Diarrhea NCP and FDAR PDF

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Diarrhea related to irritable bowel disorder as evidenced by lower abdominal pain and loose stools. Assessment Scientific Analysis Planning Intervention Rationale Safe and Quality Short Term Goal Subjective Data: Bloody diarrhea is a N/A sign of intestinal After 6-8 hrs of Nursing Care infection; sometimes, nursing Observe and document Help differentiate individual it can be an interventions the stool frequency, disease and assesses Objective Data: indication of a more patient should be characteristics, severity of episode Vital Signs serious condition, able to report amount, and HR 108 bpm such as cancer or a reduction in precipitating factors BP 122/82 mmhg vascular problem frequency of TEMP 37.4 C with your bowels stools and return 02 SAT 100% (Brunner and to more normal Promote bedrest, if Rest decreases intestinal RR 16 cpm Suddarth 2014) stool consistency. indicated, and provided motility and reduces the bedside commode. metabolic rate when Long Term Goal Slight nausea hemorrhage is a Rectal bleeding After 8 hrs of complication. Urge to Abdominal pain nursing defecate may occur without Orthostasis interventions the warning and be patient will be uncontrollable, thus Pt had 8-9 bowel able to repot increasing risk of movements reduction in incontinence and falls if yesterday; overnight frequency of facilities are not close at had several more stools, return to hand. loose bowel more normal stool movements that consistency, Remove stool Reduce noxious odors to were mainly red identify and avoid promptly. Provide room avoid undue client blood with a small contributing deodorizers. embarrassment. amount of liquid factors such as stool poor hygiene, eating large Restart oral fluid intake Provides colon rest by amounts of meat gradually, if client has omitting or decreasing the and fibers and been on bowel rest stimulus of foods and fluids drinking poor (NPO) during Gradual resumption of quality water treatment. Offer clear liquids may prevent

Evaluation After 8 hrs of nursing interventions the patient was able to report reduction in frequency of stools, returned to more normal stool consistency, identified and avoided contributing factors such as poor hygiene, eating large amounts of meat and fibers and drinking poor quality water

liquids hourly and avoid cold fluids.

Health Education Discuss patient’s usual diet. Have patient/SO identify foods and fluids that precipitate patient’s diarrhea and cramping pain.

Communication Provide opportunity to vent frustrations related to disease process.

Collaboration and Teamwork Administer medications, as indicated: Hydrochlorothiazide

cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility.

There is no one single food or group of foods that precipitates problems for everyone with LGB. Dietary needs and restrictions must be individualized, depending on which disease the patient has and what part of the intestine is affected (CCFA, 2013)

Presence of disease with unknown cause that is difficult to cure and that may require surgical intervention can lead to stress reactions that may aggravate condition.

Diuretics acts as hypertensive drug for the patient and increasing urinary excretion of sodium and water thus relieving

and Aspirin

edema, aspirin an antiinflammatory and analgesics indicated for the patient’s pain.

FDAR F- Diarrhea related to irritable bowel disorder as evidenced by lower abdominal pain and loose stools. D - 45 yr old patient with iv-f of pnss 1L at 4 gtts/min, 90cc remaining with c/c of loose stools and lower abdominal cramping. V/S: HR 108 bpm, BP 122/82 mmhg, TEMP 37.4 C, 02 SAT 100% and RR 16 cpm A - Assessed patient general status, performed bedside care, provided patient comfort, monitored and recorded vital signs, I & O and O2 saturation, assessed pain score. Observed and documented stool frequency, characteristics, amount, and precipitating factors, promoted bedrest, if indicated, and provided bedside commode. Restarted oral fluid intake gradually, discussed patient’s usual diet, provided opportunity to vent frustrations related to disease process, administered medications, as indicated R – Patient was able to report reduction in frequency of stools, returned to more normal stool consistency, identified and avoided contributing factors such as poor hygiene, eating large amounts of meat and fibers and drinking poor quality water...