Diarrhea Assessment and Management
Key Points
- Diarrhea is defined in this section as more than three unformed stools in twenty-four hours.
- Priority risks are dehydration, electrolyte imbalance, and skin breakdown from frequent watery stool.
- Causation can be infectious, medication-related, food-related, or linked to chronic GI disease.
- Infection-control measures are essential when contagious etiologies such as C. diff are suspected.
Pathophysiology
Diarrhea occurs when intestinal water absorption is reduced or fluid secretion increases, causing rapid stool transit and loose output. Acute cases are often related to infection, food intolerance, anxiety, or medications; chronic patterns can suggest inflammatory or malabsorptive disorders.
Rapid stool loss reduces intravascular volume and can trigger fluid-volume-deficit-hypovolemia-and-dehydration and potassium-balance-disorders. Frequent, urgent bowel activity also causes cramping, fatigue, and skin irritation, with greater harm when prolonged.
Classification
- Acute diarrhea: Lasts days to about one week, commonly infectious or medication related.
- Chronic diarrhea: Persists for weeks and may indicate inflammatory-bowel-disease or malabsorption.
- Infectious high-risk diarrhea: Includes C. diff patterns requiring strict transmission precautions.
Nursing Assessment
NCLEX Focus
Priority often hinges on identifying dehydration severity and determining when antidiarrheal therapy is unsafe.
- Quantify stool frequency, appearance, urgency, and duration, including recent antibiotic exposure.
- Assess dehydration cues: thirst, dry mucosa, dark urine, fatigue, dizziness, and hemodynamic changes.
- Monitor bowel sounds, abdominal cramping, and nutrition tolerance trends.
- Evaluate infection risk and implement isolation/hand-hygiene precautions when indicated.
Nursing Interventions
- Replace losses with oral rehydration or IV fluids per severity and ordered plan.
- Support symptom control with diet adjustments, including short-term bland intake when tolerated.
- Reinforce infection prevention, including contact precautions and soap-and-water hand hygiene for suspected clostridioides-difficile-infection.
- Coordinate diagnostics such as stool studies when symptoms persist, recur, or worsen.
- Reassess skin integrity and protect perianal tissue during high-output episodes.
Antidiarrheal Caution
Avoid routine antidiarrheal use when bacterial or parasitic infection is suspected, because suppressing stool transit may worsen disease course.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antidiarrheals | Loperamide | Reduces stool frequency; use cautiously and avoid in some infectious etiologies. |
| antibiotics | Etiology-directed agents | Reserve for confirmed/suspected bacterial causes and monitor response. |
| probiotics | Lactobacillus-containing products | May help reestablish gut flora in selected medication-associated diarrhea cases. |
Clinical Judgment Application
Clinical Scenario
A hospitalized adult develops foul-smelling watery stools after recent broad-spectrum antibiotics, with rising fatigue and dizziness.
Recognize Cues: Frequent watery stool, antibiotic exposure, and dehydration signs. Analyze Cues: Pattern suggests infectious diarrhea with fluid and electrolyte risk. Prioritize Hypotheses: Immediate concern is volume depletion and transmission to others. Generate Solutions: Start rehydration, institute precautions, and send ordered stool testing. Take Action: Monitor response, protect skin, and escalate hemodynamic instability. Evaluate Outcomes: Stool burden decreases, hydration improves, and complications are avoided.
Related Concepts
- constipation-clinical-management - Contrasts opposite elimination disorder and distinct treatment priorities.
- fecal-incontinence-and-bowel-retraining - Severe diarrhea can worsen leakage and urgency episodes.
- soap-and-water-hand-hygiene-for-c-difficile - Essential procedure when spores are suspected.
- fluid-volume-deficit-hypovolemia-and-dehydration - Core complication of persistent stool loss.
- potassium-balance-disorders - Common electrolyte risk during prolonged diarrhea.
Self-Check
- Which cues most strongly indicate dehydration from diarrhea?
- Why can antidiarrheal medication be unsafe in selected infectious cases?
- What infection-control step is critical in suspected C. diff diarrhea?