{
  "name": "Diarrhea",
  "slug": "diarrhea",
  "url": "https://nursingplex.com/care-plans/diarrhea",
  "category": "Gastrointestinal",
  "summary": "Frequent loose stools with fluid and electrolyte loss; replacement and perianal skin care.",
  "nursing_diagnoses": [
    "Diarrhea",
    "Deficient fluid volume",
    "Impaired skin integrity"
  ],
  "overview": [
    "Diarrhea is the passage of three or more loose or liquid stools a day, or more frequent passage than is normal for the person. Acute diarrhea is usually infectious or drug-related; chronic diarrhea suggests inflammatory bowel disease, malabsorption, endocrine disease or medication effects.",
    "The immediate dangers are fluid and electrolyte loss — especially potassium and bicarbonate, producing metabolic acidosis — and perianal skin breakdown from digestive enzymes. Infants and older adults deteriorate fastest.",
    "Nursing care replaces fluid and electrolytes, identifies transmissible causes and applies appropriate precautions, protects skin, and restores a normal diet as early as tolerated."
  ],
  "key_facts": [
    {
      "label": "C. difficile",
      "text": "Suspect after antibiotics; use contact precautions and soap-and-water handwashing, since alcohol gel does not kill spores."
    },
    {
      "label": "Oral rehydration",
      "text": "ORS with balanced glucose and sodium is first-line for most non-severe cases."
    },
    {
      "label": "Antimotility caution",
      "text": "Avoid loperamide in bloody diarrhea, suspected C. difficile or high fever."
    },
    {
      "label": "Early refeeding",
      "text": "Resuming normal age-appropriate food early shortens illness; prolonged clear liquids are not recommended."
    }
  ],
  "nursing_priorities": [
    "Restore and maintain fluid and electrolyte balance.",
    "Identify the cause and prevent transmission.",
    "Protect perianal skin.",
    "Restore nutrition safely.",
    "Monitor for dehydration and shock, particularly in the very young and old."
  ],
  "assessment": {
    "subjective": [
      "Reports of frequency, urgency, volume and character of stools",
      "Complaints of cramping, thirst, weakness or dizziness",
      "History of travel, new foods, antibiotics or sick contacts",
      "Reports of perianal burning or pain"
    ],
    "objective": [
      "Stool frequency, consistency, presence of blood, mucus or fat",
      "Vital signs, orthostatic changes, weight loss",
      "Dry mucous membranes, poor turgor, decreased urine output",
      "Electrolytes showing hypokalemia and low bicarbonate",
      "Perianal erythema, excoriation or breakdown; positive stool studies"
    ],
    "related_factors": [
      "Viral, bacterial or parasitic infection",
      "Antibiotic-associated C. difficile overgrowth",
      "Inflammatory bowel disease or malabsorption",
      "Enteral feeding formula, osmotic agents, magnesium antacids",
      "Food intolerance, anxiety or laxative overuse"
    ]
  },
  "goals": [
    "The client will return to their usual stool pattern.",
    "The client will maintain adequate hydration and normal electrolytes.",
    "The client will maintain intact perianal skin.",
    "The client and family will describe transmission-prevention measures."
  ],
  "interventions": [
    {
      "title": "Fluid and electrolyte replacement",
      "points": [
        "Record every stool with volume and character; maintain strict intake and output and daily weight.",
        "Provide oral rehydration solution in small frequent amounts, or IV fluids for severe loss.",
        "Monitor potassium, sodium, bicarbonate and renal function.",
        "Assess for orthostatic hypotension and tachycardia before ambulation."
      ]
    },
    {
      "title": "Infection control and cause",
      "points": [
        "Collect stool specimens as ordered before starting antibiotics when possible.",
        "Apply contact precautions; use soap and water for C. difficile.",
        "Review medications and enteral formulas as potential causes.",
        "Give antidiarrheals or targeted antimicrobials only as prescribed."
      ]
    },
    {
      "title": "Skin and nutrition",
      "points": [
        "Cleanse gently with pH-balanced cleanser and apply a barrier ointment after each stool.",
        "Consider a fecal management system for high-volume liquid output as ordered.",
        "Resume a regular diet early; avoid caffeine, alcohol, very fatty and high-sugar foods.",
        "Offer small frequent meals and probiotic-containing foods if approved."
      ]
    }
  ],
  "patient_teaching": [
    "Teach handwashing with soap and water and cleaning surfaces during illness.",
    "Explain how to mix and use oral rehydration solution at home.",
    "Advise seeking care for bloody stool, high fever, severe pain or signs of dehydration.",
    "Discuss food safety and travel precautions."
  ]
}