Diarrhea Nursing Care Plan 2024 Updates

According to the World Health Organization, diarrhea is the leading cause of death in children under five years old, with nearly 1.7 billion cases occurring each year globally. Diarrhea accounts for over 443,832 deaths annually in children under five, representing almost 9% of all pediatric mortality. In 2019, an estimated 1.53 million individuals worldwide died from diarrheal illnesses.

Diarrhea is the reversal of the normal net of the absorptive status of water and electrolyte absorption to secretion. The augmented water content in the stools (above the normal value of approximately 10 ml/kg/day in infants and young children, or 200 g/day in teenagers and adults) is due to an imbalance in the physiology of the small and large intestinal processes involved in the absorption of ions, substrates, and thus water.

Diarrhea is categorized into acute or chronic and infectious or non-infectious based on the duration and type of symptoms.

• Acute diarrhea. Acute diarrhea is defined as an episode lasting less than two weeks. Infection most commonly causes acute diarrhea, and the course is usually self-limited.
• Chronic diarrhea. Chronic diarrhea is defined as a duration lasting longer than two weeks and tends to be non-infectious. Common causes include malabsorption, inflammatory bowel disease, and medication side effects.

Although infectious agents are by far the most common cause of sporadic or endemic episodes of acute diarrhea, one should not dismiss other causes that can lead to the same presentation. Causes of diarrhea include the following:

1. Infections

Viruses: The most prevalent cause of diarrhea is viral infections, particularly gastroenteritis, often referred to as the “stomach flu.” Rotavirus and norovirus are common culprits, especially in children.

Bacteria: Bacterial infections can result from consuming contaminated food or water. Notable bacteria include Salmonella, Escherichia coli (E. coli), and Campylobacter.

Parasites: Parasitic infections, such as those caused by Giardia, can lead to chronic diarrhea, particularly in areas with poor sanitation.

2. Food Intolerances and Allergies

Many individuals experience diarrhea due to food intolerances, such as lactose intolerance, where the body cannot properly digest lactose found in dairy products. Allergies to certain foods can also trigger gastrointestinal reactions leading to diarrhea.

3. Medications

Certain medications, particularly antibiotics, can disrupt the natural balance of bacteria in the gut, resulting in antibiotic-associated diarrhea. Other medications, including some antacids and laxatives, may also cause diarrhea as a side effect.

4. Digestive Disorders

Chronic conditions like irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, can lead to persistent diarrhea. These disorders affect how the intestines absorb nutrients and manage waste.

5. Endocrine Disorders

Certain hormonal imbalances, such as those seen in Addison’s disease or carcinoid syndrome, can affect bowel function and contribute to diarrhea.

The clinical presentation and course of diarrhea depend on its cause and the host. Signs and symptoms may include the following:

• Frequent passage of loose or watery stools
• Dehydration (lethargy, depressed consciousness, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, poor skin turgor, delayed capillary refill)
• Failure to thrive and malnutrition (reduced muscle/fat mass, peripheral edema)
• Cramping or abdominal pain
• Active borborygmi sound upon auscultation in the abdomen

Diarrhea

Diarrhea is the result of reduced water absorption by the bowel or increased water secretion. A majority of acute diarrheal cases are due to infectious etiology, which causes the secretory form of diarrhea. In this instance, the watery stool is the result of injury to the gut epithelium. Epithelial cells line the intestinal tract and facilitate the absorption of water, electrolytes, and other solutes. Infectious etiologies cause damage to the epithelial cells which leads to increased intestinal permeability. The damaged epithelial cells are unable to absorb water from the intestinal lumen leading to loose stool.

An essential aspect of diarrhea management is replenishing fluid and electrolyte loss. The following are nursing diagnoses associated with diarrhea.

• Acute Pain
• Risk for Deficient Fluid Volume
• Knowledge Deficit
• Imbalance Nutrition: Less than Body Requirements

Diarrhea Nursing Care Plan 

Below are sample nursing care plans for the problems identified above.

Acute Pain

This diagnosis is associated with abdominal cramping and discomfort that often accompanies diarrhea, impacting the patient’s overall comfort and quality of life.

Nursing Diagnosis

• Acute Pain

Related Factors

• Inflammation or irritation of the bowel

Evidenced by

• Verbalization of abdominal pain; urgency, cramping
• Abdominal Guarding
• Facial grimace, crying

Desired Outcomes

• Patient will report a decrease in abdominal pain to 3/10 or less within 24 hours.
• Patient will demonstrate effective coping strategies for managing pain by discharge.
• Patient will verbalize understanding of pain management techniques and dietary modifications to alleviate discomfort

Interventions

Independent	Rationale
Conduct a pain assessment every shift, including location, intensity, duration, and characteristics of the pain.	To determine the severity of pain to tailor necessary interventions.
Encourage the patient to assume a position of comfort, such as lying on their side with knees drawn up to the chest, which may help alleviate abdominal cramping.	To promote comfort and ease of pain.
Provide information on pain management techniques, including relaxation exercises and deep breathing.	To help cope with discomfort.
Promote hydration by encouraging the patient to drink clear fluids to prevent dehydration,	To prevent exacerbation of abdominal pain.
Dependent
Administer antidiarrheal medications as prescribed.	Antidiarrheal medications help reduce the frequency of bowel movements and associated pain.
Administer analgesics as ordered.	To relieve pain
Collaborative
Collaborate with a dietitian to provide a bland diet that is low in fiber and fat, such as the BRAT diet (bananas, rice, applesauce, toast).	To help firm up stools and reduce cramping.

Risk for Deficient Fluid Volume

Diarrhea causes the body to lose fluids in the form of stool at a much faster rate than usual. This fluid loss can quickly lead to dehydration, a medical term for deficient fluid volume.

Diarrhea stools are mostly water, electrolytes (salts), and other nutrients. This rapid expulsion of fluids depletes the body’s water reserves. Diarrhea can also make it difficult to keep fluids down, as nausea and vomiting often accompany it. This further reduces the amount of fluids entering the body.

Nursing Diagnosis

Risk for Deficient Fluid Volume

Risk Factors

• Excessive losses due to severe frequent diarrhea
• Inflammation, fever
• Restricted intake
• Chronic, excessive laxative use

Evidenced by

[Not applicable; the presence of signs and symptoms establishes an actual diagnosis]

Desired Outcomes

• The client will maintain adequate fluid volume as evidenced by moist mucous membranes, good skin turgor, capillary refill; stable vital signs; and balanced intake and output with normal urine concentration and amount.
• The client will verbalize understanding of causative factors and behaviors necessary to correct the fluid deficit.

Independent	Rationale
Monitor intake and output. Measure urinary output and specific gravity	This provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid replacement. Increased specific gravity and decreased urine output reflect alterations in the circulating volume.
Note the number, character, and amount of stools.	In osmotic diarrhea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive. Flatulence associated with foul-smelling stools that float suggests fat malabsorption.
Evaluate skin turgor, capillary refill, and mucous membranes.	This reflects hydration status and the possible need for fluid replacement. Literature reviews have suggested that delayed capillary refill and delayed skin turgor are the most reliable clinical signs of dehydration in children.
Weigh daily.	Weight is another indicator of overall fluid and nutritional status.
Provide clear liquids in small amounts when oral intake is resumed, and progress diet as tolerated.	This reduces the risk of gastric irritation and vomiting to minimize fluid loss. A strong body of evidence now suggests that resuming the pre-diarrhea diet is perfectly safe and must be encouraged, respecting any ) usually temporary) lack of appetite.
Provide oral rehydration solutions.	Rapid oral rehydration with the appropriate solution is as effective as intravenous fluid therapy in restoring intravascular volume and correcting acidosis. ORS contains 2 to 3 g/dl of glucose, 45 to 90 mEq/L of sodium, 30 mEq/L of base, and 20 to 25 mEq/L of potassium.
Make fluids easily accessible to the client. Encourage the use of fluids that are tolerable to the client and that replace needed electrolytes, such as Gatorade and broth.	This enhances fluid intake. Certain fluids such as acidic fruit juices or iced beverages may be painful to consume due to cracked lips.
Give frequent mouth care with special attention to the protection of the lips.	Dehydration results in drying and painful cracking of the lips and mouth.
Dependent/Collaborative
Administer intravenous fluids and electrolytes, as prescribed.	The peritoneum reacts to irritation and infection by producing large amounts of intestinal fluid, pulling fluid from the vascular space, and possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances. IV fluids are mostly indicated as rehydration therapy for severe dehydration, with intravenous lactated Ringer solution or normal saline.
Avoid the administration of anti-motility agents as prescribed.	Antimotility agents are not indicated for infectious diarrhea, except for refractory cases of Cryptosporidium infection.

Knowledge Deficit

Many patients may not have been educated about the causes and consequences of diarrhea, including how dietary choices, medications, and infections can contribute to the condition. This lack of awareness can lead to ineffective management strategies and repeated episodes of diarrhea.

Patients often do not know how to manage diarrhea effectively. This includes not understanding the importance of hydration, recognizing when to seek medical help, or knowing which foods to avoid during an episode of diarrhea.

Nursing Diagnosis

Knowledge Deficit

Risk Factors

• Poor understanding of the occurrence of diarrhea
• Lack of knowledge regarding the management of diarrhea
• Lack of awareness

Evidenced by

• Verbalization of confusion about dietary restrictions and management strategies.
• Verbalization of lack of knowledge regarding diarrhea and its treatment.

Desired Outcomes

• The patient will verbalize understanding of dietary choices that contribute to diarrhea within 24 hours.
• The patient will verbalize understanding of different management strategies.

Nursing Interventions

Independent	Rationale
Evaluate the patient’s current understanding of diarrhea, its causes, and management strategies.	To assess knowledge level.
Determine specific areas where the patient lacks knowledge, such as dietary restrictions, hydration needs, and when to seek help.	To identify learning needs.
Assess the frequency and characteristics of bowel movements, including any associated symptoms like abdominal pain or dehydration signs.	To monitor symptoms and determine the status of diarrhea and align with necessary nursing interventions
Educate the patient on a bland diet, including foods that are low in fiber and easy to digest (e.g., rice, toast, bananas) while avoiding high-fiber and spicy foods that may exacerbate diarrhea.	Provide health education on proper dietary choices to prevent exacerbation of diarrhea.
Instruct the patient on the importance of hydration and recommend clear fluids or oral rehydration solutions to maintain electrolyte balance	To encourage fluid intake and emphasize the importance of hydration during episodes of diarrhea.
Educate the patient on recognizing signs of dehydration, such as dry mouth, decreased urine output, and dizziness, and emphasize the importance of seeking medical help if these occur.	To provide information about signs of dehydration.
Dependent
Administer anti-diarrheal medications as prescribed and explain their mechanism of action.	To prevent the occurrence of diarrhea and to provide education regarding the action of the drug.

Imbalanced Nutrition: Less than Body Requirements

Diarrhea leads to imbalanced nutrition primarily due to two main factors:

1. Reduced Nutrient Intake

Diarrhea often causes nausea, abdominal cramps, and discomfort, leading to a decreased desire to eat. People with diarrhea may avoid certain foods to prevent worsening their condition, which can limit nutrient intake.

2. Impaired Nutrient Absorption

Diarrhea speeds up the passage of food through the intestines, reducing the time for proper digestion and nutrient absorption. Moreover, in some cases, diarrhea can cause inflammation or damage to the intestinal lining, further hindering nutrient absorption.

Nursing Diagnosis

Imbalanced Nutrition: Less than Body Requirements

Risk Factors

• Loss of appetite
• Malabsorption of nutrients
• Decrease food and fluid intake
• Frequent passage of loose and watery stools, nausea and vomiting

Evidenced by:

• Weight loss (Low BMI)
• Poor skin turgor

Desired Outcomes

• The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Nursing Interventions

Independent	Rationale
Assess the patient’s daily nutritional intake and food habits such as meal times, and duration.	To create a baseline of the patient’s nutritional status and preferences.
Provide small, frequent meals of nutrient-dense foods that are low in fiber and fat. Avoid foods that worsen diarrhea.	To avoid episodes of diarrhea.
Weigh the patient daily and monitor laboratory values	To assess nutritional status and response to interventions.
Provide a quiet, comfortable environment during meals.	To promote appetite and minimize diarrhea.
Dependent/Collaborative
Encourage oral rehydration with electrolyte-containing fluids as prescribed.	To replace fluid and electrolyte losses from diarrhea
Administer anti-diarrhea medication as prescribed.	To control diarrhea and promote absorption.
Refer the patient to the dietitian.	To provide more specific care for the patient in terms of nutrition and diet.

Diarrhea Nursing Care Plan Sample 1

Sample 2

References

1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
2. Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. 
3. Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.