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Nursing Care of Acute Diarrhea Moderate Dehydration
Definition of Diarrhea
• According to WHO (1980), diarrhea is watery bowel movements more than 3 times a day.
• According Haroen N, S. Suraatmaja and Asdil PO (1998), watery diarrhea is the defecation of more than 3 times a day with or without blood or mucus in the stool.
• According to Betz CL & LA Sowden (1996) diarrhea is an inflammatory condition of the stomach or intestinal mucosa.
• According Suradi & Rita (2001), diarrhea is defined as a situation where the occurrence of fluid and electrolyte loss that occurs due to excessive frequency of bowel movements with one or more watery or liquid form.
Etiology of Diarrhea
1) Factors of infection: bacteria (Shigella, Shalmonella, Vibrio kholera), virus (enterovirus), parasites (worms), Candida (Candida Albicans).
2) Factors parenteral: Infections of other parts of the body (OMA often occurs in children).
3) Factors malabsorption: Carbohydrates, fats, proteins.
4) Factor Food: Food stale, poisonous, too much fat, cooked vegetables underdone.
5) Psychological factors: Fear, anxiety.
Nursing Assessment on Clients Diarrhea
1. Identity
Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. The incidence is highest age group 6-11 months. Most intestinal bacteria stimulate the immune response to infection, it helps explain the decline insidence disease in older children. At the age of 2 years or more active immunity begins to form. Most cases are due to asymptomatic intestinal infection and enteric bacteria spread mainly clients are not aware of the infection. Economic status are also influential, especially from diet and treatment.
2. Main Complaint
CHAPTER more than 3 x
3. Disease History Now
CHAPTER greenish yellow color, bercamour mucus and blood or mucus only. Watery consistency, frequency of more than 3 times, spending time: 3-5 days (acute diarrhea), more than 7 days (persistent diarrhea), more than 14 days (chronic diarrhea).
4. In the past history of disease
Had experienced diarrhea before, pemakian antibiotics or corticosteroids long term (the change from saprophyte Candida albicans become parasites), food allergy, respiratory infection, UTI, OMA measles.
5. History of Nutrition
In children ages toddler foods given as in adults, the share of a given 3 times per day with additional fruit and milk. malnutrition in children toddler age are particularly vulnerable. Pengelolahan way good food, food hygiene and sanitation, hand washing habits.
6. Family Health History
There was one family who had diarrhea.
7. Environmental Health History
Food storage at room temperature, lack of hygiene, neighborhood.
8. Historical Growth and development
a. Growth
• Increase in BB for 1 -3 years of age ranged from 1.5 to 2.5 kg (average of 2 kg), PB 6-10 cm (average 8 cm) per year.
• Increase linkar head: 12cm Ditahun first and 2 cm in the second and so on.
• 8 pieces Teething: addition of milk teeth: first molars and canines, totaling 14-16 fruit
• Eruption of teeth: molars Perama menusul canine teeth.
b. Development
• Stage of development Psychosexual according to Sigmund Freud.
Anal phase:
Expenditure feces a source of satisfaction of libido, ego meulai show, love yourself / egoistic, starting familiar with her body, the task is utamanyan hygiene training, and language development bicra (imitating and repeating simple words, hubungna interpersonal, play).
• Stage according to Erik Erikson's psychosocial development.
Autonomy vs. Shame and doundt
Perkembangn motor skills and language toddler son learned from the environment and the benefits he gained from his ability to be independent (not tergantug). Through parental encouragement to eat, dress, Chapter itself, if the parents are too overprotective yanag demanding expectations too high then the child will feel shy and hesitant as well as feelings of inadequacy that can develop in children.
• rough and smooth movement, speech, language and intelligence, sociable and independent: Age 2-3 years:
1. Standing with one foot without holding onto the slightest 2 counts (GK)
2. Mimicking make a straight line (GH)
3. Expressed a desire at least to two words (BBK)
4. Melepasa own clothes (BM)
9. Physical examination
a. measurement of length, weight decreased, shrinking arm circumference, head circumference, abdominal circumference enlarged,
b. general condition: the client is weak, restlessness, irritability, lethargy, decreased consciousness.
c. Head: crown intangible concave because it is close to the child over age 1 year
d. Eyes: sunken, dry, very concave
e. Digestive System: dry mouth mucosa, abdominal distension, peristaltic increased> 35 times / min, decreased appetite, nausea, vomiting, drinking normal or not thirsty, drink heartily and looked thirsty, drink a little or a look can drink
f. Respiratory System: dyspnea, rapid breathing> 40 times / min for metabolic acidosis (respiratory muscle contraction)
g. Cardiovascular system: rapid pulse> 120 x / mnt and weaker, tension was decreased in diarrhea.
h. Integumentary System: pale skin color, turgor decreased> 2 dt, the temperature increases> 375 0 C, akral warm, cold akral (beware of shock), capillary refill time displaying> 2 dt, redness of the perianal area.
i. Urinary system: urinary production oliguria up to anuria (200-400 ml / 24 hours), reduced the frequency of prior illness.
j. Impact of hospitalization: all the sick children that MRS may experience stress in the form of separation, loss of playing time, against the action of invasive response shown is the protest, despair, and then accept.
10. Examination Support
a) Laboratory:
• Stool culture: Bacteria, viruses, parasites, candida
• Serum electrolytes: Hypo natremi, Hipernatremi, hypokalemia
• AGD: metabolic acidosis (decreased pH, pO 2 increased, pCO2 increased, HCO3 decreased)
• Renal Physiology: UC increased (GGA)
b) Radiology: may be found bronchopemoni
Management of Diarrhea
Rehydration
1. types of liquids
a) Method of oral rehydration
• complete Formula (NaCl, NaHCO 3, KCl and glucose) as orali, pedyalit whenever diarrhea.
• simple formula (NaCl and sucrose)
b) How to parenteral
• Fluids I: RL and NS
• Fluids II: ¼ D5 copy, nabic. KCL
D5: RL = 4: 1 + KCL
D5 + 6 cc of 15% NaCl + Nabic (7 mEq / lt) + KCL
• HSD (half Strengh Darrow) D ½ NS 2.5 special fluid in diarrhea aged> 3 months.
2. Road administration
a) Oral (dehydration is, kids want to drink, good awareness)
b) Intra-gastric (if the child does not want to drink, eat, kesadran decreased)
3. The amount of fluid; depends on:
a) Deficit (degree of dehydration)
b) Loss of a moment (concurrent less)
c) maintenance (maintenance).
d) Schedule / velocity of the liquid
i. In children aged 1-5 years with 3 cups of heavy badanya when approximately 13 kg: the pemberianya are:
• weight (kg) x 50 cc
• weight (kg) x 10-20 = 130-260 cc per diarrhea = 1 GLS.
ii. Standard therapy in children with diarrhea are:
+ 50 cc/kg/3 hours or 5 drops / kg / min
Therapy
1. anti-secretory drugs: asetosal, 25 mg / day with a minimum dose of 30 mg
2. klorpromazine 0.5 to 1 mg / kg BW / day
3. Onat anti spasmotik: papaverin, opium, loperamide
4. antibiotics: when the cause is clear, there are comorbid disease
Dietetic
a. Age> 1 year with BB> 7 kg, solids / liquid food or milk
b. In case of heavy malbasorbsi and cow's milk protein allergy can be elements or semi-elemental formula.
Supportive
Vitamin A 200,000. IU / IM, ages 1-5 years
Nursing Diagnosis in Clients Diarrhea
1. Changes in nutrition less than body requirements related to diarrhea or excessive output and intake of less
2. Fluid and electrolyte balance disorders associated with fluid loss secondary to diarrhea.
3. The risk of increased body temperature associated with the process of secondary infection of diarrhea
4. Impaired skin integrity risk associated with an increased frequency of diarrhea.
5. High risk of developmental disorders associated with weight decreased continuously.
6. Child's anxiety associated with invasive measures
Diarrhea Nursing Interventions on Client
Diagnosis 1: Disorders of fluid and electrolyte balance associated with fluid loss secondary to diarrhea
Objectives: after nursing action for 3 x 24 hours and electrolyte balance is maintained to the maximum
Expected outcomes:
• Vital signs within normal limits (N: 120-60 x / mnt, S; 36 to 37.50 c, RR: <40 times / min)
• turgor elastic, mucous membranes moist lips, the eyes do not cowong, UUB not concave.
• Consistency CHAPTER flabby, frequency 1 time per day
Intervention:
1. Monitor signs and symptoms of fluid and electrolyte
Rational: The reduction in fluid volume sisrkulasi cause mucosal dryness and pemekataj urine. Early detection allows immediate fluid replacement therapy to correct the deficit
2. Monitor intake and output
Rationale: Dehydration can increase the glomerular filtration rate did not make the output aadekuat to clean the rest of metabolism.
3. Weigh weight every day
Rational: Detecting loss of fluid, decrease of 1 kg of body weight loss of fluid equal to 1 lt
4. Encourage your family to drink a lot of the Kien, 2-3 lt / hr
Rational: Replacing the lost fluids and electrolytes orally
5. Collaboration:
• Laboratory tests of serum electrolytes (Na, K, Ca, BUN)
Rational: correction of fluid balance and electrolytes, BUN to determine renal physiology (compensation).
• parenteral fluids (IV line) according to age
Rational: Replace fluids and electrolytes to adequately and quickly.
• Drugs: (antisekresin, antispasmolitik, antibiotics)
Rational: anti secretion to reduce the secretion of fluid and electrolytes to Simbang, antispasmolitik for the normal absorption process, antibiotics as a broad-spectrum antibacterial to inhibit endotoxin.
Diagnosis 2: Changes in nutrition less than body requirements related to inadequate intake and out put
Objectives: after the action at home on hospital care for nutritional needs are met
Criteria:
• increased appetite
• BB increased or normal according to age
Intervention:
1. Discuss and explain about the restriction diet (high fiber foods, fatty foods and water is too hot or cold)
Rational: high fiber, fat, water is too hot / cold can irritate the stomach and stimulate the intestinal sluran.
2. Create a clean environment, away from the smell that odor or waste, serve food in warm
Rational: the situation is comfortable, relaxed will stimulate the appetite.
3. Provide hours of rest (sleep) and reduce the excessive activity
Rationale: Reduce energy consumption of excessive
4. Monitor intake and out put in 24 hours
Rationale: Knowing the amount of output can merencenakan amount of food.
5. Collaboration with other kesehtaan team:
a. nutrition therapy: low-fiber diet TKTP, milk
b. drugs or vitamins (A)
Rational: Containing the necessary substances to the growth process
Diagnosis 3: The risk of increased body temperature associated with the secondary impact of diarrheal infections
Objectives: After making action 3x 24-hour care for no increase in body temperature
Expected outcomes:
• body temperature within normal limits (36 to 37.5 C)
• There is no sign of infection (rubur, dolor, heat, tumors, fungtio leasa)
Intervention:
1. Monitor body temperature every 2 hours
Rationale: Early detection of abnormal changes in body function (an infection)
2. Give a warm compress
Rational: stimulates the central thermostat to lower the body's heat production
3. Collaboration of antipirektik
Rationale: Stimulating central thermostat in the brain
Diagnosis 4: The risk of perianal skin integrity problems associated with an increased frequency of BAB (diarrhea)
Objectives: after tindaka keperawtan during hospital skin integrity is not compromised
Expected outcomes:
• No irritation: redness, abrasions, cleanliness maintained
• Families able to demonstrate perianal care properly
Intervention:
1. Discuss and explain the importance of maintaining a bed
Rational: Cleanliness prevents germs breeding
2. Demontrasikan and involve the family in caring for perianal (if wet clothing and replace the bottom and base)
Rationale: Prevent the occurrence of skin iritassi unexpected because kelebaban and stool acidity
3. Adjust bed or seated position with an interval of 2-3 hours
Rational: Smooth vaskulerisasi, reducing the emphasis of the old so that did not happen and irirtasi ischemia.
Diagnosis 5: Anxiety of children associated with invasive measures
Objectives: after the maintenance action for 3 x 24 hours, the client is able to adapt
Expected outcomes: Want to receive maintenance action, the client was calm and no fuss
Intervention:
1. Involve family in care action
Rationale: The initial approach to the child through the mother or the family
2. Avoid the wrong perception on nurses and hospital
Rational: reduce the fear of the child to the nurse and the hospital environment
3. Give praise if the client would be given the care and treatment measures
Rational: adds confidence to the courage and ability of children
4. Do contact as often as possible and do the communication both verbal and non verbal (touching, fondling, etc.)
Rational: the introduction of self-love saying and nurses will menunbuhkan sense of security on the client.
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