Diarrhea

Diarrhea 5 Nursing Care Plans

5 Nursing Care Plans for Diarrhea

Diarrhea is condition wherein the frequency of bowel movements is increased, accompanied with increased level of water content which makes the consistency of the stools softer than normal.

It can also occur with an increased volume of waste, abdominal pain and/or cramping, hyperactive bowel sounds, as well as increased urgency and frequency (more than 3 episodes per day). Diarrhea can be acute (short-term), or chronic (long-term) depending on the cause and factors that might have contributed to it.

Patients usually recover from mild cases of diarrhea after a few days with the help of anti-diarrheals and/or dietary changes. 

On the other hand, severe cases of diarrhea may be present for weeks or even months and can lead to serious nutritional problems and/or dehydration.

Causes of Diarrhea

Diarrhea is a common symptom of the following medical conditions:

  • Infection – can be bacterial, viral, or parasitic
  • Inflammatory bowel diseases
  • Malabsorption disorders
  • Radiation
  • Anxiety and stress
  • Short bowel syndrome
  • Food poisoning

Other factors that may increase the likelihood of having diarrhea include:

  • Disagreeable food intake
  • Side effect of drugs such as chemotherapeutic agents and antibiotics
  • Laxative abuse
  • Surgical procedures such as gastrectomy
  • Tube feeding

Complications of Diarrhea

If the patient suffers from severe and/or chronic diarrhea, he/she is at risk for the following complications:

  • Weight loss
  • Fluid and electrolyte imbalances
  • Impaired Nutrition
  • Fatigue
  • Altered Skin Integrity
  • Mood disorders
  • Poor quality of life

Nursing Care Plans for Diarrhea

Nursing Care Plan 1

Gastroenteritis

Nursing Diagnosis: Diarrhea related to bacterial gastroenteritis as evidenced by loose, watery stools, abdominal cramping and pain, increased frequency of stools (more than 3 episodes per day), and hyperactive bowel sounds.

Desired Outcome: The patient will pass formed stools less than 3 episodes per day and will present a negative stool culture.

InterventionsRationales
Obtain a stool sample from the patient.To send to the lab for stool culture.
Explore the possible causes of gastroenteritis, such as any instance of drinking contaminated water, ingesting unpasteurized dairy products, or eating raw or inadequately cooked food.Drinking contaminated water or eating contaminated food may have caused gastroenteritis. Knowing the cause not only helps in treating the condition but can also prevent its recurrence and protect the client’s significant others who are likely to drink from the same water source or practice similar cooking methods.
Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool scale.To monitor the patient’s bowel pattern.
 Administer medications for gastroenteritis as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-diarrheals and antispasmodicsAntibiotics – acute gastroenteritis may not require antibiotics; the use of antibiotics may depend on the result of the stool culture and recommendation of the microbiologist  
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of inflammatory bowel disease. High fiber and high fat foods can cause irritation in the intestines.
Educate the patient regarding frequent hand washing after each bowel movement, before preparing food, and before and after eating.Bacteria can spread through direct contact and indirect contact (surfaces and kitchen utensils). Handwashing is the most effective way to prevent the transmission of the pathogen.
Encourage the patient to increase intake of potassium-rich foods.Diarrhea usually depletes the body of potassium, which may result to hypokalemia.

Nursing Care Plan 2

Cancer – Ongoing Chemotherapy

Nursing Diagnosis: Diarrhea related to side effect of chemotherapy as evidenced by loose, watery stools, abdominal cramping and pain

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency while coping with ongoing chemotherapy sessions.

InterventionRationale
Use the Common Toxicity Criteria (CTC) to grade the chemotherapy-related diarrhea.CTC guidelines are used in many countries including the U.S. and U.K in grading and treating chemotherapy-related diarrhea. Grade 1 – an increase of less than 4 episodes per day from baseline Grade 2 – an increase of 4 to 6 episodes per day from baseline
Grade 3 – an increase of 7 or more episodes per day from baseline; hospitalization indicated; incontinence noted; self-care limiting Grade 4 – life-threatening consequences
Grade 5 – death
Identify which chemotherapy drug might have caused the diarrhea.Common chemotherapeutic drugs that cause diarrhea include alkylating agents, antimetabolites, and kinase inhibitors.  
Refer the grading of chemotherapy-related diarrhea and other associated symptoms to the oncologist.Chemotherapy dose might need reduction, put on hold, or stopped completely depending on the toxicity/grading of chemotherapy-related diarrhea.
Explore the patient’s daily nutritional intake and food habits (e.g., mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart, stool chart, and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake and alcohol and coffee intake.To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement.
Refer the patient to the oncology dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to bowel problems such as diarrhea due to ongoing chemotherapy.  
Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Provide advice on taking anti-diarrheal medications for diarrhea.To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe diarrhea.

Nursing Care Plan 3

Inflammatory Bowel Disease (IBD)

Nursing Diagnosis: Diarrhea related to inflammation of bowel as evidenced by loose, watery stools, abdominal cramping and pain, increased urgency to defecate, tenesmus, and increased bowel sounds

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.

InterventionsRationales
1. Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
2. Administer medications for inflammatory bowel disease as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-inflammatory drugs- first line of treatment for people with inflammatory bowel disease Immune system suppressors- work by prohibiting inflammatory response through suppressing the immune system Biologics- work by stopping proteins in the body from causing inflammationAnti-diarrheals and antispasmodics  
3. Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
4. Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of inflammatory bowel disease. High fiber and high fat foods can cause irritation in the intestines.
5. Start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat/residue, low fiber diet on a long-term basis, as recommended by the dietitian.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of Inflammatory bowel disease.  

Nursing Care Plan 4

Irritable Bowel Syndrome (IBS)

Nursing Diagnosis: Diarrhea related to irritable bowel syndrome as evidenced by loose, watery stools, abdominal distension abdominal cramping and pain, increased frequency of stools, and post prandial urgency (increased urge to defecate after eating).

Desired Outcome: The patient will pass formed stools less than 3 episodes per day and will achieve ideal body weight.

InterventionsRationales
1. Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
2. Administer medications for irritable bowel syndrome as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-diarrheals and antispasmodicsFiber supplementsTricyclic antidepressants and SSRIs – off-label use for their visceral analgesic properties5-HT3 receptor antagonists – to reduce hyperactivity of the bowel
3. Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
4. Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fat foods. Encourage the patient to eat a high fiber diet.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of IBS. High fat foods can cause irritation in the intestines.
Advise patient on how to manage stressors by:
Regular exercise
Adequate rest and sleep
Avoid unnecessary stress
Relaxation techniques such as meditation and deep breathing
Studies show that patients with IBS experience an increased frequency of symptoms when under periods of stress.

Nursing Care Plan 5

Lactose Intolerance

Nursing Diagnosis: Diarrhea related to lactose intolerance as evidenced by loose, watery stools, abdominal distension abdominal cramping and pain, increased frequency of stools when eating lactose-containing food and drinks.

Desired Outcome: The patient will pass formed stools less than 3 episodes per day and will achieve ideal body weight.

InterventionsRationales
1. Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
2. Administer medications as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-diarrheals and antispasmodicsFiber supplements
3. Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
4. Help the patient to select appropriate dietary choices to reduce the intake of lactose-containing food and drinks such as milk and dairy products. Advise the patient to carefully read the label on food products as many processed foods contain milk solids or milk.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits.  
5. Advise patient to take lactase-containing dietary supplements and calcium supplements.Lactase is an enzyme that breaks down lactose in the body. Calcium supplements are a good alternative of milk to reduce the risk of osteoporosis. The recommended daily calcium intake should not be more than 1,500 milligrams per day.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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