Management Of Diarrhoea In Adults , Disorders of intestinal absorption and bowel elimination do not only affect functional elimination status. Other functional health patterns affected include, but are not limited to, health perception– health management, nutritional–metabolic, activity–exercise, self-perception–self-concept and sexuality– reproductive. Bowel function is affected by inflammations, infections, tumours, obstructions or changes in bowel structure.
Normal bowel elimination patterns vary widely. For some people, two to three stools per day is their usual pattern, whereas for other people their usual pattern is three stools per week. It is important to evaluate each person’s bowel elimination against their normal pattern. One of disorders of intestinal absorption is Diarrhoea.
Diarrhoea is an increase in the frequency, volume and fluid content of the stool. In diarrhoea, the water content of faeces is increased, usually due to either malabsorption or water secretion in the bowel. It is a clinical manifestation, rather than the primary disorder. Diarrhoea may be acute or chronic. Acute diarrhoea (lasting less than a week) is usually due to an infectious agent. Chronic diarrhoea (persisting longer than 3 to 4 weeks) may be caused by inflammatory bowel disorders, malabsorption or endocrine disorders.
manifestations of diarrhoea depend on the cause, duration, severity and area of bowel affected, as well as a person’s age and general health. Diarrhoea presents as several large, watery stools daily or very frequent small stools containing blood, mucus or exudates.
Complications Diarrhoea can have devastating effects. Water and electrolytes are lost in diarrhoeal stools, leading to dehydration, particularly in the very young, older adults or debilitated individuals unable to respond to thirst. With severe diarrhoea, vascular collapse and hypovolaemic shock may occur. Potassium and magnesium are lost, potentially leading to hypokalaemia and hypomagnesaemia. The loss of bicarbonate in the stool can lead to metabolic acidosis.
Management of diarrhoea focuses on identifying and treating the underlying cause. Additionally, the diarrhoea itself needs to be treated, comfort promoted and complications prevented. A health history (including the onset and associated circumstances of the diarrhoea) and physical examination often provide enough information to identify its cause. However, precise diagnosis is only achieved with laboratory investigations.
Antidiarrhoeal medications are used sparingly or not at all until the cause of diarrhoea is identified. In diarrhoea associated with botulism or bacillary dysentery, giving an antidiarrhoeal agent worsens or prolongs the infection by slowing toxin elimination from the bowel. Once the underlying cause for diarrhoea is established, specific medications, if appropriate, are ordered to treat the underlying cause. Antibiotics are used cautiously as these alter the bowel’s normal bacterial population and may actually increase diarrhoea. A balanced electrolyte solution may be required to replace fluid and electrolyte losses. Intravenous or oral potassium preparations may also be prescribed.
Opium and some of its derivatives, anticholinergics, absorbents and demulcents are commonly used as antidiarrhoeal preparations. Specific preparations, their method of action and nursing implications for these medications are outlined in the following ‘Medication administration’ box.
Fluid and electrolyte replacement is of primary importance in managing a person with diarrhoea. If the person is tolerating oral fluids (i.e. the person is not experiencing nausea and vomiting), an oral glucose/balanced electrolyte solution provides the best fluid replacement. Several commercial preparations (e.g. Gastrolyte) are available, as are paediatric solutions which can be used for adults as well as children. During acute diarrhoea, the person’s diet should be modified to rest the bowel. During the first 24 hours, solid food should be withheld. After this time, frequent, small amounts of starchy foods can be added. Milk and milk products are added last, as these contain lactose which frequently aggravates the diarrhoea. Raw fruit and vegetables, fried foods, bran, wholegrain cereals, condiments, spices, coffee and alcoholic beverages are avoided during the recovery period as the bowel has difficulty processing these complex materials. People with chronic diarrhoea may benefit by eliminating specific foods from their diet. Foods and non-food substances aggravating diarrhoea are outlined in Table 23.1. The diet should be high in kilojoules and nutritional value. Vitamin supplements may be necessary, particularly the fat- soluble vitamins (A, D, E, and K). Occasionally, people with severe chronic diarrhoea require parenteral nutrition.
Complementary and alternative therapies
Herbal or homeopathic therapies may be used to help relieve diarrhoea. People with lactose intolerance may use lactase enzymes tablets or drops when consuming milk products. Herbal treatments include a strong tea of black pepper, chamomile, coriander, rosemary, sandalwood or thyme. Ginger tea or capsules are helpful in reducing intestinal inflammation and decreasing the effects of food poisoning. Probiotics, live microogranisms similar to those normally found in the gut, may be used to prevent or treat antibiotic- associated diarrhoea (Campbell, 2014; Reintam Blaser, Deane & Fruhwald, 2015). Probiotics are available as dietary supplements and food (e.g. yoghurt, yoghurt drinks). The person should consult a qualified medical or homeopathic practitioner when choosing to manage their diarrhoea with complementary and alternative therapies.
Prevention of diarrhoeal diseases essentially involves avoiding infectious agents (Lee & Bishop, 2013). Educating individuals and their families about the importance of handwashing is a primary measure to prevent and reduce the spread of infectious diseases, including those causing diarrhoea. Educating people about safe food handling techniques prevents bacterial contamination. Discuss measures to ensure safe drinking water. For people planning travel to remote areas or outside Australia, discuss the importance of avoiding the consumption of high-risk foods (especially raw foods) and beverages, and purification methods for drinking and cooking water.