Sunday, January 15, 2006

diarrhea

Diarrhea is a series of loose, watery stools that is a result of a change in the fecal contents or an increase in intestinal transmit time so that less fluid is reabsorbed. Diarrhea may be caused by the intake of certain foods, stress, or an infectious or inflammatory process. Specific drugs such as iron and digitalis may also cause diarrhea. Diarrhea is often severe in the elderly and can be life-threatening. Thirty-four percent of diarrhea in the elderly is caused by viruses and 14 percent by bacteria.
Viral diarrhea has an abrupt onset and tends to be short-lived (one to five days). In diarrhea caused by bacteria, bloody stools and a sharp rise in temperature is found. Dehydration can occur quickly in the elderly. About 75 percent of all diarrhea cases will subside within 7-14 days. Outbreaks in nursing homes, however, can last 4-6 weeks. Scrupulous hygiene and isolation procedures are necessary to curb the spread of this problem.
Symptoms of diarrhea include abdominal cramping or distention, and fatigue. Dehydration can result from diarrhea, causing low sodium and potasium and other electrolyte problems.
Treatment of diarrhea usually consists of correcting the underlying cause, allowing the bowel to rest, and obtaining electrolyte balance. Drugs used for decreasing intestinal motility are opium derivatives, such as paregoric. Lomotil is commonly prescribed. Providing bulk, such as Metamucil, to decrease the fluidity of stools may be helpful. If diarrhea occurs primarily after meals, antidiarrheal medications should be given 30 to 60 minutes before the meal for maximum effect.
Dietary restrictions decrease stimulation of the intestinal tract, thereby allowing the bowel to rest. With severe diarrhea food may be withheld for 24 to 48 hours, with a gradual progression to a low fiber/high protein and calorie diet.
Frequent watery stools cause perineal irritation. The perineal area must be kept dry and clean to prevent skin breakdown.
Phipps, W. J., et al. Medical Surgical Nursing. St. Louis: C. V. Mosby Co., 1983. Scherer, J.C. Introductory Medical Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co. 1983.

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