Treating Dehydration

what is the first nursing step with a hospitalized patient who has diarrhea?

answer the call bell immediately and assist to the bathroom/commode safely

what must we do before giving antidiarrheal meds?

figure out whats causing the diarrhea first

why do we identify the cause of diarrhea before giving meds?

because treatment differs by cause and meds can mask or worsen the problem

what is the main replacement needed during diarrhea?

fluids and electrolytes

• oral first and iv if severe

diet during active diarrhea

low fiber/low residue

• eggs

• fish or poultry

• noodles

• refined breads/cereals

• well-cooked fruits and vegetables

foods and drinks to avoid during diarrhea

prunes, bran, chocolate, spicy foods, alcohol, coffee/caffeine

role of probiotics during diarrhea

help restore gut flora, especially with antibiotic- or c. diff-related diarrhea

definition of acute vs chronic diarrhea

• acute lasts hours–days

• chronic lasts >3–4 weeks and needs further workup

who is at highest risk for dehydration from diarrhea

infants, young children, and older adults

key infection prevention for diarrhea patient education

hand hygiene and safe food handling (wash produce; avoid damaged packages; avoid raw eggs; cook to safe temps)

general rule for antidiarrheals

use sparingly or not at all until cause is known; avoid if bloody diarrhea or fever

loperamide (Imodium) — key points

slows peristalsis

• stop if no improvement in 48 hours

• do not use with suspected or confirmed c. diff

• high doses can cause cardiac dysrhythmias

• may cause drowsiness

when should you stop using loperamide (Imodium)?

if it doesnt work after 48 hours

when do we not use loperamide (Imodium) or diphenoxylate/atropine (lomotil)?

with suspected or confirmed C. diff

diphenoxylate/atropine (lomotil) — key points

opioid agonist that slows motility

• avoid in c. diff\

• avoid with current opioid use

• can cause confusion and falls, especially in older adults

bismuth subsalicylate (pepto-bismol) — key points

antimicrobial and antisecretory

• does not cause drowsiness

• avoid with salicylate allergy, pregnancy, and in children <12

• may turn stool black

• use caution with aspirin

who cannot use pepto bismol?

children under 12, and pregnant women

what might pepto bismol due to stool?

make it black/tarry

when to avoid antimotility agents

when diarrhea is bloody or accompanied by fever

traveler’s diarrhea — common cause

contaminated food or water with bacteria, viruses, or parasites

how to prevent raveler’s diarrhea

• strict hand hygiene and safe food/water practices

• consider bismuth prophylaxis

traveler’s diarrhea — when to see a provider

diarrhea more than 2 days, signs of severe dehydration, bloody or black stools, fever >102°f

traveler’s diarrhea — initial treatment

hydrate with bottled/treated fluids; antibiotics/antimicrobials only if indicated by severity and cause