MAITRI COLLEGE OF NURSING

ANJORA, DURG
SUBJECT: - CHILD HEALTH NURSING

HEALTH TALK
ON
DIARRHOEA
SUBMITTED TO :- MR.JACOB THOMAS SUBMITTED BY :- R.S.RAMYA
LECTURER, MCON M.Sc. NURSING 2ND YEAR
SUBJECT : CHILD HEALTH NURSING
TOPIC : DIARRHOE

DURATION : 45 MINUTES

VENUE : DISTRICT HOSPITAL, DURG, (C.G.)

NO. OF PARTICIPANTS :

DATE OF PRESENTATION :

METHODS OF TEACHING : LECTURE CUM DISCUSSION

A-V AIDS : CHART

NAME OF THE EVALUATOR :

CENTRAL OBJECTIVE:
To teach the people about the introduction , definition, , types, cause, pathophysiology, sign and symptoms, treatment,
and complication of diarrhoea.

SPECIFIC OBJECTVE:
On completion of the session, the participant will be able to:

 Introduction about diarrhoea.

 Define the term diarrhoea.
 Enlist the causes of the diarrhoea.
 List down the types of diarrhoea.
 Discuss the clinical manifestation of diarrhoea.
 Enumerate the diagnostic test of diarrhoea.

 Explain the treatment of diarrhoea.

S.NO TIME SPECIFIC CONTENT TEACHING/ A-V AIDS EVALUATION

OBJECTIVE LEARNING
ACTIVITY
1 5 min
Introduction about INTRODUCTION Lecture _ What do you
diarrhoea mean by
Diarrhoea is the sudden increase in the frequency and looseness of diarrhoea?
stools. Mild diarrhoea is the passage of a few loose or mushy
stools. Severe diarrhoea is the passage of many watery stools.
Watery stools that occur every hour is definitely severe diarrhoea.
The best indicator of the severity of the diarrhoea is its frequency
or blood in the stools.
The main complication of diarrhoea is dehydration from the loss
of too much fluid from the body. Symptoms of dehydration are a
dry mouth, the absence of tears, infrequent urination (for example,
none in 8 hours), and a darker, concentrated urine. The main goal
of diarrhoea treatment is to prevent dehydration.

2 5 min Define the term DEFINITION Discussion _ What is the

diarrhoea. definition of
Diarrhoea is the condition of having three or more loose or liquid diarrhoea?
bowel movements per day. It is a common cause of death in
developing countries and the second most common cause of infant
deaths worldwide. The loss of fluids through diarrhoea can cause
dehydration and electrolyte disturbances such as potassium
deficiency or other salt imbalances.

Diarrhoea is defined as loose, watery, unformed stools occurring

more than three times in one day. It is not the occasional loose
stool or the frequent passing of formed stools.

CAUSES
3 7 min Enlist the causes of Lecture _ What are the
the diarrhoea. Acute diarrhoea is usually caused by a bacterial, viral, or parasitic causes of
infection. Chronic diarrhoea is usually related to a functional diarrhoea?
disorder such as irritable bowel syndrome or an intestinal disease
such as Crohn’s disease.
The most common causes of diarrhoea include the following:
 Bacterial infections: Several types of bacteria consumed through
contaminated food or water can cause diarrhoea. Common culprits
include Campylobacter, Salmonella, Shigella, and Escherichia coli
(E. coli).

Viral infections: Many viruses cause diarrhoea, including

rotavirus, nor virus, cytomegalovirus, herpes simplex virus, and
viral hepatitis. Infection with the rotavirus is the most common
cause of acute diarrhoea in children. Rotavirus diarrhoea usually
resolves in 3 to 7 days but can cause problems digesting lactose
for up to a month or longer.

Parasites; Parasites can enter the body through food or water and
settle in the digestive system. Parasites that cause diarrhoea
include Giardia lamblia, Endamoeba histolytica, and
Cryptosporidium.

Functional bowel disorders: Diarrhoea can be a symptom of

irritable bowel syndrome.

Intestinal diseases: Inflammatory bowel disease, ulcerative

colitis, Crohn’s disease, and celiac disease often lead to diarrhoea.

Food intolerances and sensitivities: Some people have difficulty

digesting certain ingredients, such as lactose, the sugar found in
milk and milk products. Some people may have diarrhoea if they
eat certain types of sugar substitutes in excessive quantities.

Reaction to medicines: Antibiotics, cancer drugs, and antacids

containing magnesium can all cause diarrhoea.

TYPES
4 7 min List down the Lecture _ What are the
types of diarrhoea. Acute diarrhea, meaning diarrhea that is not long-term, is a very types of
 common cause death in developing nations, especially among diarrhoea?
young children and babies. It usually appears rapidly and may last
from between five to ten days.
Chronic diarrhea, meaning long-term diarrhea is the second
cause of death among children in developing countries.
Other classification
 Severe diarrhea means having more than 10 loose, watery
stools in a single day (24 hours).
Severe diarrhea: caused by intestinal infections.
Gastrointestinal symptoms:The stools become more frequent, >10
times daily, watery in consistency, yellow or greenish yellow,
sometimes with mucus, pus and blood. Vomiting is severe even
blood in vomitus. .
Other symptoms include: anorexia, nausea, abdominal pain and
abdominal distension.
Systemic symptoms: Obvious systemic toxic symptoms. Infants
may be very irritable, lethargy even coma. The temperature may
be high or low.
Water and electrolyte disturbances: usually present moderate even
severe dehydration, acidosis and electrolyte disturbances.
 Moderate diarrhoea means having more than a few but
not more than 10 diarrhoea stools in a day.
 Mild diarrhoea means having a few diarrhoea stools in a
day.
Mild diarrhoea: caused by dietary factors or extra gastro intestinal
infections.
Gastrointestinal symptoms: The stools become frequent but
usually no more than ten times a day, gruel like or watery, yellow
or greenish yellow in colour, smell sour, Vomiting is less common
and abdominal pain is mild.
Systemic symptoms: There are no obvious systemic symptoms.
Infants may be restless or irritable, temperature is normal or slight
high. There are no dehydration, electrolyte and acid base
disturbances.

5 5 min Discuss the clinical CLINICAL MANIFESTATIONS Lecture _ Which are the
manifestation of following
 diarrhoea. Classification by the course of diarrhoea clinical
Acute diarrhoea: continuous course < two weeks manifestations
Prolonged diarrhoea: continuous course varies between 2 weeks ~ of diarrhoea?
2 months
Chronic diarrhoea: > 2 months.
Signs and symptoms associated with diarrhea may include:
 Frequent loose, watery stools
 Abdominal cramps
 Abdominal pain
 Fever
 Bleeding
 Light-headedness or dizziness from dehydration
Dehydration: Excessive Loss of Water and Electrolytes Due to
Diarrhoea and Vomiting.
Some signs are usually used as criteria.
 Dryness of lips, skin and mucous membranes.
 Poor skin turgor (elasticity).
 Depressed anterior fontanel.
 Lack of tears.
 Sunken eyes socket.
 Signs of shock: poor peripheral circulation. They may show
tachycardia, thin and thread pulse, a low or falling blood pressure,
pallor, cool extremities, delayed capillary refilling, hypothermia,
oliguria

DIAGNOSTIC TESTS
6 6 min Enumerate the Lecture _ What are the
diagnostic test of Medical history and physical examination: The doctor will ask diagnostic test
diarrhoea. about eating habits and medication use and will perform a of diarrhoea?
physical examination to look for signs of illness.

Stool culture: A sample of stool is analysed in a laboratory to

check for bacteria, parasites, or other signs of disease and
infection.
 Blood tests: Blood tests can be helpful in ruling out certain
diseases.

Routine culture – this will look for a variety of intestinal

bacterial infections such as Salmonella and E-coli.

Rotavirus antigen – this will detect the most common cause of

diarrhoea infection in infants and young children. Usually your
doctor can diagnose this infection without needing this test.

Giardia antigen – this is a parasite, and is a fairly common cause

of abdominal pain and diarrhoea. It won't be found on O and P
test.

Hem cult test – this checks for hidden blood in the diarrhoea,
which can help your doctor determine the cause

TREATMENT
7 10 Explain the Lecture _ What treatment
min treatment of Drink plenty of fluids - diarrhoea often carries a risk of given to the
diarrhoea. dehydration, especially if it includes vomiting. It is important to diarrhoea
make sure babies and children are getting plenty of fluids. patients?

Diarrhoea may affect the balance of salts and electrolytes in

the body. Special dehydration drinks can be bought in a pharmacy
to restore their balance. A pharmacist can advise on which drinks
to consume.

Eat as soon as you feel up to it - doctors used to tell people not to

eat until the symptoms went away. They now recommend patients
start with foods such as pasta, bread, rice or potatoes - foods high
in carbohydrates, as soon as possible. Add a bit of salt to the food
to replace salt loss. Avoid foods that are high in fat.

Medications - such medicines as loperamide may slow down

bowel movements and may also increase the gut's water
absorption. Do not give anti-diarrhoea medications to children
without checking first with a doctor. Do not take anti-diarrhoea
medications if there is blood in the stools or if you have a fever.

Breastfeeding or Bottle-feeding babies - doctors recommend

that feeding continue as normal if the baby has diarrhoea. If
necessary, add rehydration drinks that are bought from a
pharmacy.

Pain -killers - for fever or headache doctors recommend Tylenol

(paracetamol) or ibuprofen. If you have kidney, liver or long-term
stomach problems do not take ibuprofen. Do not give aspirin if
your child is under 16 years of age.

Probiotics - these are supposed to treat diarrhoea, among other

things. However, a study published in the British Medical Journal
indicated that some of them don't work, while others do.
Researchers from Rand Health, Santa Monica, California, USA,
revealed in JAMA (Journal of the American Medical Association)
in May 2012 that eating probiotic foods reduces the risk of
diarrhoea caused by taking antibiotics. Diarrhoea is a common
side effect of antibiotic use.

Diet: Rule of thumb for G.I. upsets: Feed half as much twice as
often. Offer food and fluids more frequently but in smaller
amounts. Try sips and chips: frequent sipping and ice chips or
white grape juice, or Popsicles made with oral electrolyte solution.
Let your child suck on these all day long.
Mild diarrhoea – defined as 2 – 4 loose stools in a 24-hour
period.
BRAT diet – this is an age old, time-tested diet.
2. Bananas
3. Rice or rice cereal
4. Apple sauce
5. Toast, unbuttered
6. Yogurt (See Intestinal Healing Properties of )Yogurt
 Breast milk or formula
White grape juice or oral electrolyte solution such as Pedialyte.
Popsicles also work well.
Moderate diarrhoea – defined as 4 – 8 loose or watery stools per
day, but child is generally not acting sick.
BRATY diet, but only very small amounts
Breast milk or half-strength formula (formula mixed half and half
with an oral electrolyte solution such as Pedialyte)
White grape juice, oral electrolyte solution or popsicles.
Severe diarrhoea – defined as 10 or looser, watery, foul stools
and child is acting sick. Consult your paediatrician.
BRATY diet, but only very small amounts
Breast milk. Do not give formula until child improves or as
directed by your paediatrician.
White grape juice, oral electrolyte solution or popsicles

Oral rehydration therapy

Oral rehydration therapy (ORT) with glucose-electrolyte
solutions is one of the greatest therapeutic advances of the 20th
century. ORT is effective in acute diarrheal disease of diverse
aetiology, particularly gastroenteritis or gastroenteropathy, such as
that caused by cholera or rotavirus. The most widely used oral
rehydration solution (ORS) worldwide is that recommended by
the World Health Organization (Na 90, K 20, glucose 111 and
citrate 10 mmol/L). Attempts to improve the efficacy of ORS have
been made by using complex substrates (rice and other cereals) in
place of glucose, and by reducing osmolality by decreasing
glucose and sodium concentrations in monomeric ORS. ORS may
have wider applications in the management of patients with the
short bowel syndrome and in post-surgical patients
Fluid therapy should include the following three elements:
rehydration, replacement of on-going losses, and maintenance.
.
Mild Dehydration (standard replacement)
 Total ORS: 50 ml/kg over 4 hours by syringe, spoon
or cup
 Give 1 ml/kg of ORS by syringe every 5 minutes for
 4 hours or
 Give 3 ml/kg of ORS every 15 minutes for 4 hours
Moderate Dehydration (accelerated replacement)
 Total ORS: 100 ml/kg over 4 hours
 Infant: 1 ounce/hour
1. Give 30 ml per hour of ORS
2. Give 5-10 ml (1-2 tsp) every 15 minutes
 Toddler: 2 ounces/hour
1. Give 60 ml per hour of ORS
2. Give 15 ml (3 tsp) every 15 minutes
 Child: 3 ounces/hour
1. Give 90 ml per hour of ORS
2. Give 20-25 ml (1/2 to 1 oz) every 15 minutes
Ongoing losses (added replacement per stool or Emesis)
1. Method 1: Give an additional 10 ml/kg per stool or 2
ml/kg per Emesis or
 Method 2: Give an additional one-half to one cup
ORS per stool (older children)
Vomiting
 Pause feeding for 30-60 minutes if Vomiting occurs
 Give 5-10 ml every 5 minutes
 May resume above Diarrheal replacement after
no Vomiting for 30-60 minutes
 Consider Ondansetron (Zofran) 4 mg ODT tablets
a. See Ondansetron for dosing
b. Weight 8-15 kg: Ondansetron 2mg (half tab)
c. Weight 15-30 kg: Ondansetron 4 mg (one
tab)
d. Weight >30 kg: Ondansetron 8 mg (two
tabs)

There are certain contraindications to the use of ORT:

 Protracted vomiting despite small, frequent feedings
 Worsening diarrhoea and an inability to keep up with losses
 Stupor or coma
 Intestinal ileus.
Preparations: Preferred - Commercial ORS

A. Commercial products (available in liter containers, juice

boxes and popsicles)
1. Pedialyte
2. Rehydrate
3. Infalyte
4. Resole
5. Naturalyte
B. Ingredients (similar to WHO, but with 50% of sodium to
match Rotavirus losses)
1. Sodium: 45-50 meq/L
2. Glucose (Dextrose): 25 g/L
3. Bicarbonate: 30 mEq/L
4. Potassium: 20 mEq/L

Preparations: Preferred - WHO-ORS

A. Instructions
1. Dissolve WHO packet in 1 Liter Water
B. Ingredients of WHO packet
1. Sodium Chloride 3.5 grams (90 meq/L Sodium)
2. Potassium Chloride 1.5 grams (20 meq/L Potassium)
3. Glucose (Dextrose) 20 grams (2% Carbohydrate)
4. Sodium Bicarbonate 2.5 grams (30 meq/L
bicarbonate)
5. Alternative: Trisodium Citrate 2.9 grams

The "Simple Solution" - Home made Oral Rehydration Salts

(ORS) Recipe
Preparing 1 (one) Litre solution using Salt, Sugar and Water at
Home

Mix an oral rehydration solution using the following recipe.

Ingredients:

 Six (6) level teaspoons of Sugar

 Half (1/2) level teaspoon of Salt

 One Litre of clean drinking or boiled water and then

cooled - 5 cupfuls (each cup about 200 ml.)
Preparation Method:
Stir the mixture till the salt and sugar dissolve.

1. Wash your hands with soap and water before preparing

solution.
2. Prepare a solution, in a clean pot, by mixing
- Six (6) level teaspoons of sugar and Half (1/2) level
teaspoon of Salt
or
- 1 packet of Oral Rehydration Salts (ORS) 20.5 gram
mix with: One litre of clean drinking or boiled water (after
cooled)Stir the mixture till all the contents dissolve.
3. Wash your hands and the baby's hands with soap and water
before feeding solution.
4. Give the sick child as much of the solution as it needs, in
small amounts frequently.
5. Give child alternately other fluids - such as breast milk and
juices.
6. Continue to give solids if child is four months or older.
7. If the child still needs ORS after 24 hours, make a fresh
solution.
8. ORS does not stop diarrhoea. It prevents the body from
drying up. The diarrhoea will stop by itself.
9. If child vomits, wait ten minutes and give it ORS again.
Usually vomiting will stop.
10. If diarrhoea increases and /or vomiting persists, take child
 over to a health clinic.

Instructions:
Mix well the rice cereal (or sugar), water, and salt together until the
mixture thickens but is not too thick to drink.

Give the mixture often by spoon and offer the child as much as he or
she will accept (every minute if the child will take it).

Continue giving the mixture with the goal of replacing the fluid lost:
one cup lost, give a cup. Even if the child is vomiting, the mixture
can be offered in small amounts (2-1 tsp.) every few minutes or so.

 Banana or other non-sweetened mashed fruit can help provide

potassium.

 Continue feeding children when they are sick and to continue

breastfeeding if the child is being breastfed.
REPLICATION:

1. Define diarrhoea?
2. Describe the causes of diarrhoea?
3. Explain the treatment of the diarrhoea?

CONCLUSION:
At the end of the health talk, the people understand about the definition, introduction, types, causes, sign and symptoms,
treatment, complication. They listened carefully and aware all the questions.

SUMMARY:
Diarrhoea is the sudden increase in the frequency and looseness of stools. Mild diarrhoea is the passage of a few loose
or mushy stools. Severe diarrhoea is the passage of many watery stools. Watery stools that occur every hour is
definitely severe diarrhoea. The best indicator of the severity of the diarrhoea is its frequency or blood in the stools.
Diarrhoea is the condition of having three or more loose or liquid bowel movements per day.It is a common cause of
death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids
through diarrhoea can cause dehydration and electrolyte disturbances such as potassium deficiency or other salt
imbalances.
BIBILIOGRAPHY:
 Parul Data, Text Book Of Pediatric Nursing, 2nd Edition, Jaypee Publication, Page No. 172

 Marlow R.Dorothy, Redding A.Barbara,Text Book Of Paediatric Nursing. Sixth Edition, Published

By Elsevier, India, Page No: 294

 T.M.Assume Beevi, Text Book Of Paediatric Nursing, First Edition, Elsevier Health Science

Publication, India, Page No: 135

 Ghai O.P, Book Of Essential Pediatrics,Eeventh Edition,CBS Publication, New Delhi Page No:213

 Manoj Yadav, Text Book Of Child Health Nursing, 1st Edition, P.V.Publication, Page No. -143