Nursing Diagnosis for Urinary / Bowel Elimination : Diarrhea, Constipation

Nanda Nursing Diagnosis for Urinary / Bowel Elimination : Diarrhea, Constipation


1. Alteration in Bowel Elimination : Diarrhea

Intervention:

• Help need for defecation (if bed rest to prepare the necessary tools near the bed, attach the curtains and immediately dispose of faeces after defecation).
• Increase / maintain fluid intake by mouth.
• Teach about the foods and drinks that can worsen / precipitate diarrhea.
• Observation and record the frequency of defecation, fecal volume and characteristics.
• Observation fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety and lethargy.
• Collaboration of appropriate medication therapy program (antibiotics, anticholinergics, corticosteroids).

2. Alteration in Bowel Elimination : Constipation

Intervention:

• Encourage lots of drinking with ambulation dinikolab laxative administration.
• Rationalization:
• Many drinks can help dissolve the stool with ambulation reduce constipation.
• Formation of stools soft launch.

3. Alteration in Bowel Elimination: Constipation related to neurological disorders of the intestine and rectum.

Intervention:

• Auscultation of bowel sounds, note the location and characteristics. Rational: bowel sounds may be absent during spinal shock.
• Observe for abdominal distention.
• Note the presence of complaints of nausea and want to vomit, pairs of NGT. Rational: gantrointentinal and gastric bleeding may occur due to trauma and stress.
• Provide a balanced diet high in calories and protein; Liquid. Rational: improving stool consistency.
• Give laxatives to order. Rational: stimulate the intestines.

4. Altered Urinary Elimination related to the drainage of urine.

Intervention:

• Assess urine drainage system immediately.
• Assess the adequacy of urine output and drainage system patency.
• Use aseptic procedures and washing hands when providing care and action.
• Maintain a closed urine drainage system.
• If irrigation is needed and prescribed, do this action carefully using sterile saline.
• Assist patients in the mobilization.
• Observation of color, smell and consistency of urine volume.
• Reduce trauma and manipulation of catheters, drainage system and urethra.
• Clean the catheter carefully.
• Maintain adequate fluid intake.

5. Impaired Urinary Elimination

Intervention:

• Observation of the bladder.
• Encourage regular bowel movements.
• Give warm compresses.
• Rationalization:
• The content of urinary maintain contractions or uterine involution.
• Urine retained causes infection.
• Relaxation springter urine.

6. Altered Urinary Elimination related to paralysis of the urinary condition.

Intervention:

• Assess the pattern of urination, and record urine output per hour.
• Rationale: determine kidney function.
• Palpation of the possibility of bladder distension.
• Instruct the patient to drink a 2000 cc / day.
• Rationale: helps maintain kidney function.
• Attach the catheter Dower.
• Rational assist the process of urine.

7. Constipation
Intervention:

• Observation bowel sounds periodically.
• Suggest to increase fluid intake at least 2 liters a day when no contra indications.
• Increase activity on a regular basis.
• For the provision of appropriate therapy, investigation is needed.
• Dietis team collaboration for the provision of a balanced diet and high in fiber.

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Causes of Diarrhea : Virus, Bacteria, Protozoa and Helminth

Cause of Diarrhea: (Tantivanich, 2002; Sirivichayakul, 2002; Pitisuttithum, 2002)

1. Virus:
Is the highest cause of acute diarrhea in children (70-80%). Some types of viruses that cause acute diarrhea:

• Rotavirus serotypes 1,2,8, and 9: in humans. Serotype 3 and 4 were found in animals and humans. And serotypes 5,6, and 7 were found only in animals.
• Norwalk virus: present in all ages, generally due to food borne or water borne transmission, and the transmission can also occur person to person.
• Astrovirus, found in children and adults
• Adenovirus (type 40, 41)
• Small bowel structured viruses
• Cytomegalovirus

2 Bacteria:

• Enterotoxigenic E. coli (ETEC). Have two important virulence factor is a factor that causes bacterial colonization is attached to the enterocytes of the small intestine and enterotoxin (heat labile (HL) and heat stabile (ST) which causes the secretion of fluid and electrolytes that produce watery diarrhea. ETEC causes no damage to brush border or invade the mucosa.
• Enterophatogenic E. coli (EPEC). The mechanism of diarrhea is not clear. Found the process of attachment of EPEC to intestinal epithelial damage of membrane micro-villi which would disturb the surface absorption and disaccharidase activity.
• Enteroaggregative E. coli (EAggEC). These bacteria are strongly attached to the mucosa of the small intestine and causes typical morphological changes. How does the mechanism of the onset of diarrhea is still unclear, but it may play a role cytotoxins.
• Enteroinvasive E. coli (EIEC). In serologic and biochemical similar to Shigella. Such as Shigella, EIEC penetrate and multiply within colonic epithelial cells.
• Enterohemorrhagic E. coli (EHEC). EHEC producing verocytotoxin (VT) 1 and 2, which is also called Shiga-like toxin that causes diffuse edema and bleeding in the colon. In children often progress to hemolytic-uremic syndrome.
• Shigella spp. Shigella invade and multiply within colonic epithelial cells, causing cell death and the onset of mucosal ulceration. Shigella rarely enter into the bloodstream. Virulence factors including: smooth cell-wall lipopolysaccharide antigen and endotoxin activity has helped the process of invasion and toxin (Shiga toxin and Shiga-like toxin) that are cytotoxic and neurotoxic and may cause watery diarrhea.
• Campylobacter jejuni (Helicobacter jejuni). Humans become infected through direct contact with animals (birds, dogs, cats, sheep and pigs) or with animal feces through contaminated food such as chicken and water. Sometimes the infection can be spread through direct person to person contact. C.jejuni may cause diarrhea by invasion into the small intestine and colon great.There 2 types of toxin produced, the heat-labile cytotoxin and enterotoxin. Histopathological changes that occur similar to the process of ulcerative colitis.
• Vibrio cholerae 01 and V.cholerae 0139. water or food contaminated with this bacteria will transmit cholera. Through person to person transmission is rare.
• V.cholerae attached and proliferated on the mucosa of the small intestine and produces an enterotoxin that causes diarrhea. Cholera toxin is very similar to the heat-labile toxin (LT) of ETEC. The last discovery of the existence of other enterotoxin that has its own characteristics, such as the accessory cholera enterotoxin (ACE) and zonular occludens toxin (ZOT). Both of these toxins cause fluid secretion into the intestinal lumen.
• Salmonella (non-typhoid). Salmonella can invade intestinal epithelial cells. Produced enterotoxin causing diarrhea. If there is damage that causes mucosal ulcers, bloody diarrhea will occur.

3. Protozoa:

• Giardia lamblia. This parasite infects the small intestine. Patogensis mechanism remains unclear, but is believed to affect the absorption and metabolism of bile acids. Transmission through the fecal-oral route. Host-parasite interactions is affected by age, nutritional status, endemicity, and immune status. Areas with high endemicity, giardiasis can be asymptomatic, chronic, persistent diarrhea with or without malabsorption. In areas with low endemicity, outbreaks can occur within 5-8 days after exposure to the manifestation of acute diarrhea is accompanied by nausea, epigastric pain and anorexia. Sometimes encountered malabsorption with faty stools, abdominal pain and bloated.
• Entamoeba histolytica. Dysentery amoeba prevalence varies, but its spread throughout the world. The incidence increases with age, and teranak in adult males. Approximately 90% of asymptomatic infections caused by non-pathogenic E.histolytica (E.dispar). Symptomatic amebiasis can be mild and persistent diarrhea to fulminant dysentery.
• Cryptosporidium. In developing countries, cryptosporidiosis 5-15% of cases of diarrhea in children. The infection is usually symptomatic and asymptomatic infants in older children and adults. Clinical symptoms of acute diarrhea with watery type of diarrhea, usually mild and self-limited. In people with impaired immune systems such as AIDS patients, cryptosporidiosis is a reemerging disease with more severe diarrhea and resistant to some antibiotics.
• Microsporidium spp
• Isospora belli
• Cyclospora cayatanensis

4. Helminths:

• Strongyloides stercoralis. Abnormalities in intestinal mucosa caused by adult worms and larvae, causing diarrhea.
• Schistosoma spp. The blood worms cause abnormalities in various organs including the intestinal manifestations, including diarrhea and intestinal bleeding.
• Capilaria philippinensis. This worm is found in the small intestine, especially jejunu, causing inflammation and villous atrophy with clinical symptoms of watery diarrhea and abdominal pain.
• Trichuris trichuria. Adult worms live in the colon, caecum, and appendix. Severe infections can cause bloody diarrhea and abdominal pain.

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Pathophysiology of Diarrhea - NCP

Pathophysiology of Diarrhea

The main function of the gastrointestinal tract is preparing food for living cells, the secretion of bile from the liver restriction and expenditure leftover food that is not digested. This function requires a variety of diverse physiological processes of digestion, the digestive activity can be either: (Sommers, 1994; Noerasid, 1999 cit Sinthamurniwaty 2006)

The process of entry of food from the mouth into the intestine.
The process of chewing (mastication): smoothing the food chewing and mixing with enzymes in the oral cavity.
The process of swallowing food (diglution): the movement of food from the mouth to the stomach.
Digestion: mechanical destruction of food, food ingredients mixing and hydrolysis by enzymes.
Food absorption (absorption): food molecules traveling through the mucous membranes of the intestines into the blood and lymph circulation.
Peristalsis: rhythmic movements of the intestinal wall in the form of a wave of contraction that moves food from the stomach to the distal.
Bowel movements (defecation): disposal of food waste in the form of feces.
Under normal circumstances where the effective functioning digestive tract will produce as much fecal residues 50-100 grams a day and water containing as much as 60-80%. In the gastrointestinal tract, fluid passively following movement of bidirectional transmucosal or longitudinal intraluminal with solid electrolytes and other substances that have active osmotic properties. The fluid that was in the gastrointestinal tract consists of the incoming fluid by mouth, saliva, gastric secretions, bile, pancreatic secretions and intestinal secretions smooth. The liquid is absorbed by the small intestine, and large intestine reabsorbs subsequent intestinal fluid, so that the remaining approximately 50-100 g as a stool.

Motility of the small intestine has the function to:

• Regularly move the bolus of food from the stomach to the cecum.
• Mix chyme with pancreatic enzymes and bile.
• Prevent bacteria to breed.

Physiological factors that cause diarrhea are very closely related to each other. For example, the increase in the intraluminal fluid will cause the intestine stimulated mechanically, thus increasing intestinal peristalsis and will speed up the time trajectory of chyme in the gut. This condition will shorten the time to touch chyme with intestinal mucous membrane, so that the absorption of water, electrolytes and other substances will be impaired.

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Nursing Management for Diarrhea

Nursing Management for Diarrhea

Diarrhea is often caused an extraordinary event, such as the number of cholera patients a lot in a short time. But with the management of diarrhea fast, precise and quality, mortality can be reduced to a minimum.

Problem Formulation

1. What Definition of Diarrhea?
2. What Etiology of Diarrhea?
3. How Pathophysiology of Diarrhea?
4. What Are the Clinical Symptoms of Diarrhea?
5. What are the Complications of Diarrhea?
6. How Nursing Care Plan of Diarrhea?

Purpose

1. Knowing the Definition of Diarrhea.
2. Knowing the etiology of diarrhea.
3. Knowing the pathophysiology of diarrhea.
4. Know the Clinical Symptoms Diarrhea.
5. Knowing the Complications of diarrhea.
6. Knowing Nursing diarrhea.

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