HEALTH EDUCATION PLAN

(DIARRHEA)
Submitted By: RN Heals Mae Geraldine Dacer, RN, MAN Marion Mae Estancia, RN Kristina Marie Jadulco, RN Levie Glare Ngoho, RN

Submitted To: Mr. Eufronio Quial Chief Nurse

I. TOPIC DIARRHEA is Dangerous. It causes dehydration. Diarrhea is a defense mechanism of the body where the body removes the germs that one ingests. The problem with diarrhea is, not only the toxins and germs are expelled, but also the fluids, salts and sugar or electrolytes and nutrients. This loss of fluids and electrolytes can lead to dehydration and continuous loss nutrients can lead to malnutrition. Dehydration and malnutrition lead to complications that may eventually lead to death. A child can have an average of 3 diarrhea episodes every year. This can alter the nutritional status of the child. It also weakens the child and makes him prone to other illnesses like cough and colds, pneumonia, repeated diarrhea and measles. An undernourished child has a tendency of developing more severe forms of diarrhea and thus, has higher risk of dying. Every day, around 34 Filipino children under five years old die due to dehydration caused by diarrhea. Every year, a total of 12,500 Filipino children below 5 years of age die due to dehydration caused by diarrhea. Diarrhea needs to be distinguished from four other conditions. Although these conditions may accompany diarrhea, they often have different causes and different treatments than diarrhea. These other conditions are: 1. incontinence of stool, which is the inability to control (delay) bowel movements until an appropriate time, for example, until one can get to the toilet 2. rectal urgency, which is a sudden urge to have a bowel movement that is so strong that if a toilet is not immediately available there will be incontinence 3. incomplete evacuation, which is a sensation that another bowel movement is necessary soon after a bowel movement, yet there is difficulty passing further stool the second time 4. bowel movements immediately after eating a meal How is DIARRHEA defined? Diarrhea can be defined in absolute or relative terms based on either the frequency of bowel movements or the consistency (looseness) of stools. Frequency of bowel movements. Absolute diarrhea is having more bowel movements than normal. Thus, since among healthy individuals the maximum number of daily bowel movements is approximately three, diarrhea can be defined as any number of stools greater than three. Relative diarrhea is having more bowel movements than usual. Thus, if an individual who usually has one bowel movement each day begins to have two bowel

movements each day, then diarrhea is present-even though there are not more than three bowel movements a day, that is, there is not absolute diarrhea. Consistency of stools. Absolute diarrhea is more difficult to define on the basis of the consistency of stool because the consistency of stool can vary considerably in healthy individuals depending on their diets. Thus, individuals who eat large amounts of vegetables will have looser stools than individuals who eat few vegetables. Stools that are liquid or watery are always abnormal and considered diarrheal. Relative diarrhea is easier to define based on the consistency of stool. Thus, an individual who develops looser stools than usual has diarrhea--even though the stools may be within the range of normal with respect to consistency. DIARRHEA generally is divided into two types, acute and chronic. Acute diarrhea lasts from a few days up to a week. Chronic diarrhea can be defined in several ways but almost always lasts more than three weeks. It is important to distinguish between acute and chronic diarrhea because they usually have different causes, require different diagnostic tests, and require different treatment. What are common causes of ACUTE DIARRHEA? The most common cause of acute diarrhea is infection--viral, bacterial, and parasitic. Bacteria also can cause acute food poisoning. A third important cause of acute diarrhea is starting a new medication. a) Viral gastroenteritis Viral gastroenteritis (viral infection of the stomach and the small intestine) is the most common cause of acute diarrhea worldwide. Symptoms of viral gastroenteritis (nausea,vomiting, abdominal cramps, and diarrhea) typically last only 48-72 hrs. Unlike bacterial enterocolitis (bacterial infection of the small intestine and colon), patients with viral gastroenteritis usually do not have blood or pus in their stools and have little if any fever. b) Food poisoning Food poisoning is a brief illness that is caused by toxins produced by bacteria. The toxins cause abdominal pain (cramps) and vomiting and also cause the small intestine to secrete large amounts of water that leads to diarrhea. The symptoms of food poisoning usually last less than 24 hours. With some bacteria, the toxins are produced in the food before it is eaten, while with other bacteria, the toxins are produced in the intestine after the food is eaten.

c) Traveler's diarrhea There are many strains of E. coli bacteria. Most of the E. coli bacteria are normal inhabitants of the small intestine and colon and are non-pathogenic, meaning they do not cause disease in the intestines. Nevertheless, these non-pathogenic E. coli can cause diseases if they spread outside of the intestines, for example, into the urinary tract (where they cause bladder or kidney infections) or into the blood stream (sepsis). d) Bacterial enterocolitis Disease-causing bacteria usually invade the small intestines and colon and cause enterocolitis (inflammation of the small intestine and colon). Bacterial enterocolitis is characterized by signs of inflammation (blood or pus in the stool, fever) and abdominal pain and diarrhea. Campylobacter jejuni is the most common bacterium that causes acute enterocolitis in the U.S. Other bacteria that cause enterocolitis include Shigella, Salmonella, and EPEC. These bacteria usually are acquired by drinking contaminated water or eating contaminated foods such as vegetables, poultry, and dairy products. e) Parasites Parasitic infections are not common causes of diarrhea in the U. S. Infection with Giardia lamblia occurs among individuals who hike in the mountains or travel abroad and is transmitted by contaminated drinking water. Infection with Giardia usually is not associated with inflammation; there is no blood or pus in the stool and little fever. Infection with amoeba (amoebic dysentery) usually occurs during travel abroad to undeveloped countries and is associated with signs of inflammation--blood or pus in the stool and fever. f) Drugs Drug-induced diarrhea is very common because many drugs cause diarrhea. The clue to drug-induced diarrhea is that the diarrhea begins soon after treatment with the drug is begun. The medications that most frequently cause diarrhea are antacids and nutritional supplements that contain magnesium. Other classes of medication that cause diarrhea include:

nonsteroidal anti-inflammatory drugs (NSAIDs), chemotherapy medications, antibiotics, medications to control irregular heartbeats (antiarrhythmics), and Medications for high blood pressure.

A few examples of specific medications that commonly cause diarrhea are: misoprostol (Cytotec), quinidine (Quinaglute, Quinidex), olsalazine (Dipentum),

colchicine (Colchicine), metoclopramide (Reglan), and cisapride (Propulsid, Motilium).

What are common causes of CHRONIC DIARRHEA? a) Irritable bowel syndrome The irritable bowel syndrome (IBS) is a functional cause of diarrhea or constipation. Inflammation does not typically exist in the affected bowel. (Nevertheless, recent information suggests that there MAY be a component of inflammation in IBS.) It may be caused by several different underlying problems, but it is believed that the most common cause is rapid passage of the intestinal contents through the colon. b) Infectious diseases There are a few infectious diseases that can cause chronic diarrhea, for example, Giardia lamblia . Patients with AIDS often have chronic infections of their intestines that cause diarrhea. c) Bacterial overgrowth of the small intestine Because of small intestinal problems, normal colonic bacteria may spread from the colon and into the small intestine. When they do, they are in a position to digest food that the small intestine has not had time to digest and absorb. The mechanism that leads to the development of diarrhea in bacterial overgrowth is not known. d) Post-infectious Following acute viral, bacterial or parasitic infections, some individuals develop chronic diarrhea. The cause of this type of diarrhea is not clear, but some of the individuals have bacterial overgrowth of the small intestine. This condition also is referred to as post-infectious IBS. e) Inflammatory bowel disease (IBD) Crohn's disease and ulcerative colitis, diseases causing inflammation of the small intestine and/or colon, commonly cause chronic diarrhea. f) Colon cancer Colon cancer can cause either diarrhea or constipation. If the cancer blocks the passage of stool, it usually causes constipation. Sometimes, however, there is secretion of water behind the blockage, and liquid stool from behind the blockage leaks around the cancer and results in diarrhea. Cancer, particularly in the distal part of the colon, can lead to thin stools. Cancer in the rectum can lead to a sense of incomplete evacuation. g) Severe constipation By blocking the colon, hardened stool can lead to the same problems as colon cancer, as discussed previously.

h) Carbohydrate (sugar) malabsorption Carbohydrate or sugar malabsorption is an inability to digest and absorb sugars. The well-recognized malabsorption of sugar occurs with lactase deficiency (also known as lactose or milk intolerance) in which milk products containing the milk sugar, lactose, lead to diarrhea. The lactose is not broken up in the intestine because of the absence of an intestinal enzyme, lactase that normally breaks up lactose. Without being broken up, lactose cannot be absorbed into the body. The undigested lactose reaches the colon and pulls water (by osmosis) into the colon. This leads to diarrhea. i) Fat malabsorption Malabsorption of fat is the inability to digest or absorb fat. Fat malabsorption may occur because of reduced pancreatic secretions that are necessary for normal digestion of fat (for example, due to pancreatitisor pancreatic cancer) or by diseases of the lining of the small intestine that prevent the absorption of digested fat (for example, celiac disease). Undigested fat enters the last part of the small intestine and colon where bacteria turn it into substances (chemicals) that cause water to be secreted by the small intestine and colon. Passage through the small intestine and colon also may be more rapid when there is malabsorption of fat. j) Endocrine diseases Several endocrine diseases (imbalances of hormones) may cause diarrhea, for example, an over-active thyroid gland (hyperthyroidism) and an under-active pituitary or adrenal gland (Addison's disease). k) Laxative abuse The abuse of laxatives by individuals who want attention or to lose weight is an occasional cause of chronic diarrhea. What are the complications of DIARRHEA? Dehydration occurs when there is excessive loss of fluids and minerals (electrolytes) from the body due to diarrhea, with or without vomiting.

Dehydration is common among adult patients with acute diarrhea who have large amounts of stool, particularly when the intake of fluids is limited by lethargy or is associated with nausea and vomiting. It also is common in infants and young children who develop viral gastroenteritis or bacterial infection. Patients with mild dehydration may experience only thirst and dry mouth. Moderate to severe dehydration may cause orthostatic hypotension with syncope (fainting upon standing due to a reduced volume of blood, which causes a drop in blood pressure upon standing), a diminished urine output, severe weakness, shock, failure, confusion, acidosis (too much acid in the blood), and coma.

Electrolytes (minerals) also are lost with water when diarrhea is prolonged or severe, and mineral or electrolyte deficiencies may occur. The most common deficiencies occur with sodium and potassium. Abnormalities of chloride and bicarbonate also may develop. Finally, there may be irritation of the anus due to the frequent passage of watery stool containing irritating substances Management of DIARRHEA: In DIARRHEA, there is loss of: a. Fluids b. Electrolytes / salt and sugar c. Nutrients - Leading to dehydration and malnutrition. Therefore, it should be replaced with a. Fluids b. Electrolytes / salt and sugar c. Nutrients - To prevent dehydration and malnutrition.

Diarrhea can be managed at home or anywhere by anyone. Management of diarrhea is simple, cheap and readily available. 3-Fs of Saving Life 90% of dehydration and malnutrition due to diarrhea can be prevented by Oral Rehydration Therapy (ORT). ORT is simple, cheap and readily available. The 3 Fs of Saving Life are: 1. increased Fluid 2. increased Feeding 3. Fast referral

1. FLUIDS A child with diarrhea should be given any available fluid at home at once. These fluids can be given alternately and continuously during diarrhea. a) b) c) d) e) f) RECOMMENDED FLUIDS am These contains water, salt, buko juice sugar and nutrients which fresh fruit juices effectively replace lost soups & broths fluids. safe water This helps rehydrate the child ORS(oresol)

- This contains water, salt, sugar and other electrolytes. - This is best for diarrhea. However, not all households have the supply of Oresol. - Therefore, families should start giving fluids that are immediately available at home. NOT RECOMMENDED a) softdrinks - Contains more sugar. More sugar can cause more diarrhea and could therefore lead to further dehydration and malnutrition. b) coffee & tea This will stimulate more diarrhea and urination. Therefore, more fluid will be lost and the more a child will become dehydrated and undernourished. c) salt sugar solution or home-made Oresol There is a chance that more salt or sugar may be added to the solution and this will do more harm rather than prevention of dehydration. d) herbal decoction Most of herbal decoction contain pectin or anti-diarrheal effect. If the diarrhea is stopped, the toxins and germs that are ingested will still be present in the body and will harm the child. e) gewgaw decoction This has no salt, sugar or nutrient contents. This cannot replace the fluid and nutrient lost by the body. f) anti-diarrheal drugs NOT RECOMMENDED. This will stop the diarrhea. Toxins and germs that were ingested cannot be expelled from the body. This can harm the child. g) Antibiotics This should only be dispensed by health personnel. Almost 80-90% of diarrhea cases are caused by a virus. Therefore, antibiotics are not needed. After 3-5 days, diarrhea will stop even without antibiotics since viral infection are selflimiting. Only diarrhea caused by bacteria or parasites should be given with antibiotics or anti-parasitic drugs. 2. FEEDING Feeding should not stop. It should be continued in a small but done frequently. - If diarrhea has stopped, feeding should be continued. - Provide additional meals so that the child can recover more quickly. Breastfeeding should not stop. Instead, breastfeeding should given more frequently. - Breastfeeding will prevent dehydration and malnutrition because of its fluid, electrolyte and nutrient content. - It will help prevent the baby from contacting diarrhea and other infectious diseases because of its protective effect.

3. FAST REFERRAL Take the child to the nearest health center if the child - does not get better within 3 days - passes many stools - has sunken eyes - has fever - has blood in his stools Prevention of DIARRHEA: a) Breasfeeding - breasmilk helps protect babies against diarrhea and other illnesses. b) Handwahing - This prevents a child from ingesting contaminated food and water. Wash hands with soap and clean water before eating and after using the toilet. c) Use toilets - This will prevent spread of germs and prevent contamination of the surroundings. d) Use clean water - Clean water will prevent ingestion of germs. e) Immunization against measles - Measles result in serious diarrhea. Prevent a child from contacting measles by immunizing the child with measles vaccine. f) Appropriate supplementary feeding - At age 6 months, a child should be given clean, nutritious, well-mashed, semisolid foods. Breastfeeding should be continued up to 2 years. g) Proper disposal of young childrens stools - Childrens feces should be flushed in a toilet to prevent spread of germs and contaminating the surroundings. II. EXPECTED LEARNING OUTCOMES After 30 minutes of lecture- discussion the participants will be able to: 1. define diarrhea. 2. present major causes and symptoms associated with diarrhea. 3. know guidlines as to when to seek medical attention for diarrhea.

III. TEACHING METHODOLOGY Flip Chart and Lecture IV. METHOD OF EVALUATION Q&A, Self Made Questionnaire V. DATE OF HEALTH EDUCATION IMPLEMENTED December 7, 2011 @ Station 2 Pedia Ward VI. DOCUMENTATION

VII. RESULTS OF EVALUATION We had 7 participants during our heath education class. All have children suffering from diarrhea or have suffered diarrhea themselves. 6 out seven have all agreed that diarrhea can be prevented with proper management while the other 1 left undecided and thinks that diarrhea can be prevented also by proper intervention from the government. VIII. INTERPRETATION
Almost 95 % of our participants had understood our health teaching.