Constipation & Diarrhea F12 (1)

Symptoms 48 hours need to be referred but may be

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Symptoms > 48 hours need to be referred but may be managed with fluid/electrolyte replacement, dietary modifications, and OTC treatment Persistent Duration = 2-4 wks Self-care not appropriate Refer to health care provider Chronic Duration >4 wk Self-care not appropriate Refer to health care provider
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Types of Diarrhea Osmotic Unabsorbed solutes in intestine Prevent fluid from being absorbed Causes Viruses, E. coli , lactase deficiency, magnesium- containing drugs Secretory secretion of electrolytes (primarily Cl - ) and fluids into intestinal lumen Causes E.coli , Salmonella , Shigella , viruses, ileal resection
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Types of Diarrhea Exudative Defective colonic absorption and leaking of mucus, blood and pus into intestinal lumen Causes Inflammatory bowel disease, E. Coli , Salmonella , Shigella Motor Rapid intestinal transit time Causes Irritable bowel syndrome
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Causes Viruses (cause up to 85% of all cases of acute gastroenteritis) Norovirus (most common) Contaminated water/food Rotavirus Common in children (Nov-Feb) Spread by fecal-oral route
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Causes Bacteria Invade mucosa Campylobacter, Salmonella, Shigella Often caused by contaminated food Produce enterotoxin E. coli (O157:H7) Staphylococcus aureus Often caused by contaminated food Others C. difficile (“C. diff”) (often cause by antibiotics)
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Causes Protozoal Giardia lamblia Giardiasis Contaminated water; sexual contact Entamoeba histolytica Can also cause Traveler’s diarrhea (especially in areas with poor sanitation)
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Causes Food Food allergy Fatty or spicy foods fiber Lactase deficiency (intolerant of dairy products) Inability to hydrolyze lactose and sucrose to monosaccharides Build-up of lactose and sucrose hyperosmolarity Draws fluid into intestinal lumen
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Drug-Induced Causes Antibiotics Can disrupt normal intestinal microflora Can lead to an overgrowth of C. diff All antibiotics have been associated with C. diff Clindamycin, ampicillin, amoxicillin, and cephalosporins have highest incidence Laxatives Magnesium-containing antacids Cholinergic drugs Metoclopramide
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Potential Complications Fluid and electrolyte imbalance Dehydration Need to assess degree of dehydration to determine if self-care is appropriate or if patient should be referred to health care provider
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Clinical Assessment of Degree of Dehydration Minimal or No Dehydration Mild-Moderate Dehydration Severe Dehydration Degree (loss of body weight) <3% 3-9% >9% Mental status Well, alert Normal, fatigued or restless, irritable Apathetic, lethargic, unconscious Thirst Drinks normally Thirsty; eager to drink Drinks poorly; unable to drink HR Normal Normal to Tachycardia BP Normal Orthostatic hypotension Low Mucous membranes Moist Dry Parched Skin turgor Instant recoil Recoil in < 2 sec Recoil in > 2 sec Extremities Warm Cool Cold, cyanotic Urine output Normal to Minimal to none
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Situations in Which Self-Care is  Inappropriate < 6 months of age Or ≥6 months with persistent high fever (>102.2°F)
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Symptoms 48 hours need to be referred but may be managed...

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