STUDY - Technical - New Dacian's Medicine
Diarrhea
(Classical / Allopathic Medicine)
Usually a chief
sign of an intestinal disorder, diarrhea is an increase in the
volume of stools compared with the patient's normal bowel
habits. It varies in severity and may be acute or chronic.
Acute diarrhea may result from acute infection, food
sensitivities, stress, fecal impaction, or the effects of
certain drugs. Chronic diarrhea may result from food
allergies, chronic infection, obstructive or inflammatory
bowel disease, malabsorption syndrome, an endocrine disorder,
or GI surgery. Periodic diarrhea may result from food
intolerance or from the ingestion of spicy or high-fiber foods
or caffeine.
One or more
pathophysiologic mechanisms may contribute to diarrhea. The
fluid and electrolyte imbalances it produces may precipitate
life-threatening arrhythmias or hypovolemic shock.
ALERT:
If the patient's diarrhea is profuse:
- check for signs of shock, such as tachycardia, hypotension, and cool, pale, clammy skin
- check for electrolyte imbalances
- look for an irregular pulse, muscle weakness, anorexia, nausea and vomiting
- keep emergency resuscitation equipment handy.
If the patient isn't in shock, perform a focused assessment.
If the patient's diarrhea is profuse:
- check for signs of shock, such as tachycardia, hypotension, and cool, pale, clammy skin
- check for electrolyte imbalances
- look for an irregular pulse, muscle weakness, anorexia, nausea and vomiting
- keep emergency resuscitation equipment handy.
If the patient isn't in shock, perform a focused assessment.
HISTORY:
Explore signs and symptoms associated with diarrhea. Does the patient have abdominal pain and cramps? Difficulty breathing? Is he weak or fatigued?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he has had recent GI surgery or radiation therapy.
Ask the patient to briefly describe his diet. Does he have any known food allergies?
Ask the patient if he's under unusual stress.
Explore signs and symptoms associated with diarrhea. Does the patient have abdominal pain and cramps? Difficulty breathing? Is he weak or fatigued?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he has had recent GI surgery or radiation therapy.
Ask the patient to briefly describe his diet. Does he have any known food allergies?
Ask the patient if he's under unusual stress.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs. Take his blood pressure with him lying, sitting, and standing. Take his temperature, and note any chills. Check his weight.
Evaluate hydration, and check skin turgor. Also, look for a rash.
Inspect the abdomen for diffuse distention. Auscultate bowel sounds, and palpate for tenderness.
Take the patient's vital signs. Take his blood pressure with him lying, sitting, and standing. Take his temperature, and note any chills. Check his weight.
Evaluate hydration, and check skin turgor. Also, look for a rash.
Inspect the abdomen for diffuse distention. Auscultate bowel sounds, and palpate for tenderness.
SPECIAL
CONSIDERATIONS:
Administer an analgesic for pain and an opiate to decrease intestinal motility. Ensure the patient's privacy during defecation. Maintain skin integrity by cleaning the perineum thoroughly and applying ointment.
Administer an analgesic for pain and an opiate to decrease intestinal motility. Ensure the patient's privacy during defecation. Maintain skin integrity by cleaning the perineum thoroughly and applying ointment.
PEDIATRIC
POINTERS:
Diarrhea in children commonly results from infection, but chronic diarrhea may result from malabsorption syndrome, an anatomic defect, or allergies.
Because dehydration and electrolyte imbalance occur rapidly in children, diarrhea can be life-threatening.
Diarrhea in children commonly results from infection, but chronic diarrhea may result from malabsorption syndrome, an anatomic defect, or allergies.
Because dehydration and electrolyte imbalance occur rapidly in children, diarrhea can be life-threatening.
AGING ISSUES:
In the elderly patient with new-onset segmental colitis, always consider ischemia before diagnosing his condition as Crohn's disease.
In the elderly patient with new-onset segmental colitis, always consider ischemia before diagnosing his condition as Crohn's disease.
PATIENT
COUNSELING:
Advise the patient to avoid caffeine, milk, and spicy and high-fiber foods. Suggest smaller, more frequent meals if he has had GI surgery or a disease. If appropriate, teach the patient stress-reducing exercises, such as guided imagery and deep-breathing techniques, or recommend counseling. If the patient has inflammatory bowel disease, stress the need for medical follow-up because his condition places him at increased risk for developing colon cancer.
Advise the patient to avoid caffeine, milk, and spicy and high-fiber foods. Suggest smaller, more frequent meals if he has had GI surgery or a disease. If appropriate, teach the patient stress-reducing exercises, such as guided imagery and deep-breathing techniques, or recommend counseling. If the patient has inflammatory bowel disease, stress the need for medical follow-up because his condition places him at increased risk for developing colon cancer.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)