PERCENTAGE PAPERS

English
Diarrhea

This paper is made to fulfill the coursework

English Semester III

Compiled by:
Group IV

1. ISMAIL M. TAKANAMA
2. ANITA SARI
3. FIRA SAFITRI
4. SAGITA AMALIYA RIZKY
5. ZALZA NURHALIZA

MINISTRY OF HEALTH REPUBLIC OF INDONESIA

HEALTH POLYTECHNIC OF KENDARI
NURSING DEPARTMENT
2019
 Foreword

Praise Allhamdulillah We give praise to the Kehadirat of God who is the Lord of the
Almighty, because it has bestowed his mercy in the form of opportunity and knowledge so that
this paper we can solve in time.

Thank you also we say to friends who have contributed by giving his ideas so that this
paper with the title of diarrhea can be compiled well and neatly.

We also would like to thank you very much thanks to the lecturer of the English
language course of Ibu Nurmayanti, SPd., MA in providing solutions so that this paper is
structured and ready to be presented.

And we hope this paper can add to the knowledge of our class friends, but regardless,
the paper is still far from the word perfect, so we expect the criticism and suggestions that are
constructive for the creation of this paper Better yet.

Kendari, 29 September 2019

Drafting Team
 TABLE OF CONTENTS

Foreword .....................................................................................................
Table of Contents ........................................................................................

CHAPTER I INTRODUCTION
1.1 Background ...............................................................................
1.2 Formula problems .....................................................................
1.3 Purposes of writing ...................................................................
1.4 Writing Benefits ........................................................................

CHAPTER II DISCUSSION
1.5 Definition of diarrhea................................................................
1.6 Etiology of diarrhea ..................................................................
1.7 pathophysiology Diarrhea .........................................................
1.8 Manifestations of Clinic............................................................
1.9 Diagnostic Checks ....................................................................
1.10 Prevention ..............................................................................
1.11 Penatalaksanaa ........................................................................

CHAPTER III NURSING CARE

1.12 Assessment..............................................................................
1.13 Nursing Diagnosis...................................................................
1.14 Intervention Table ...................................................................
1.15 Implementation Table .............................................................
1.16 Evaluation ...............................................................................
 CHAPTER1
PRELIMINARYA

A. Background
Diarrhea is often considered an ordinary disease and is often considered trivial
treatment. In fact diarrhea can cause system disorders or complications that are very
dangerous for sufferers. Some of them are disorders of fluid and electrolyte balance,
hypovolemia shock, disruption of various organs of the body, and if not handled
properly can cause death. Thus it becomes important for nurses to find out more about
diarrhea, the resulting negative effects, as well as efforts to handle and prevent
complications.
In the case of compliance with fluid and electrolyte balance disorders, there are
actually nursing diagnoses that may arise. But in this case the case is focused on
diarrhea, so that nursing action is more directed at the rehydration of the patient, and
apparently there is a lot that must be considered and considered.

B. Formulation
The formulation of the problem that I use includes:
1. What is diarrhea?
2. What is the etiology of diarrhea?
3. What is the pathophysiology of diarrhea?
4. What are the clinical manifestations of diarrhea?
5. How is the diagnostic check for diarrhea?
6. How to prevent diarrhea?
7. How is the management of diarrhea?
C. Purpose Based on the background and formulation above the writing of this
paperaimsto:

1. Know the meaning of diarrhea.

2. Know the etiology of diarrhea.
3. Know the pathophysiology of diarrhea
.4. Knowing the clinical manifestations of diarrhea.
5. Know the diagnostic test for diarrhea
.6. Knowing how to prevent diarrhea.
7. Knowing the management of diarrhea.

D. BenefitsThe benefits of writing this paper include:

1. Provide knowledge about understanding diarrhea.
2. Provide knowledge about the etiology of diarrhea
.3. Provide knowledge about the pathophysiology of diarrhea.
4. Provide knowledge about the clinical manifestations of diarrhea.
5. Provide knowledge about diagnostic diarrhea checks.
6. Provide knowledge about how to prevent diarrhea.
7. Provide knowledge about the management of diarrhea.
 CHAPTER II
DISCUSSION

A. Definition of Diarrhea

Diarrhea is defined as a condition where there is a change in the density and

character of the stool and water stools are released three or more times per day
(Ramaiah, 2007: 13).

Diarrhea occurs due to digestion of E. coli bacteria to food. This bacterium is

very happy to be in human feces, dirty water, and stale food. To prevent diarrhea, the
food given to children must be hygienic. Don't forget to always wash your hands
thoroughly (Widjaja. 2005: 26).
Meanwhile, according to Suriadi (2006: 80) states that diarrhea is the loss of
excess fluid and electrolytes that occur due to the frequency of one or more forms of
watery or liquid stools.
According to Suradi, and Rita (2001), diarrhea is defined as a condition in
which excessive fluid and electrolyte loss occurs due to the frequency of defecation
once or more in a thin or liquid form.Enteritis is an infection caused by viruses or
bacteria in the intestinal tract (eg cholera, amoebic dysentery). Psychogenic diarrhea is
diarrhea that accompanies a period of nervous tension / stress.
If judging by definition, diarrhea is a symptom of defecation with consistency
of soft, or liquid stool (feces), even in the form of water. The frequency can occur
more than twice a day and last for a long time but less than 14 days. As is known, in
normal conditions, people usually defecate once or twice a day with a solid or hard
stool consistency.So diarrhea can be interpreted as a condition, defecation that is not
normal that is more than 3 times a day with the consistency of a runny stool can be
accompanied or without accompanied by blood or mucus as a result of the
inflammatory process in the stomach or intestine.
B. Etiology of Diarrhea
According to Dr. Haikin Rachmat, MSc., The causes of diarrhea can be
classified into six groups:
1. Infection caused by bacteria, viruses or parasites.
2. There is a disruption of food absorption or called malabsorbsi.
3. Allergy
4. Chemical poisoning or poisons contained in food.
5. Immunodeficiency, namely decreased immunity.
6. Other causes.
Director of Direct Communicable Disease Eradication (PPML), Directorate
General of Communicable Disease Eradication and Environmental Health (P2MPL)
Ministry of Health which is often found in the field is diarrhea caused by infection and
poisoning. After undergoing laboratory examinations, the source of the transmission
comes from foods or drinks that are contaminated with the virus. Concretely, the case
of diarrhea is related to environmental and behavioral problems. Changes from the dry
season to the rainy season which cause floods, lack of clean water facilities, and less
clean environmental conditions cause an increase in diarrhea cases. The facts show that
the majority of patients actually live in less clean and unhealthy areas. When the
supply of clean water is very limited, people then use river water that is obviously dirty
with waste. Even a place to defecate. Obviously the water can't be used. Do not be
surprised if there are so many diarrhea sufferers because they use water that has been
polluted by germs or chemicals that poison the body. Behavioral problems can also
cause someone to have diarrhea. For example, consuming food or drinks that are not
clean, polluted, and contain germs. If the immune system turns out to be weak, as a
result diarrhea occurs.
 Diarrhea can be caused by environmental factors or from the diet.
Environmental factors can cause children to be infected with bacteria or viruses that
cause diarrhea. Foods that are not suitable or that cannot be digested and are well
received by children and food poisoning can also cause diarrhea.Sometimes it is
difficult to know the cause of diarrhea. Diarrhea can be caused by an infection in the
stomach or intestines. Inflammation or infection of the intestine by the causative agent:

1. Infection factors: Bacteria, viruses, parasites, candida

2. Parenteral factors: infection in other parts of the body (AOM often occurs in
children)

3. Malbabsorption factors: carbohydrates, fats, proteins

4. Food factors: stale food, poisonous, too much fat, vegetables cooked
undercooked, hand washing habits

5. Psychological factors: fear, anxiety

C. Pathophysiology

This disease can occur due to contact with infected feces directly, such as:

1. Food and drink that has been contaminated, both that has been contaminated
by insects or contaminated by dirty hands.

2. Playing with contaminated toys especially in infants often put hands / toys /
anything in the mouth. Because this virus can survive on the surface of the air
for several days.

3. Use of water sources that have been polluted and do not boil water with the
correct water.

4. Do not wash your hands thoroughly after defecating.

 The cause of acute gastroenteritis is the entry of viruses (Rotravirus,
Adenovirus enteris, VirusNorwalk), bacteria or toxins (Compylobacter, Salmonella,
Escherihia Coli, Yersinia and others), parasites (Biardia Lambia, Cryptosporidium).
Some of these pathogenic microorganisms cause infections in cells, produce
enterotoxins or cytotoxins which damage cells, or attach to the intestinal wall in acute
gastroenteritis.The basic mechanism causing diarrhea is an increase in intestinal noise
and secretion of intestinal contents as an effort by the body to excrete irritants or
infectious agents. Besides causing interference with the secretion of toxins in the
intestinal wall, so that water and electrolyte secretion increases then diarrhea occurs
and absorption of water and electrolytes is disrupted. As homeostasis of the body, as a
result of the entry of an irritant agent in the colon, there is an attempt to immediately
remove the agent. So that the colon produces excessive mucus and HCO3 which have
an effect on intestinal mutility disorders that result in hyperperistaltic and
hypoperistaltic. As a result of diarrhea itself is a loss of water and electrolytes
(dehydration) which causes acid base disorders, nutritional disorders, and blood
circulation disorders.

The process of gastroenteritis can be caused by a variety of possible factors

including:

1. Infection factors, this process can be initiated by the presence of microorganisms

(germs) that enter the digestive tract which then develops in the intestine and damage
intestinal mucosal cells which can decrease the intestinal surface area. Furthermore,
there is a change in the capacity of the intestine which eventually results in impaired
intestinal function in absorption of fluids and electrolytes. Or it is also said that the
presence of bacterial toxins will cause the active transport system in the small intestine,
cells in the intestinal mucosa to experience irritation and increased fluid and
electrolytes. Incoming microorganisms will damage the intestinal mucosa cells so that
it decreases the intestinal surface area, changes in intestinal capacity and disrupts the
absorption of fluid and electrolytes.

2. Malabsorption factor is a failure in absorbing which results in increased osmotic

pressure resulting in a shift in water and electrolytes to the intestinal tract that can
increase intestinal cavity so that gastroenteritis occurs.

3. This food factor can occur if the toxin is not able to be absorbed properly. This
results in an increase in intestinal peristaltic which results in a decreased opportunity to
absorb food which then causes gastroenteritis.

4. Psychological factors can influence the increase in peristalticusus which ultimately

affect the process of absorption of food which can cause gastroenteritis (Hidayat Azis,
2006).

D. Clinical Manifestations

1. Increased bowel sounds, abdominal pain or mules

2. Diarrhea, vomiting, signs of dehydration (+)
3. Acidosis, hypokalemia, hypotension, oliguria, shock, coma

4. Examination of micro organisms (+) (eg amoeba)

5. There can be blood and mucus (mucus) in the stool (for example in amoebic
dysentery)

6. Frequent bowel movements with a consistency of liquid or runny stool.

7. There are signs and symptoms of dehydration; bad skin turgor (decreased
skin elasticity), crown and sunken eyes, dry mucous membrane

8. Abdominal cramps

9. Fever

10. Nausea and vomiting

11. Anorexia
 12. Weak

13. Pale

14. Changes in vital signs; pulse and rapid breathing

15. Decreased or no urine output

Acute diarrhea due to infection can be accompanied by vomiting, fever,

tenesmus, hematoschezia, abdominal pain and or stomach cramps. The most fatal
consequence of long-standing diarrhea without adequate rehydration is death from
dehydration which results in a hypovolemic shock or biochemical disorder in the form
of continued metabolic acidosis. Someone who lacks fluids will feel thirsty, heavy
reduced body, sunken eyes, dry tongue, cheekbones appear more prominent, decreased
skin turgor and hoarseness. These complaints and symptoms are caused by isotonic
water depletion. Due to the loss of bicarbonate (HCO3), the comparison with carbonic
acid decreases resulting in a decrease in blood pH which stimulates the respiratory
center so that the breathing frequency increases and deeper (Kussmaul
breathing)Cardiovascular disorders in severe hypovolemic stages can be in the form of
shock with signs of rapid pulse (> 120 x / min), blood pressure decreases until it is not
measurable. The patient starts to get restless, pale face, acral cold and sometimes
cyanosis. Because potassium deficiency in acute diarrhea can also arise cardiac
arrhythmias. Decreased blood pressure will cause decreased kidney perfusion until
oliguria / anuria develops. If this condition is not immediately overcome, there will be
complications of acute renal tubular necrosis, which means a state of acute kidney
failure.
E. Diagnostic Checks

1. History of allergies to drugs or food

2. Fecal culture

3. Examination of electrolytes, BUN, creatinine, and glucose

4. Stool examination; pH, leukocytes, glucose and blood

F. Prevention

Diarrhea can be prevented through (Widoyono, 2005: 151)

1. Using clean waterClean water signs:

a) Colorless

b) Does not smell

c) Does not taste

2. Cooking water before boiling before drinking to kill most germs.

3. Dispose of the stools of infants and children properly.

Prevention of vomiting can be done by promoting a clean and healthy environment:

1. Try to always wash your hands before touching food.

2. Also try to maintain the cleanliness of cutlery.
3. We recommend drinking water to meet the needs of standard sanitation in a
temporary environment. The boiled water is really boiling, clean, odorless,
colorless and tasteless.
4. Cover food and drinks provided at the table.
5. Every time you go out try to always wash your hands, feet and face
.6. Familiarize children to eat at home and not snack at random places. If you
can bring your own food when you go to school
 7. Make healthy basic sanitation facilities in the neighborhood, such as clean
water and adequate latrines / toilets.
8. The construction of latrines must comply with standard sanitation
requirements. For example, the distance between a latrine (also a neighbor's toilet) and
a well or water source is at least 10 meters so that water is not contaminated. Thus,
residents can use clean water for daily needs, for cooking, bathing, and so on.

G. Management

Management of fluid deficiency is the first step in treating diarrhea patients.

Simple things like drinking lots of water or oral rehydration solution (ORS) like ORS
should be done quickly. This gift is given immediately if the symptoms of diarrhea
have started and we can do it ourselves at home. A common mistake is that
administration of ORS is only made after symptoms of dehydration appear.

In patients with diarrhea accompanied by vomiting, intravenous administration

of electrolyte solutions is the primary choice for replacing body fluids, or in other
words needing to be infused. Problems can arise because there are some people who
are reluctant to treat patients, with various reasons, ranging from costs, difficulty in
maintaining, fear of getting worse after being hospitalized, and others. This much
consideration causes the response time to overcome the problem of diarrhea longer,
and the faster the patient's condition decreases towards fatal.

Viral diarrhea usually does not require treatment other than ORS. If the
condition is stable, then the patient can recover because the infection of the virus that
causes diarrhea can be overcome by the body (self-limited disease).

Diarrhea due to bacterial and parasitic infections such as Salmonella sp, Giardia
lamblia, Entamoeba coli need to get rational antibiotic therapy, meaning that the
antibiotics given can kill germs.Because the most common cause of diarrhea is a virus
that does not require antibiotics, the introduction of symptoms and laboratory testing
needs to be done to determine the exact cause. In cases of acute and severe diarrhea,
supportive treatment takes precedence and sometimes does not require further
examination if the condition has improved. The management that can be done is as
follows:

1. Drink a lot
2. Perinfusion rehydration
3. Appropriate antibiotics
4. Diit is high in protein and low in residues
5. Anti-cholinergic drugs to eliminate abdominal spasms
6. Opium and paregoric tintura to treat diarrhea (or other drugs)
7. Transfusion if bleeding occurs
8. Surgery if perforation occurs
9. Observe fluid balance
10. Prevent complications
 CHAPTER III
NURSING CARE
Based on
(SDKI, SIKI AND SLKI)

A. ASSESSMENT
Main Complaints by patients who have diarrhea in which frequent faecal
discharge is frequent and when the faeces comes out it is in the form of soft, liquid and
even to the out of shape.
The client will experience abdominal pain due to intestinal function that should
be normal in absorbing food debris that cannot be controlled by the nervous system,
and open only the intestine. This requires a further examination to find out whether
there is infalamation or inflammation, infection process, gastrointestinal irritation or
malabsorption.
Clients will experience fatigue quickly, this is because the intake of nutrients
that enter the body is very little compared to expenditure.

Clients will experience weight loss due to dehydration that is so fast.

Functional health patterns :

a. Health maintenanceLack of personal hygiene: habit of maintaining nails,
washing hands before eating, food served not covered, stale food.
b. Nutrition and metabolicHyperthermia, total body weight of up to 50%,
dinoteksia, vomiting.
c. CHAPTER EliminationWatery stool, the frequency varies from> from 3 to 8
times per day.
d. ActivityWeaknesses are intolerant of activity.
e. SensoryPain is marked by pain in the abdomen.
B. DATA CLASSIFICATION
a) Subjective data: collection of data from primary / client sources) is the client's
perception of his health problems usually includes feelings of anxiety, physical
discomfort or mental stress.
-Client complains of diarrhea continuously
-Client says watery / runny stool
-Client complains of heartburn-
-Client says abdominal pain

b) Objective data: (data collection from secondary sources) are observations or

measurements made by data collectors.
-The client looks weak-
-Client is seen holding his stomach area
-Client Looks limp
-Peristaltic Hyperactivity
- Gatstrointestinal Section Inflammation
Physical examinationa. :
General situation:
a. bdominal pain, Look weak and in pain.
b. Vital sign:
Body weight decreases by 2%
mild dehydrationBody weight decreases by 5%
moderate dehydrationBody weight decreased by 8%
by severe dehydration
TD: 90/80 mmHg
RR: 28 x / minute (KUSMAUL)
Temperature: 38.8C (Due to Inflammation)
Pulse: 110 X / minute (peripheral pulse weakens)
c. Sunken eyes
d. Mouth: dry mucosa
e. Abdomen: Turgor is ugly
f. Skin: dry, capillary refill> 2
 C. NURSING DIAGNOSIS.
A. Diarrhea b.d Gastrointestinal Inflammation, Malabsorption, Infection
Process d.d Defecation more than three times in 24 hours, Stool soft or liquid,
increased peristalsis frequency, hyperactive bowel sounds.
B. Acute Pain b.d Physiological Agents (Inflammation) d.d Seeming,
Restlessness, Increased Pulse Frequency, Difficult Sleep, Increased Blood
Pressure, Changing Breath Patterns.
C. Hypovolemia b.d active fluid loss, lack of fluid intake d.d increased pulse
frequency, decreased blood pressure, skin turgor, decreased.

C. INTERVENTION

No. Nursing Diagnosis Criteria Intervention

1. Diarrhea b.d After the Nursing Diarrhea Management:
Gastrointestinal Actions are carried out 1. Observation Actions:
Inflammation, for 3 x 24 hours, the - Identify the cause of diarrhea.
Malabsorption, Infection liquid status improves - Identify the history of feeding
Process d.d Defecation with the expected .- Monitor color, volume,
more than three times in results: frequency, and stool consistency
24 hours, Stool soft or 1. Improved skin .- Monitor the amount and
liquid, increased turgor. expenditure of diarrhea.
peristalsis frequency, 2. Increased body 2. Therapeutic Actions:
hyperactive bowel weight. - Provide oral fluid intake (eg
sounds. 3. Extra breath sugar salt solution, ORS,
sounds decrease. pedialytes, renalytes.
4. The pulse rate - Install the intravenous line.-
improves. Give intravenous fluids (ex:
5. Mucous Ringer acetate, Ringer Lactate,)
membranes if necessary.
improve. - Take stool samples for culture,
6. Body if necessary.
 temperature 3. Educational measures:
improves. - Encourage small portions of
7. Improved fluid food and often in stages
intake. .- Encourage avoidance of gas-
forming, spicy, and lactose
-containing foods.
- Encourage continued
breastfeeding.
4. Collaborative Actions:
- Collaborative administration of
antimotility drugs (eg:
loperamide, diphenoxylate)
.- Collaboration of
antispasmodic / spasmolytic
drugs (eg papverin, belladonna
extract, mebeverine).
-Collaboration of Stool
hardeners (ex: Atapulgit,
smectite, kaolin-pectin).
2. Acute Pain b.d After 2 x 24 Hours of Pain Management
Physiological Agents Nursing Action Then, 1. Observation Actions:
(Inflammation) d.d Gastrointestinal - Identify the location,
Seeming, Restlessness, Function Improves with characteristics, duration,
Increased Pulse Criteria Results: frequency, quality, intensity of
Frequency, Difficult 1. Increased pain.
Sleep, Increased Blood appetite. - Identification of pain scale
Pressure, Changing 2. Abdominal pain .- Identify factors that aggravate
Breath Patterns. decreases, and ease pain.
3. CHAPTER - Monitor the side effects of
Frequency analgesic use.
Improved. 2. Therapeutic Actions:
 4. Improved Stool - Control the environment that
Consistency. aggravate the pain.
5. Improved - Facilitating rest and sleep
intestinal .- Consideration of the type and
peristalsis. source of pain in the selection of
6. Improved stool pain relief strategies.
color. 3. Educational measures:
- Explain the causes, periods,
and triggers of pain.
- Explain strategies to relieve
pain.
- Encourage pain monitoring
independently.
- Teach nonpharmacological
techniques to reduce neyri.
4. Collaborative Actions:
- Collaborative analytical
giving, if necessary.
3. Hypovolemia b.d active After 1 x 24 Hours of Management of Hypovolemi
fluid loss, lack of fluid Nursing Action the 1. Observation Actions:
intake d.d increased pulse Liquid Status Improves - Check for signs and symptoms
frequency, decreased with Criteria Results: of hopovolemia (eg increased
blood pressure, skin 1. Increased skin pulse frequency, weak palpable
turgor, decreased. turgor. pulses, decreased blood
2. The pulse pressure, narrowed pulse
frequency is pressure, decreased skin turgor,
improving. dry mucous membrane,
3. .Blood pressure decreased urine volume,
improves.Fluid increased hematocrit, thirst,
intake weakness).
improves. - Monitor fluid intake and
output.
2. Therapeutic Actions:
- Calculate fluid requirements.
- Give a modified trendelenburg
position.
- Give oral fluid intake.
3. Educational measures:
- Encourage increasing oral
fluid intake.
- Suggest avoiding sudden
position changes.
4. Collaborative Actions:
- Collaborative administration of
isotonic IV fluids (eg NaCl,
RL)Collaboration of blood
products.
 D. IMPLEMENTATION

No. Day/Date/Time Nursing Diagnosis Implementation

1. Senin Diarrhea b.d Diarrhea Management
23 September 2019 Gastrointestinal 1. Observation measures:
10.00 s/d 10.20 pagi Inflammation, -Identifying causes of diarrhea.
Malabsorption, -Identifying food feeding history.
Infection Process d.d -Monitor the color, volume, frequency,
Defecation more than and consistency of feces.
three times in 24 -Monoporing The amount and
hours, Stool soft or production of diarrhea.
liquid, increased 2. Therapeutic measures:
peristalsis frequency, -Installing intravenous pathways.
hyperactive bowel -Provides intravenous fluid (e.g.,
sounds. Ringer's acetate, Ringer's lactate) if
necessary.
-Take samples of feces for culture, if
necessary.
3. Tindaka Education:
-Advocating small meals and often
gradually.
-Recommend avoiding gas-forming
foods, spicy, and lactose-containing.
-Advocating continuing BREAST
feeding.
4. Collaborative actions:
-To metabolize antimotility drugs (eg:
loperamide, Difentoksilat).
-To spread antispasmodic/spasmolitic
Drug Administration (eg: Papverin,
Ekstak Belladonna, Mebeverine).
 -To be prescribed for the
treatment of feces hardener (e.g.
Atapulgit, Smektite, kaolin-
pectin).

2. Selasa Acute Pain b.d Pain Management

24 September 2019 Physiological Agents 1. Observation measures:
13.00-13.15 siang (Inflammation) d.d -Identifying location,
Seeming,Restlessness, characteristic, duration,
IncreasedPulse frequency, quality, pain
Frequency,Difficult intensity.
Sleep,Increased Blood -Identifying pain scales.
Pressure,Changing -Identifying factors that are
Breath Patterns. severe and relieves pain.
-Monitor the side effects of
analytic use.
2. Therapeutic action:
-Control the environment that
weighs the pain.
-Facilitate rest and sleep.
-Weighting the type and source
of pain in the selection relieves
pain.
3. Educational Action:
-Explains the cause, period, and
pain triggers.
-Explaining the pain relief
strategy.
-Recommend monitoring the
pain independently.
-Teaches nonpharmacological

3. Rabu Hypovolemia b.d Management of Hypovolemia
25 September 2019 active fluid loss, lack
20.00-20.34 malam of fluid intake d.d
increased pulse
frequency, decreased
blood pressure, skin
turgor, decreased.
techniques to reduce the sense of
Neyri.
4. Collaborative actions:
- -To analyse the analysis, if
necessary.
1. Observation measures:
-Examining signs and symptoms
of hopovolemia (eg: increased
pulse frequency, weak palpable
pulse, decreased blood pressure,
narrowed pulse, turgor
decreased skin, dry mucous
membranes, decreased urine
volume, hematocrit increased,
thirst, weak).
-Monitors the intake and fluid
outputs.
2. Therapeutic action:
-Calculate fluid needs.
-Provide a modified
Trendelenburg position.
-Provide oral fluid intake.
3. Educational Action:
-Encourage increasing oral fluid
intake.
-Recommend avoiding sudden
position change.
4. Collaborative actions:
-To spread isotonous IV fluid
administration (eg. NaCl, RL)
- -To spread blood product
delivery.
 E. EVALUATION

No. Day/ Date/ Time Nursing Diagnosis Developer notes

1. Jumat Diarrhea b.d Gastrointestinal S:-Ny. A said it has not
27 September 2019 Inflammation, Malabsorption, experienced the
13.00-13.35 siang Infection Process d.d Defekation for 3 x 24
Defecation more than three hours.
times in 24 hours, Stool soft or O:-TTV:
liquid, increased peristalsis TD: 100/80 mmHg
frequency, hyperactive bowel RR: 26X/minute
sounds. N: 58X/minute
S: 37, 8C
TheUsusdown peristalsis.
Noisy bowel decline.
A:-Acute pain persists.
P: Resume Intervention
2. Sabtu Acute Pain b.d Physiological S : Ny. A said the pain in
28 September 2019 Agents (Inflammation) d.d his stomach has
16.35-17.00 sore Seeming,Restlessness, decreased, sleep patterns
IncreasedPulse somewhat improved.
Frequency,Difficult O:-TTV
Sleep,Increased Blood TD: 110/80 mmHg
Pressure,Changing Breath RR: 24X/min
Patterns. N: 68X/min
S: 36, 6X/min
Pain Scale: 6 (moderate)
A:-Some pain is resolved
by medium pain Scale
(6).
The pattern of breath is
still abnormal
 P: Resume further
intervention.
3. Minggu Hypovolemia b.d active fluid S : Ny. A says it has been
29 September 2019 loss, lack of fluid intake d.d a thirst, not easy to get
19.00-20.00 malam increased pulse frequency, tired, the body kondsi
decreased blood pressure, skin somewhat better.
turgor, decreased. O: TTV:
TD: 120/80 mmHg
RR: 20X/minute
N: 78X/min
S: 36, 4X/min
A:-Problems solved with
the problem of fluid
needs, partially resolved
pain, pulse frequency
pattern improved, sleep
patterns improved,
normal defekation back.
P: Stop the intervention
 CHAPTER IV
CLOSING

A. Conclusion
Diarrhea is watery defecation more than 3 times a day with or without blood or
mucus in the stool due to the inflammation of the stomach or intestinal mucosa,
resulting in excessive loss of fluid and electrolytes.As a result of reduced absorption of
fluids and electrolytes in the large intestine, several nursing problems arise from this
diarrhea, including disruption of fluid and electrolyte balance;
lack of need and nausea.From this problem, several management actions were
chosen, including:
a. Drink plenty of (ORS)
b. Perinfusion rehydration (crystalloid isotonic type)
c. Appropriate antibiotics (eg ciprofloxacin and metronidazole)
d. Diit is high in protein and low in residues
e. Anti-cholinergic drugs to relieve abdominal cramps
f. Opium and paregoric tintura to treat diarrhea (or other drugs), for example
carboadsorben
g. Observe fluid balance and electrolyte levels
h. Prevent complications

B. Suggestions

1. Get used to always live healthy so that we don't get diarrhea.

2. Improve the health of both individuals and the environment, so as not to
develop diseases.
3. Cook drinking water until it boils.
4. Wash your hands before and after eating.
5. Defecate (BAB) and defecate (toilet) in the toilet (WC).
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Widjaja. 2007. Tropical Disease, Epidemiology, Transmission, Prevention and Eradication.

Jakarta: Erlangga.

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