Self Care Exam Iii Diarrhea

Front 1

what is acute diarrhea?

Back 1

diarrhea lasting < 14 days

Front 2

what is persistant diarrhea?

Back 2

diarrhea lasting 14 days to 1 month

Front 3

what is chronic diarrhea

Back 3

diarrhea lasting longer than 1 month

Front 4

Causes of diarrhea
Infectious:
(most common)

Back 4

Viral gastroenteritis
-Norovirus, rotavirus.
Bacterial gastroenteritis
-Campylobacter, Salmonella, E. Coli, Clostridium difficile.
Protozoal diarrhea
-Giardia, Cryptosporidium.

Front 5

Causes of diarrhea
Non-Infectious:

Back 5

Medication-related
-Antibiotics, magnesium containing products.
Food allergies/ intolerances
-Lactose intolerance
Fatty, spicy foods, seeds.
Gastrointestinal diseases
-Inflammatory bowel disease, irritable bowel syndrome

Front 6

C-Diff

Back 6

Gram positive, toxin-producing bacteria
Usually occurs as a complication of antibiotic therapy particularly in elderly, hospitalized patients
Increases in incidence, severity, and mortality has been seen in the US
“Community-acquired”
Treatment includes stopping offending antibiotic; metronidazole or oral vancomycin

Front 7

Food Borne Diarrhea

Back 7

May be bacterial, viral, or parasitic
Common pathogens include Salmonella, Campylobacter, and norovirus
Recent public health concerns with E. Coli from hamburger, unpasturized apple cider, spinach, lettuce
Symptoms may occur shortly after food ingested or days later. Diarrhea often accompanied by N/V, abdominal pain, fever
Antidiarrheal medication may prolong illness

Front 8

Food Safety

Back 8

Do not drink unpasturized milk or foods containing unpasturized milk
Wash raw fruits and vegetables
Keep refrigerator < 40 degrees F; freezer < 0 degrees F
Keep raw meat, fish, poultry separate from other food
Wash hands, knives, cutting boards after handling uncooked food
Cook meats to a safe internal temperature
Cook seafood thoroughly
Refrigerate foods within 2 hours

Front 9

Additional recommendations apply to pregnant women and patients with weakened immune system

Back 9

Avoid hot dogs, luncheon meat/ deli meat
Avoid pre-prepared salads i.e. tuna salad, chicken salad
Avoid soft cheeses such as feta, Brie unless made from pasteurized milk
See www.foodsafety.gov

Front 10

Traveler’s Diarrhea Prevention and Treatment from CDC

Back 10

Avoid eating foods or drinking beverages purchased from street vendors or other places where unhygienic conditions are present
Avoid eating raw or undercooked meat and seafood
Avoid eating raw fruits and vegetables unless traveler peels them
CDC does not recommend antimicrobial drugs to prevent traveler’s diarrhea
Supportive treatment with fluid replacement
May consider antibiotics or antidiarrheals
Do NOT use antimotility agents (loperamide) if fever or bloody diarrhea

Front 11

traveler's diarrhea is a common illness affecting travelers. some facts:

Back 11

Usually occurs 4-14 days after arrival
Diarrhea may be associated with nausea and vomiting, abdominal cramping, fever, malaise
Many cases resolve in 1-2 days
CDC has information for travelers
-www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm

Front 12

what is the most common type- bacterial, viral, protozoal?

Back 12

bacterial

E-coli most common

Front 13

what is the source of infection for traveler's diarrhea?

Back 13

ingestion of contaminated food/water

- fruits, vegetables, water, ice cubes

Front 14

high risk travel destinations for traveler's diarrhea

Back 14

High risk: Asia (except Singapore), Africa (except South Africa), South and Central America, Mexico

Front 15

treatment goals for diarrhea

Back 15

Prevent/ correct fluid and electrolyte loss
Identify and correct underlying cause
Treat symptoms
Prevent additional complications

Front 16

complications of diarrhea

Back 16

Dehydration
Electrolyte Abnormalities
Acid-Base Abnormalities

Front 17

exclusions for self care

Back 17

Age < 6 months
Moderate-severe dehydration
Fever
Blood, mucus, or pus in stool
Severe abdominal pain
6 or more stools in 24 hours
Diarrhea lasting > 48 hours
Prolonged vomiting
Pregnancy
Risk for significant complications: elderly, immunocompromised
Chronic or persistent diarrhea

Front 18

diarrhea in children

Back 18

Viral gastroenteritis is most common cause
CDC has guidelines for management of gastroenteritis in children
Self-care management in young children limited to prevention/ treatment of dehydration
Risk for serious dehydration, electrolyte abnormalities

Front 19

signs and symptoms of dehydration in children

Back 19

Dry mouth and tongue
Sunken and/ or dry eyes
Absence of tears
Sunken fontanelle
Decreased urine output (dry diapers)
Fast heartbeat
Decreased skin turgor (prolonged skin ‘tenting’ when pinched)
Mental status changes
-Unusual sleepiness, decreased alertness
-Body is ‘floppy’
-Difficulty waking up

Weight loss
Dark urine

Front 20

non pharmacologic treatment of diarrhea

Back 20

Fluid and electrolyte management
Dietary management
Preventive measures

Front 21

fluid and electrolyte management

Back 21

Rehydration with oral rehydration solution (ORS) preferred for mild-to-moderate dehydration
Contain carbohydrate (dextrose) and electrolytes sodium, chloride, potassium
Use commercially available, premixed solution like Pedialyte, Rehydralyte, Enfalyte
Sports drinks, sodas, apple juice not recommended for young children with diarrhea

Front 22

fluid and electrolyte management
dosing:

Back 22

Dosing for mild-to-moderate dehydration (children): 50-100 ml of ORS/ kg of body weight over 3-4 hours. Give additional ORS to replace ongoing loses
To replace ongoing losses:
--Children < 10 kg: 60-120 ml (2-4 ounces) for each episode of vomiting or diarrheal stool
--Children > 10 kg: 120-240 ml (4-8 ounces) for each episode of vomiting or diarrheal stool
If child is vomiting, give small amounts (i.e. one teaspoon) every few minutes
What does product labeling say?

Front 23

dietary management

Back 23

Withdrawal of food unnecessary
BRAT diet (bananas, rice, applesauce, toast) unnecessary
Usual age-appropriate diet as soon as rehydrated
Avoid fatty foods, foods high in simple sugars

Front 24

preventative measures

Back 24

Follow food safety recommendations
WASH HANDS!!!

Front 25

pharmacologic treatment

Back 25

Loperamide (Immodium)
Bismuth Subsalicylate
Digestive Enzymes (Lactase)

Front 26

loperamide

Back 26

Products: Loperamide (Immodium) and various generics
Indication: symptomatic relief for acute diarrhea
MOA: Antimotility agent. Synthetic opioid agonist that stimulates opioid receptors in the GI tract to slow intestinal motility and decreases GI secretion

Works like narcotics that can cause constipation.

Front 27

Bismuth Subsalicylate

Back 27

Brand name: Pepto-Bismol
Indication: acute diarrhea including Traveler’s Diarrhea
MOA: antidiarrheal effects from antimicrobial and antisecretory properties
DI: tetracyclines, anticoagulants, NSAIDs/ aspirin

Front 28

Bismuth Subsalicylate
warnings:

Back 28

ulcer or bleeding disorder, aspirin allergy, ringing in ears, avoid in children < 12 years, Reye syndrome, contraindicated in pregnant or nursing women, rare risk for neurotoxicity

Front 29

Bismuth Subsalicylate
side effects:

Back 29

harmless discoloration of stool and tongue, constipation

Front 30

Bismuth Subsalicylate
dosing:

Back 30

525 mg every 30-60 minutes up to 8 doses per day (Max duration for self-care is 48 hours)

*** harmless discoloration of stool…. ***

Front 31

digestive enzymes

Back 31

For patients with lactase deficiency
Take lactase enzyme preparations with milk or dairy products. In general 1-2 capsules with first bite of dairy product
Products: Lactaid, Lactaid Fast Act
Combination product with lactase enzyme and probiotic available

Front 32

alternative therapy: probiotics I

Back 32

Defined as “live micro-organisms which when administered in adequate amounts confer a health benefit on the host”
Regulated as dietary supplements or food
Contain yeast or bacteria
Commonly used bacteria: Lactobacillus and Bifidobacterium
May help restore balance between beneficial and harmful bacteria in gut after disruptions by antibiotics, immunosuppressive medications, surgery

Front 33

alternative therapy: probiotics II

Back 33

Evidence to support use in certain diarrheal illnesses such as rotavirus in children
Evidence to support use to decrease symptoms of lactose intolerance
Inconsistent data for antibiotic-associated diarrhea and travelers’ diarrhea
Health benefits from one strain may not be seen with another strain i.e. not all probiotics are created equal
Well tolerated. Mild bloating, flatulence
Probiotic-induced sepsis??
Quality control

Shorter duration
Shorter hospital stay