Diarrhea is one of many symptoms that may complicate the hospitalization of a critically ill patient. Diarrhea is caused by a variety of etiologies; identifying the etiology aids in the appropriate selection of interventions. Care of the patient with diarrhea should be guided by the evidence and best practices available in the literature. This article defines and describes diarrhea and its pathophysiology. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with diarrhea is presented, using levels of recommendation based on the strength of the available evidence. A case study is presented to illustrate application to clinical practice. Commentary about the case is provided to review salient points of care.
Illness and injury are physiologic stressors that alter the body’s metabolic and energy demands. Approximately 30 to 55% of hospitalized patients have evidence of malnutrition, which makes nutrition screening and assessment an integral part of the evaluation of the critically ill adult. 1,2 Nutritional assessment relies on a complete history and physical examination, appropriate laboratory measurements, and diagnostic testing as warranted. Although a single laboratory result may be helpful for nutritional screening, there is no single parameter that is both sensitive and specific for the diagnosis of malnutrition. Instead, nutritional assessment must be ongoing and be derived from a variety of sources in order to identify nutritional trends over time. Early identification and nutritional intervention can lessen morbidity and mortality risks; however, underlying acute and/or chronic disease processes often need to be identified and corrected before the body can reverse abnormal nutrient metabolism. 1 A comprehensive nutritional assessment, incorporated with clinical status, will provide the basis for a nutritional support plan and evaluation strategies. In order to help the advanced practice nurse determine the appropriate nutritional regimen, this article discusses the importance of the patient history, physical examination, body composition measurement techniques, and laboratory data assessment.
The incidence of acute and chronic diarrhea in hospitalized adults ranges widely. This variation has been attributed to subjective definitions of diarrhea and to use of imprecise measurement methods. The differential diagnosis of diarrhea is broad, ranging from acute infectious causes to those of longer chronicity involving pathophysiologic mechanisms, The clinical significance of this problem varies from patient discomfort to life-threatening disorders related to the loss of nutrients, severe dehydration, and electrolyte imbalances