16.7 Diarrhea

Diarrhea is defined as having more than three unformed stools in 24 hours. It can cause dehydration, skin breakdown, and electrolyte imbalances. Diarrhea is caused by increased peristalsis, causing the stool to move too quickly through the large intestines so that water is not effectively reabsorbed, resulting in loose, watery stools.

Many conditions can cause diarrhea, such as infectious processes (bacteria, viruses, and protozoa), food poisoning, medications (such as antibiotics and laxatives), food intolerances, allergies, anxiety, and medical conditions like irritable bowel disease and Crohn’s disease or dumping syndrome for clients receiving tube feeding or those who underwent gastric bypass. Antibiotic therapy also places clients at risk of developing Clostridium difficile (C-diff) infection due to the elimination of normal flora in the gastrointestinal tract. Clients with C-diff have very watery, foul-smelling stools, and transmission-based precautions are implemented to prevent the spread of infection.

Interventions

Treatment of diarrhea includes promoting hydration with water or other fluids (e.g., sports drinks) that improve electrolyte status. Intravenous fluids may be required if the client becomes dehydrated. Medications such as loperamide, psyllium, and anticholinergic agents may be prescribed to treat diarrhea causing dehydration. In some cases, rectal tubes may be prescribed to collect watery stool when skin breakdown or wound contamination is a concern, or if rectal antibiotics are prescribed with a dwelling time. However, strict monitoring is required due to possible damage to the rectal mucosa.