Diarrhea is an increase in the frequency of bowel movements often characterized by loose stools and urgency. Diarrhea can be acute (lasting only a few days) or chronic (lasting for weeks). Mild cases will resolve on their own while more severe cases accompanied by an infectious process, cancer, or disease, can lead to dehydration and require further assessment and treatment.
Nurses should monitor a patient’s diarrhea for worsening symptoms and subsequent alterations to nutrition, vital signs, lab values, and skin integrity. Nurses should also educate patients on diet recommendations, medication use, and hydration guidelines to prevent diarrhea.
Causes of Diarrhea (Related to)
- Infection/Parasites
- Laxative use
- Medication side effects
- Chemotherapy/Radiation
- Travel
- Consuming contaminated food or water
- Tube feedings
- Gastrointestinal inflammation
- Anxiety/Stress
- Alcohol abuse
- Malabsorption
- Autoimmune disorders (Crohn’s disease or ulcerative colitis)
- Gastrointestinal surgery (colectomy, bowel resection)
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Abdominal pain
- Gas, bloating
- Urgency and frequency
Objective: (Nurse assesses)
- Hyperactive bowel sounds
- Three or more loose stools per day
- Blood or mucus in the stool
Expected Outcomes
- Patient will verbalize understanding of foods that contribute to diarrhea
- Patient will maintain adequate fluid intake to prevent dehydration of at least 1500 mL/day
- Patient will report experiencing less than three loose stools per day
- Patient will report stools are formed and soft without blood or mucus
- Patient will report relief from abdominal pain, gas, or cramping
Nursing Assessment for Diarrhea
1. Assess onset and pattern of diarrhea.
Note when symptoms started, recent foods eaten, any recent travel, or change in medications. Length of time of diarrhea can dictate between acute or chronic diarrhea and determine treatment.
2. Assess characteristics and number of stools.
Either through observation or patient verbalization, gather an understanding of the number of loose stools per day, the color, and any blood or mucus in the stool.
3. Obtain a stool culture.
A stool culture will help determine treatment if a specific organism can be identified.
4. Assess for abdominal pain and related symptoms.
Assess the type and location of abdominal pain as well as related symptoms of nausea, vomiting, loss of appetite, fever, and faintness or dizziness from dehydration.
5. Assess bowel sounds.
Diarrhea normally results in hyperactive bowel sounds.
6. Monitor electrolyte imbalances.
Severe or prolonged diarrhea can result in dehydration and electrolyte imbalances. Obtain these results through blood work.
7. Assess gastrointestinal history.
Assess for a history of colitis, Clostridium Difficile, autoimmune diseases, or recent GI surgery that may be causing diarrhea.
Nursing Interventions for Diarrhea
1. Encourage a liquid diet.
Diarrhea normally requires bowel rest and the healthcare provider may order an NPO diet, but more likely a clear or full liquid diet.
2. Educate on diet changes to prevent diarrhea.
A bland diet with low fiber is needed to bulk the stools. This includes soft foods without added sugar or spices such as white rice, white toast, crackers, and eggs. Raw, fresh foods and caffeine are not recommended.
3. Review medications.
Medications may need to be changed if diarrhea is an intolerable side effect. Review how a patient is taking their medications. If they are taking laxatives or stool softeners, educate on the appropriate use and to discontinue if diarrhea develops.
4. Administer antidiarrheals as appropriate.
Once the cause of diarrhea has been determined and it is not contraindicated, administer antidiarrheals to stop diarrhea. These should not be given if the patient has a parasitic infection as the infectious process needs to be eliminated.
5. Correct electrolyte imbalances.
Dehydration is common with diarrhea. Administer IV fluids if dehydration is severe. Replace electrolytes such as potassium if required.
6. Children may need oral rehydration.
Children experiencing diarrhea may need oral rehydration solutions such as Pedialyte. These can also be concocted through a mixture of water, sugar, and salt to replace lost fluids.
7. Promote relaxation for stress or anxiety.
Stress can exacerbate an inflammatory reaction by disrupting the immune system and intestinal microbiome which can exacerbate inflammatory bowel disease including Crohn’s disease or ulcerative colitis.
8. Promote skin integrity.
Frequent diarrhea can cause skin breakdown to the perianal area. Educate on proper wiping from front to back and the use of non-irritating cleansers. If the patient is incontinent, provide frequent diaper changes and keep the perineum dry and apply skin barrier ointments.
9. Educate on proper food handling.
Food poisoning is a common cause of diarrhea. Ensure the patient understands how to properly handle and cook food. Prevent cross-contamination when handling raw meats and clean produce before ingesting. Do not eat food that has not been properly refrigerated or cooked. Always wash hands before eating.
10. Refer to specialists for chronic diarrhea.
Chronic diarrhea that lasts longer than four weeks requires further assessment. The patient may need a referral to a gastroenterologist to investigate for a possible inflammatory bowel disease or a cause of malabsorption. Procedures such as a colonoscopy may be needed. Allergists can assist if diarrhea seems to be related to certain foods such as gluten. Dieticians can recommend diet adjustments.
11. Lifestyle modifications.
Alcohol can be irritating to the intestines and speeds digestion. Chronic alcohol use has been shown to increase bacterial overgrowth in the small intestine. Smoking is a common cause of developing and exacerbating Crohn’s disease. Educate patients on the consequences of their lifestyle behaviors and provide resources to quit.
12. Educate on post-surgical expectations.
Patients undergoing GI surgeries will likely have loose stools for days to weeks. Dumping syndrome occurs when part of the stomach or esophagus is removed causing food to move too quickly into the small intestine. Patients who have ostomies, particularly ileostomies, in which the colon is completely or partially removed, tend to have looser stools with frequent output.
References and Sources
- Bland diet. (2020, January 7). MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000068.htm
- Chiba T, Phillips SF. Alcohol-related diarrhea. Addict Biol. 2000 Apr 1;5(2):117-25. doi: 10.1080/13556210050003702. PMID: 20575826.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- IBD Clinic. (n.d.). Smoking and Crohn’s Disease. IBD Clinic. http://www.ibdclinic.ca/ibd-and-lifestyle/smoking-and-ibd/smoking-and-crohns-disease/
- Jamrozy, K. (2021, November 9). Alcohol and Diarrhea. Alcohol Rehab Help. https://alcoholrehabhelp.org/addiction/effects/diarrhea/
- Lamont, T. (2020, September 11). Patient education: Chronic diarrhea in adults (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/chronic-diarrhea-in-adults-beyond-the-basics
- Mayo Clinic. (n.d.). Dumping Syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc-20371915
- Oral rehydration therapy. (2019, October 30). About Kids Health. https://www.aboutkidshealth.ca/Article?contentid=982&language=English
- Sun, Y., Li, L., Xie, R., Wang, B., Jiang, K., & Cao, H. (2019). Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Frontiers in pediatrics, 7, 432. https://doi.org/10.3389/fped.2019.00432
- Tresca, A. (2021, March 12). Normal Stool After Ostomy Surgery. Verywell Health. https://www.verywellhealth.com/what-is-normal-stool-after-ostomy-surgery-4177816
