in stool.
Causative micro-organism either :
a- Bacteria e.g:shigella,cambylobacter.
b- Paracytice.g:entameba histolytica.
NOTE: most common cause of diarrhea in children is ROTA virus(70%),the
remaining is bacteria e.g:E.coli,Salmonella,Shigella.
Predisposing factor for diarrhea:
1- Age :younger child age are more susceptible.
2- Malnutrition:malnourished children are more susceptible.
3- Climate:during hot weather the micro-organism growth increase.
4- Environmental factor :over crowding, poor facility for preparation and refrigeration of food, contaminated food.
Epidemiology of diarrhea:
Factors which increase risk of diarrhea:
1- Failure of exclusive breast feeding in the first 4-6 months.
2- Using bottle feeding .
3- Storage of food at room temperature.
4- Using contaminated water.
5- Failure of hand washing after toilet.
6- Bad sewage disposal.
1- Failure of breast feeding in the first 2 years.
4- Immune deficiency.
Mode of transmission (feco-oral transmission route): That is infected person and animal will contaminate water and food which is taken by the susceptible person.
Causes of diarrhea:
2- Ingestion of poison.
3- Communicable disease.
4- Respiratory tract infection.
5- Emotional tension.
2- Anatomical defect.
4- Abnormal bowel motility.
Diarrhea leads to malnutrition because:
1- Child eats less.
2- Decrease absorption.
3- Nutrient requirement increase in infection.
Severe diarrhea needs:
2- Parenteral fluid.
3- Comprehensive evaluation.
1- Weighing the child on admission.
3- Observation of complication by checking vital signs, behavior and consciousness.
4- Prevent skin break down by:
a- changing diaper. b-skin care. c-expose red area to air.
5- Maintain hydration by:-
a- Increase oral feeding. b-giving fluid. c-check intake and out put.
6- Assess progress of hydration (weighing the child daily).
7- The nurse is responsible for collecting stool sample for laboratory examination.
NOTE: avoid rectal thermometer because it stimulate the bowel.
ASSESS your patient for dehydration:
Oral rehydration solution(O.R.S)
– It is recommended in management of diarrhea with no or some dehydration.
– O.R.S consist of :-
1- Sodium chloride (3.5) gm.
2- Trisodium citrate(2.9)gm,or sodium bicarbonate 2.5gm.
3- Potassium chloride(1.5)gm.
– It should be prepared by dissolving the whole packet in sterilized cold water.
– One litter water=1000ml= 4bottle of Pepsi= 2bottle of milk.
NOTE: it should be used in 24 hours then discarded.
It means visible blood in stool.
Management: give antimicrobial drugs against shigella e.g: Ampicillin or metheprim or Nigram for 5days. Do not use flagyl unless you see trophozoite and cyst of Entameba histolytica containing R.B.C in general stool examination.
Examine your patient after 2 days especially in case of:
1- Patient less than 1 year old .
2- Presence of dehydration.
3- If still bloody diarrhea.
4- If no response to treatment.