NURSING CARE PLAN DIARRHEA

A. Understanding
1. Diarrhea is a bowel movement (defecation), with feces as a liquid or
semi-liquid, thus the water content in the stools more than normal
defecation once ie 100-200 ml (Hendarwanto, 1999).
2. According to WHO (1980) defecate diarrhea is watery or liquid for more
than three times a day.
3. Diarrhea is the state of the frequency of bowel movements more than 4
times in infants and more than 3 times in children with watery stool
consistency, can be green or can be mixed with mucus and blood
(Ngastiyah, 1997).
4. Infectious diarrhea is a condition where children frequent bowel
movements with watery stools as a result of an infection.
(Www.medicastore, 2007)

B. Etiology
1. Factors infection
a) Enteral infections, gastrointestinal infections are a major cause of
diarrhea, including infectious bacteria (Vibrio, E. coli, Salmonella,
Shigella, Campylobacter, Yersinia, Aeromonas, etc.), viral infections
(enterovirus, adenovirus, Rotavirus, Astrovirus, etc.) , parasitic infections
(E. hystolytica, G.lamblia, T. hominis) and fungi (C. albicans).
b) Parenteral Infection; an infection outside the digestive system that can
cause diarrhea, such as: acute otitis media, tonsillitis, bronchopneumonia,
encephalitis and so forth.
2. Factors malabsorption
Carbohydrate malabsorption: disaccharides (lactose intolerance, maltose and
sucrose), monosaccharides (glucose intolerance, fructose and galactose).
Lactose intolerance is the most important cause of diarrhea in infants and
children. In addition it is also possible malabsorption of fat and protein.
3. Food factor:
Diarrhea may occur due to eating spoiled food, toxic and allergic to certain
foods.
4. Psychological Factors
Diarrhea may occur due to psychological factors (fear and anxiety)

C. Pathophysiology
The basic mechanism that causes diarrhea are:
1. Impaired osmotic
The presence of food or substance that can not be absorbed to cause osmotic
pressure in the intestinal lumen increased resulting in a shift of water and
elektroloit into the intestinal lumen. Fill cavity of excessive bowel will
stimulate the intestines to release it causing diarrhea.
2. Impaired secretion
Due to certain stimuli (eg toxins) in the intestinal wall will increase secretion,
water and electrolytes into the intestinal lumen and diarrhea because arises
subsequent increase in intestinal luminal contents.
3. Gut motility disorders
Hiperperistaltik will cause a reduction in the gut a chance to absorb food,
causing diarrhea. In contrast when intestinal peristalsis decreases will result in
excessive growth of bacteria, subsequent diarrhea can occur as well.

D. Clinical Manifestations
a. Throw up
b. Fever
c. Abdomen Pain
d. Mucous membranes of the mouth and dry lips
e. Sunken Fontanel
f. Weight loss
g. No appetite
h. Weak
 Acute diarrhea due to infection can be accompanied by vomiting, fever,
tenesmus, hematoschezia, and abdominal pain or stomach cramps. The most fatal
result of diarrhea that lasted long without adequate rehydration is the cause of
death from dehydration or hypovolemic shock biochemical disturbances in the
form of ongoing metabolic acidosis. Seseoran a lack of fluids will feel thirst,
weight loss, sunken eyes, dry tongue, cheek bones appear more prominent,
decreased skin turgor and the voice becomes hoarse. Complaints and symptoms
caused by the depletion of isotonic water.
Because the loss of bicarbonate (HCO3), the comparison with carbonic
acid is reduced resulting in decreased blood pH, which stimulates the respiratory
center so that the frequency of respiration increased and deeper (Kussmaul
breathing).
Cardiovascular disorders at this stage can be a severe hypovolemic shock
with signs of rapid pulse (> 120 x / min), blood pressure drops to be measured.
The patient became restless, pale face, cold akral and sometimes cyanosis.
Because of potassium deficiency on acute diarrhea can also arise cardiac
arrhythmias.
Decrease in blood pressure will cause renal perfusion decreased to arise
oliguria/anuria. If this situation does not immediately diatsi will arise
complications of acute renal tubular necrosis, which means a state of acute renal
failure.

E. Complications
a. Dehydration
b. Hypovolemic shock
c. Convulsions
d. Bacteremia
e. Mal nutrition
f. Hypoglycemia
g. Intolerance secondary to intestinal mucosal damage.
 From complications of gastroenteritis, dehydration level can be classified
as follows:
a) Mild dehydration
Loss of fluid 2-5% of body weight with the clinical picture is less elastic skin
turgor, hoarseness, the patient has not fallen on the state of shock.
b) Moderate Dehydration
Loss of fluid 5-8% of body weight with poor skin turgor clinical picture,
hoarseness, people with pre-shock pulse falling fast and deep.
c) Dehydration Weight
Loss of fluid 80-10% of bedrat body with such clinical signs of dehydration is
coupled with decreased consciousness, apathy to coma, stiff muscles until
cyanosis.

F. Examination Support
Diagnosis based on symptoms and physical examination.
Blood tests conducted to determine electrolyte levels and white blood cell count.
To determine the causative organism, carried breeding of stool samples.
Laboratory examination. Stool examination. Examination of acid-base balance
disorders in the blood Astrup, if possible by determining the pH balance of blood
gas analysis or Astrup, if possible. Examination urea and creatinine levels to
determine kidney puncture.
Duodenal intubation electrolyte examination to determine the micro-
organism or parasite, quantitatively, mainly performed in patients with chronic
diarrhea.

G. Management
1. In children with diarrhea without dehydration (dehydration).
Action:
• To prevent dehydration, give children drink more than usual
- ASI (Air Susu Ibu) forwarded
- Food is given as usual
 - When state child gain weight, immediately take it to the nearest health
center
2. In children with diarrhea with dehydration mild/moderate
Action:
- Give ORS
- ASI (Air Susu Ibu) forwarded
- Forward feeding
- We recommend a soft, easily digested and does not stimulate
- When there are no immediate changes to get it back to the nearest health
center
3. In children with diarrhea with severe dehydration
Action:
- Immediately taken to the hospital / health center with treatment facilities
- ORS and breast milk can still be continued for a drink

NURSING CONCEPTS WITH DIARRHEA

A. Assessment
Systematic assessment includes data collection, data analysis and problem
determination. The collection of data obtained by means of intervention,
observation, psikal assessment. Assess the data by Cyndi Smith Greenberg, 1992
are:
a. The identity of the client.
b. History of nursing.
c. Prefix attack: Originally whiny child, anxiety, increased body temperature,
anorexia and diarrhea occur.
d. The main complaint: the more liquid Faeces, vomit, if losing a lot of water
and electrolytes occur symptoms of dehydration, body weight decreased. In
infants sunken fontanel large, tone and reduced skin turgor, mucous
membranes of the mouth and lips dry, CHAPTER frequency more than 4
times with watery consistency.
e. Past medical history.
f. History of the illness, history of immunization.
g. Family psychosocial history.
Treated will be a stressor for the child itself and for the family, the anxiety
increases if the parents do not know the procedure and treatment of children,
after realizing her illness, they will react with anger and guilt.
h. Basic needs.
i. The pattern of elimination: will change the BAB more than 4 times a day,
BAK few or rare.
j. Nutritional pattern: beginning with nausea, vomiting, anopreksia, causing
weight loss patients.
k. The pattern of sleep and rest will be disturbed because of abdominal
distension that would cause discomfort.
l. Pattern hygiene: bathing habits every day.
m. Activities: will be disturbed because the body is very lamah and the pain due
to abdominal distension.
n. Physical examination.
o. Psychological examination: general condition seemed weak, kesadran
composmentis to coma, high body temperature, rapid and weak pulse,
breathing rather quickly.
p. Systematic examination:
· Inspection: sunken eyes, large fontanel, mucous membranes, mouth and
dry lips, weight loss, anal redness.
· Percussion: presence of abdominal distension.
· Palpation: less elastic skin turgor
· Auscultation: bowel sounds hearing.
q. Examination tinglkat growth and development.
Diarrhea in children will experience disruption due to child dehydration so
that body weight decreased.
r. Investigations.
 Stool examination, complete blood and doodenum intubation is to find the
cause of the quantitative and qualitative.

B. Nursing Diagnosis
1. Lack of fluid volume bd excessive loss through feces and vomiting and
restricted intake (nausea).
2. Changes in nutrition less than body requirements bd disturbance nutrient
absorption and increase intestinal peristalsis.
3. Pain (acute) bd hiperperistaltik, irritation perirektal fissure.
4. Anxiety bd family child health status change
5. Lack of family knowledge about the condition, prognosis and therapy
needs bd limited exposure information, misinterpretation of information
and / or cognitive limitations.
6. Bd child separation anxiety with parents, new environments.

C. Nursing Plan
1. Lack of fluid volume b / d of excessive loss through feces and vomiting and
restricted intake (nausea)
Objective: The need will be met with the criteria liquid no signs of
dehydration
Intervention & Rational
- Give fluid according to the oral and parenteral rehydration program
Monitor intake and output.
R /: In an effort rehydration to replace fluids that come out with feces
- Provide information to determine the status of fluid balance fluid needs
replacement.
- Assess vital signs.
R /: signs / symptoms of dehydration and laboratory test results
- Assessing hydration status.
R /: electrolyte and acid base balance
- Collaboration execution of definitive therapy.
 R /: Delivery of drugs causally important after the cause of diarrhea in
mind
2. Changes in nutrition less than body requirements b / d disturbance nutrient
absorption and increase intestinal peristalsis.
Objective: The nutritional requirements are met by the criteria of an increase
in fallow body
Intervention & Rational
- Maintain bed rest and limitation of activity during the acute phase.
R /: Lowering the metabolic needs
- Maintain the status of fasting during the acute phase (based therapy
programs.)
R /: restricted diet by mouth may be determined during the acute phase to
reduce peristalsis resulting in nutritional deficiencies
- Immediately begin oral feeding after the client's condition allows.
R /: Delivery of food as soon as may be necessary after the client's clinical
condition allows.
- Assist the implementation of appropriate feeding with diets
R /: Meeting the nutritional needs of clients
- Collaboration parenteral nutrition as indicated.
R /: resting the gastrointestinal work and overcome / prevent further
nutritional deficiencies
3. Pain (acute) b / d hiperperistaltik, irritation perirektal fissure.
Objectives: Pain is reduced to the criteria there are no blisters on perirektal
Intervention & Rational
- Set a comfortable position for the client, for example with knee flexion.
R /: Lowering the surface tension and reduce abdominal pain
- Do activities transfer to give a sense of comfort such as back massage and
warm compresses abdomen.
R /: Improve relaxation, shifting the focus of attention kliendan improve
coping skills
 - Clean the area with mild soap and anorectal airsetelah defecation and
provide skin care.
R /: Protecting skin from feces acidity, preventing irritation
- Collaboration of analgesics and / or anticholinergic drugs as indicated.
R /: Analgesic as an anti-pain and anticholinergic agents to reduce the
spasm of the GI tract can be given according to clinical indication
- Assess complaints of pain by Visual Analog Scale (scale 1-5), changes in
the characteristics of pain, verbal and non verbal clues.
R /: Evaluating the development of pain to determine the next intervention
4. Family anxiety b / d of changes in health status of children.
Objective: The family expressed anxiety is reduced.
Intervention & Rational
- Encourage clients to discuss family concerns and provide feedback on
appropriate coping mechanisms.
R /: Help identify the cause of anxiety and alternative solutions to
problems
- Emphasize that anxiety is a common problem that occurs in the elderly
clients whose children have the same problem.
R /: Helps to reduce stress by knowing that the client is not the only people
who experience such problems
- Create a calm environment, show warm-hearted and sincere attitude in
helping klien.
R /: Reduce external stimuli that can trigger an increase in anxiety
5. Lack of family knowledge about the condition, prognosis and therapy needs b
/ d of exposure information is limited, incorrect interpretation of information
and / or cognitive limitations.
Goal: Families will understand about the disease and treatment of children,
and able to demonstrate the care of children at home.
Intervention & Rational
- Assess client's readiness to follow the family learning, including
knowledge about the disease and child care.
 R /: Effectiveness of learning is influenced by physical and mental
readiness as well as prior background knowledge.
- Explain about his disease process, causes and consequences of disruption
of daily needs of everyday activities.
R /: An understanding of this issue is important to increase the
participation of the client families and families in the process of client care
- Explain the purpose of drug administration, dosage, frequency and route of
administration and possible side effects.
R /: Increase understanding of the client and family participation in
treatment.
- Explain and demonstrate how to perineal care after defecation.
R /: Improve client independence and family control of self-care needs of
children.
6. Bd child separation anxiety with parents, of environmental newly
Objective: Anxiety is reduced by the criteria of children showing signs of
comfort
Intervention & Rational
- Encourage the family to always visit clients and participate in perawatn
performed.
R /: Preventing stress associated with separation
- Give a touch and talk to children as often as possible.
R /: Providing a sense of comfort and reduce stress
- Perform sensory stimulation or play therapy in accordance with ingkat
client development.
R /: Improving the optimum growth and development.

D. Evaluation
Evaluation is measuring the success of the extent to which that goal is
reached. If there is not reached then conducted the review, then prepared a plan,
then implemented in the implementation of nursing evaluated plainly, if the
evaluation is not resolved then made the first step again and so on until the
destination is reached.
· Volume of fluid and electrolytes returned to normal as needed.
· Nutritional needs are met in accordance of body’s need.
· Skin integrity returns to normal.
· Comfort are met.
· Knowledge ancestry increases.
· Anxious in client is resolved.
 BIBLIOGRAPHY

Manasikana, Moh. 2011. Askep Children With Gastroenteritis/Diarrhea.

Vini. 2010. NCP Diarrhea. http://vinnivicci.blogspot.com/2010/11/ncp-nursing-