NURSING CHILDREN WITH DIARRHEA

NURSING CHILDREN WITH DIARRHEA


A. Definition

Diarrhea is a bowel movement (defecation) by the number of stools more than normal (normal 100-200 cc / hr feces). With liquid stools / semi-solid, can be accompanied by an increased frequency. According to WHO (1980), diarrhea is watery bowel movements more than 3 times daily. Diarrhea is divided into 2 based on initial and duration, namely acute and chronic diarrhea (Mansjoer, A.1999, 501).

B. Cause
According Ngastiyah (1997), the cause of diarrhea can be divided into several factors:

Factors infection
Enteral infection
Is a major cause of diarrhea in children, which include: bacterial infections, viral infections (enteovirus, polimyelitis, echo coxsackie virus). Adeno virus, Rota virus, astrovirus, etc.) and parasitic infections: worms (Ascaris, Trichuris, oxyuris, strongxloides), protozoa (Entamoeba histolytica, giardia lamblia, trichomonas homunis) mushrooms (canida albicous).
Parenteral infection
is an infection beyond the means of digestion of food such as acute otitis media (OMA), tonsillitis / tonsilofaringits, bronkopeneumonia, encephalitis, and so forth. This situation is mainly found in infants and children under two (2) years.
Factors malabsorption
Malabsorption of carbohydrates, fats and proteins.
Food factor
Spoiled food, toxic, too much fat, cooked vegetables underdone.
Psychological factors
Fear, anxiety

According Haroen NS, Suraatmaja and PO Asnil (1998), from the point of the pathophysiology, causes of acute diarrhea can be divided into two groups, namely:

Secretory diarrhea (secretory diarrhoe), caused by:
Viral infections, pathogenic germs and apatogen like shigella, salmonella, E. Coli, vibrio group, B. Cereus, clostridium perfarings, stapylococus aureus, comperastaltik small intestine caused by food chemicals (eg food poisoning, food is spicy, sour terlalau), psychological disorders (fear, nervousness), neurological disorders, cold, allergy, and so forth.
Deficiency Imum especially SIGA (secretory imonol bulin A) which resulted in a doubling of bacteria / fungi flata intestine and especially canalida.
Osmotic diarrhea (osmotic diarrhea), caused by:
Malabsorption of food: carbohydrates, fats (LCT), protein, vitamins and minerals.
Less calories of protein.
Low birth weight infants and newborn.

C. Pathophysiology
The main cause of diarrhea is osmotic disruption, caused by food or substance that can not be absorbed by the intestines will cause the osmotic pressure rises in the gut cavity, resulting in a shift of water and electrolytes into the intestinal cavity, the contents of this excessive intestinal cavity will stimulate the intestines to remove it so that arise diarrhea.
Diarrhea also occurs due to certain stimuli (eg toxins) in the intestinal wall will increase the water and electrolytes into the gut cavity and then diarrhea arises because there is an increasing content of intestinal cavity.
Diarrhea may also occur due to the entry of microorganisms living in the intestine after successfully passing the stomach acid barrier, these microorganisms multiply, then remove toxins and these toxins occur due to hypersecretion which in turn will cause diarrhea.
Motalitas intestinal disorders also cause diarrhea, the occurrence will result in reduced opportunities hiperperistaltik intestine to absorb food, causing diarrhea, decreased intestinal peristalsis vice versa if the bacteria will cause excessive arise which can cause diarrhea as well.

D. Signs and Symptoms

Children frequent bowel movements with the consistency of liquid or watery stools.
Children whiny, restless, body temperature may be increased, decreased appetite.
Stool color changed to greenish because of mixed bile.
The area around the anus redness and blisters due to frequent difekasi and stools become more acidic due to the number of lactic acid.
There are signs and symptoms of dehydration, clear skin turgor (skin elistitas decreased), the crown and sunken eyes and dry mucous membranes accompanied by weight loss.
Changes in vital signs, pulse and respiration, blood pressure fell rapidly, rapid heart rate, the patient is very weak to cause awareness decreases.
Diuresis decrease (oliguria to anuria).

E. Examination Support

Stool examination
Macroscopic and microscopic
PH and sugar content in feces
When you need to hold the test bacteria
Examination of acid-base balance disorders in the blood, to determine the pH and alkaline reserve and blood gas analysis.
Examination urea and creatinine levels to determine kidney function.
Checking electrolyte levels, especially Na, K, Calcium and Phosphate.

F. Management

Fluid, fluid type, how to give fluids, the amount of administration.
Oral fluid
In clients with mild dehydration and was given orally in the form of liquids which are NaCl and NaHCO3 and glucose. For acute diarrhea and cholera in children above 6 months 90 meg Sodium content / l. In children under 6 months with mild to moderate dehydration sodium levels 50-60 meg / l. Complete formula called ORS, while salt and starch sugar solution is called an incomplete formula because many contain sodium chloride and sucrose.
Parenteral fluids
Given to clients who experience severe dehydration, with details as follows:
For children age 1 bl-2 years 3-10 kg body weight
The first 1 hour: 40 ml / kg / min = 3 tts / kg / min (infusion set size 1 ml = 15 or 13 tts tts / kg / min (set infusion of 1 ml = 20 drops).
7 hours later: 12 ml / kg / min = 3 tts / kg / min (infusset measuring 1 ml = 15 tts or 4 tts / kg / min (set infusion of 1 ml = 20 drops).
The next 16 hours: 125 ml / kg / ORS
For children over 2-5 years with 10-15 kg weight
The first 1 hour: 30 ml / kg / hour or 8 tts / kg / min (1 ml = 15 or 10 tts tts / kg / min (1 ml = 20 drops).
For children more than 5-10 years old with body weight 15-25 kg
The first 1 hour: 20 ml / kg / hour or 5 tts / kg / min (1 ml = 15 or 7 tts tts / kg / min (1 ml = 20 drops).
7 hours of the following: 10 ml / kg / hour or 2.5 tts / kg / min (1 ml = 15 or 3 tts tts / kg / min (1 ml = 20 drops).
16 hours of the following: 105 ml / kg ORS orally.
For newborn babies weighing 2-3 kg
Needs fluid: 125 ml + 100 ml + 25 ml = 250 ml/kg/BB/24 hours, type of fluid 4:1 (4 parts 5% glucose + 1 part of 1 ½% NaHCO3.
Speed: 4 first hour: 25 ml / kg / hour or 6 tts / kg / min (1 ml = 15 tts) 8 tts / kg / BW / mt (1MT = 20 tts).
For low birth weight babies
Fluid requirements: 250 ml/kg/BB/24 hours, type of fluid 4:1 (4 parts 10% glucose + 1 part NaHCO3 1 ½%).
Dietetic treatment
For children under 1 year and children over 1 year weighing less than 7 kg, the type of food:
Milk (breast milk, infant formula and low lactose-containing unsaturated fats.
Semi-solid foods (mashed or solid food (rice team).
Special milk, adjusted for the abnormalities found in such milk that contains no lactose and medium-chain fatty acids or unsaturated.
Drugs
The principle of treatment to replace fluids lost with the fluids that contain electrolytes and glucose or other carbohydrates.

Nursing Children with Diarrhea

Assessment

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 gut bacteria to stimulate immunity against 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 infections and enteric bacteria spread mainly client is not aware of the infection. Economic status are also influential, especially seen from the diet and treatment.
Main complaint
CHAPTER more than 3 x
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 (prolonged diarrhea), more than 14 days (chronic diarrhea).
History Formerly Disease
Ever had diarrhea earlier, pemakian antibiotics or long-term corticosteroid (candida albicans changes from saprophyte to parasite), food allergy, respiratory infection, UTI, OMA measles.
Nutrition History
In children ages toddler food provided as in adults, the portion given 3 times per day with additional fruit and milk. malnutrition in children ages toddler very vulnerable. How pengelolahan good food, personal hygiene and food sanitation, hand washing habits,
Family Health History
There was one family who had diarrhea.
Environmental Health History
Storing food at room temperature, lack of personal hygiene, living environment.
Historical Growth and development
Growth
The increase in body weight since age 1 -3 years 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 from first and 2 cm in the second and so on.
Teething 8 pieces: additional milk teeth, first molars and canines, totaling 14-16 units.
Tooth eruption: molar perama menusul canines.
Development
Psychosexual developmental stage according to Sigmund Freud.
Phase anal:
Expenditure feces become a source of satisfaction libido, meulai shows keakuannya, love yourself / egoistic, his body began to familiar with, the task is utamanyan hygiene training, development and language bicra (imitate and repeat simple words, hubungna interpersonal, play).
Stage according to Erik Erikson’s psychosocial development.
Autonomy vs. Shame and doundt
Perkembangn motor and language skills learned toddler from the environment and benefits that he obtained Dario puannya ability to be independent (not tergantug). Through the encouragement of parents to eat, dress, CHAPTER itself, if the parents are too overprotective yanag demanding expectations too high then the child will feel ashamed and hesitant as well as feelings of inadequacy that can develop in children.
Rough and smooth movement, bacara, language and intelligence, sociable and independent: Age 2-3 years:
Standing on one foot without holding the slightest 2 counts (GK).
Imitating a straight line (GH).
Expressed a desire at least with two words (BBK).
Melepasa own clothes (BM).
Physical examination
Measurement of body length, body weight decreased, smaller arm circumference, head circumference, abdominal circumference enlarged.
General condition: the client is weak, anxiety, irritability, lethargy, decreased awareness.
Head: crown intangible concave because it is close to children over age 1 year.
Eyes: sunken, dry, very concave.
Digestive system: dry mouth mucosa, abdominal distension, peristaltic increase> 35 x / min, decreased appetite, nausea, vomiting, drinking is normal or not thirsty, drink voraciously and seemed thirsty, drink a little or look can drink.
Respiratory System: dyspnea, rapid breathing> 40 x / min because of metabolic acidosis (respiratory muscle contraction).
Cardiovascular system: rapid pulse> 120 x / min and weaker, tension decreased in moderately severe illness.
Integumentary system: pale skin color, turgor decreased> 2 sec, the temperature rise> 375 0 c, akral warm, cold akral (alert shock), displaying a capillary refill time> 2 sec, redness on perianal area.
System urinal: urine production oliguria to anuria (200-400 ml / 24 hours), reduced the frequency of prior illness.
Impact of hospitalization: all children are sick that MRS may experience stress in the form of separation, loss of time to play, against invasive measures the response shown is the protest, despair, and then accept.

Nursing Diagnosis

Changes in nutrition less than body requirements related to diarrhea or excessive output and intake are lacking.
Fluid and electrolyte balance disorders associated with fluid loss secondary to diarrhea.
The risk of increased body temperature associated with the process of secondary infection of diarrhea.
The risk of skin integrity problems associated with an increased frequency of diarrhea.
High risk of growth disturbance associated with body weight decreased continuously.
Child anxiety related to invasive measures.

Intervention
Diagnosis 1.:
Fluid and electrolyte balance disorders associated with fluid loss secondary to diarrhea
Objectives:
Once the action has been nursing for 3 x 24 hours and electrolyte balance is maintained to maximum
Criteria results:

Vital signs within normal limits (N: 120-60 x / min, S; 36 to 37.50 c, RR: <>
Turgor elastic, mucous membranes moist lips, eyes not cowong, UUB not concave.
CHAPTER soft consistency, frequency 1 time per day.

Intervention:

Monitor signs and symptoms of dehydration and electrolyte
R / decrease in liquid volume sisrkulasi cause dryness pemekataj mucosa and urine. Early detection allows immediate fluid replacement therapy to improve deficits
Monitor intake and output
R / Dehydration can increase glomerular filtration rate did not make the output aadekuat to clean the rest of metabolism.
Weigh the body weight every day
R / Detecting loss of fluid, a decrease of 1 kg body weight equal to 1 lt water loss
Encourage families to give to drink a lot at Kien, 2-3 lt / hr
R / Replacing the lost fluids and electrolytes orally
Collaboration:
Laboratory tests of serum electrolytes (Na, K, Ca, BUN)
R / correction fluid and electrolyte balance, BUN to determine kidney function (compensation).
The liquid parenteral (IV line) according to age
R / Replace fluids and electrolytes are adequately and quickly.
Drugs: (antisekresin, antispasmolitik, antibiotics)
R / anti-secretion to reduce the secretion of fluid and electrolytes for simbang, antispasmolitik for the normal absorption process, antibiotics as a broad-spectrum anti-bacterial properties 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 results:

Increased appetite
BB increased or normal according to age

Intervention:

Discuss and explain the restriction of diet (high fiber foods, fatty and water is too hot or cold).
R / high fiber, fat, water is too hot / cold can stimulate sluran irritate the stomach and intestines.
Create a clean environment, away from the smell that was pleasant or trash, serve food in a warm state.
R / situation comfortable, relaxed will stimulate the appetite.
Provide hours of rest (sleep) and reduce excessive activity.
R / Reduce excessive energy consumption
Monitor intake and output in 24 hours.
R / Knowing the amount of output can merencenakan amount of food.
Collaboration with other kesehtaan team:
nutrition therapy: low-fiber diet TKTP, milk.
medicines or vitamins (A)
R / Containing the necessary substances for the growth process

Diagnosis 3. :
The risk of increased body temperature associated with the process of infection of diarrhea secondary impact
Objectives:
After treatment measures for 3x 24 hours there was no increase in body temperature
Criteria results:

Body temperature within normal limits (36 to 37.5 C)
There is no sign of infection (rubur, dolor, calor, tumor, fungtio leasa)

Intervention:

Monitor body temperature every 2 hours
R / Early detection of abnormal changes in body function (an infection)
Give a warm compress
R / stimulates the central regulator of heat to reduce the production of body heat
Collaboration granting antipirektik
R / Stimulate the central regulator of heat in the brain

Diagnosis 4.:
The risk of perianal skin integrity problems associated with an increased frequency of BAB (diarrhea)
Objectives:
After tindaka keperawtan in the hospital during skin integrity is not compromised.
Criteria results:

No irritation: redness, abrasions, cleanliness maintained
Families able to demonstrate good perianal care and correct

Intervention

Discuss and explain the importance of maintaining a bed
R / Cleanliness prevent proliferation of germs
Demontrasikan and involve the family in treating perianal (when wet clothing and replace the bottom and base)
R / Prevent the occurrence of skin iritassi unexpected because kelebaban and stool acidity
Set position to sleep or sit with an interval of 2-3 hours
R / Smooth vaskulerisasi, reducing the emphasis of the old so that does not happen ischemia and irritation.

Diagnosis 5.:
Child anxiety related to invasive measures
Objectives:
After treatments for 3 x 24 hours, the client is able to adapt
Criteria results:

Want to receive treatment action, the client looks calm and exacting

Intervention:

Involve family in care action
R / initial approach to the child through the mother or the family
Avoid a wrong perception on nurses and hospital
R / reduce the fear of children against nurses and hospital environment
Give praise if the client would be given care and treatment measures
R / add a child’s confidence will be the courage and ability
Make contact as often as possible and do good verbal communication and non verbal (touching, fondling, etc.)
R / Love and the introduction of self saying nurses will menunbuhkan sense of security on the client.
Give your child toys as sensory stimuli