Diarrhea Flashcards
Characteristic of diarrhea:
abnormal increase in stool frequency, liquidity, or weight
How many bowel movements per day is considered abnormal?
more than 3
What counts as acute diarrhea?
symptoms that last less than 14 days
How to treat acute diarrhea:
- fluid and electrolyte replacement
- dietary interventions
- nonrx drug treatment
What counts as persistent diarrhea?
symptoms that lasts 14 days to 4 weeks
What counts as chronic diarrhea?
symptoms that lasts more than 4 weeks
Persistent and chronic diarrhea are…
secondary to other medical conditions or treatments
- need to refer
What is the most common cause of diarrhea in adults?
noroviruses
- plays major role in sporadic acute gastroenteritis
What is the most common cause of severe gastroenteritis infants and young children?
rotavirus
- two oral vaccines are available
- seasonal infection w/ peaks between nov-feb
Most cases of bacterial gastroenteritis result from…
food-borne transmission
- pathogens: salmonella, shigella, e. coli, clostridium perfringens, staph aureus
What is responsible for most cases of traveler’s diarrhea?
e. coli
Symptoms of traveler’s diarrhea usually subsides over..
3-5 days
Disease of small intestine is indicated by…
undigested food particles in stool
Upper GI bleeding is indicated by…
black, tarry stools
Red stools may indicate…
lower bowel or hemorrhoid bleeding or red foods or drugs
Yellow stools indicate…
presence of bilirubin and potentially serious liver problem
Whitish tint to stool indicates…
fat malabsorption disease
What are the major complications of diarrheal illness?
fluid and electrolyte imbalance
What is a key factor in determining if self-care is appropriate?
assessment of patient’s risk for dehydration and the degree of dehydration present
Signs and symptoms of minimal or no dehydration:
- < 3% loss of body weight
- alert
- drinks normally
- normal heart rate
- normal urine output
Signs and symptoms of mild-moderate dehydration:
- 3-9% loss of body weight
- restlessness
- irritable
- thirsty
- normal-increased heart rate
- decreased urine output
Signs and symptoms of severe dehydration:
- > 9% loss of body weight
- lethargic
- unable to drink
- increased heart rate
- minimal urine output
- not self-treatable
Initial self-management for mild-moderate, uncomplicated diarrhea should focus on..
fluid and electrolyte replacement
Exclusions to self-treatment:
- < 6 months old
- > 6 months w/ persistent fever
- children w/ severe dehydration
- blood, mucus, or pus in stool
- protracted vomiting
- severe abdominal pain
- pregnancy
Non-pharmacologic therapy:
- fluid and electrolyte management
- dietary management
- preventive measures
Examples of electrolytes:
- sodium
- chloride
- citrate
- potassium
What are the two phases for fluid and electrolyte management?
- rehydration
- maintenance therapy
Rehydration phase of fluid and electrolyte management is when…
one quickly replenishes water and electrolyte deficits over 3-4 H
Maintenance therapy phase of fluid and electrolyte management is when…
electrolyte solutions are given to maintain normal body composition until dietary intake is reestablished
Examples of fluid and electrolyte management:
- Pedialyte
- Enfamil enfalyte solution
- ceralyte powder packets
- usually for children
T/F: there is little evidence that supports use of oral rehydration solutions (ORS) in adults
T
Since ORS has little effect in adults, what are other ways they can increase fluid and electrolytes?
- clear juices
- soups
- sports drinks
For dietary management, it’s recommended that you withhold food for no longer than…
24 H and encourage reintroduction of normal diet once patient has been rehydrated (3-4H)
Avoid _____ diet while having mild-moderate diarrhea
BRAT, which is bananas, rice, applesauce, and toast
- insufficient calories, protein, and fat
Examples of foods to avoid:
- fatty
- sugary
- spicy
What are some appropriate food options for a patient with mild-moderate diarrhea?
- carb-rich
- yogurt
- lean meats
- fruits
- vegetables
Examples of preventative measures:
- isolate individual with symptoms
- wash hands
- strict food handling
Pharmacologic treatments:
- loperamide
- bismuth subsalicylate (BSS)
- digestive enzymes
Loperamide dosages:
4 mg initially, then 2 mg after each loose stool
- don’t exceed 8 mg/day
- not for children < 6 YO
Duration of use for loperamide:
48 H
Bismuth subsalicylate dosages:
525 mg every 30-60 min, up to 4200 mg/day
- max: 8 doses/day
- not for children < 12 YO
Digestive enzyme dosages:
- liquid: 5-15 drops placed/taken with dairy product
- 1-3 tab or 1-2 cap with 1st bite of dairy product
- children is the same dosage
Duration of use for bismuth subsalicylate dosages:
48 H
Duration of use for digestive enzyme dosages:
take with each consumption of dairy product
Loperamide is an effective antidiarrheal agent in…
traveler’s diarrhea
Side effects of loperamide:
- dizziness
- constipation
- abdominal pain
- dry mouth
Examples of loperamide:
- Imodium A-D
- Imodium Advanced Formula Caplets
Bismuth subsalicylate is an effective antidiarrheal agent in…
traveler’s disease and Helicobacter pylori (associated with peptic ulcer disease)
Patients who take bismuth subsalicylate should be cautious when taking…
aspirin or other drugs with salicylate b/c toxic levels of salicylate may be reached
Adverse effects of bismuth subsalicylate:
- mild tinnitus (dose related)
- Reye’s syndrome
- neurotoxicity
- harmless black staining of stool or tongue
Drug interactions with bismuth subsalicylate:
- warfarin
- valproic acid
- methotrexate
- tetracyclines
- quinolones
- same as ones for aspirin
Examples of bismuth subsalicylate:
- pepto bismol
- kaopectate
- maalox
Examples of digestive enzymes:
- lactaid
- lacteez drops
- lactrase capsules
For children 5 YO and under, they should only treat with…
oral rehydration solutions
- medications not recommended
For elderly people 65 and older, they should be strongly cautioned against…
self-treatment with medications b/c reactions are more likely to be severe or possible fatal
If one is pregnant, they should be…
referred to MD
When should you refer a patient after treatment?
if it hasn’t been resolved after 72 H of treatment
