Clinical Findings

Skin: Fever.

GI/GU: Frequent loose, watery stools (may contain blood, pus, or mucus), abdominal pain, cramps, flatulence, nausea, vomiting, dehydration.

MS: Fatigue.

Possible Causes: Viral, bacterial, or parasitic gastroenteritis; food-borne diarrhea; ulcerative colitis; Crohn’s disease; AIDS; PMC; drug side effect; inflammatory bowel disease.

Collaborative Management

• Monitor VS and I&O.
• Provide comfort measures and perineal care.
• Encourage fluids if able to tolerate.
• Establish IV access, and administer IVF as ordered; Pt may need fluid replacement if diarrhea severe.
• Monitor hydration status (orthostasis, hypotension, and tachycardia; tissue turgor, mucous membrane moisture, mentation, UO).
• Assess recent GI history (onset, frequency and nature of stools, presence or absence of blood and mucus, vomiting, cramps, and fever).
• Place Pt on contact precautions in a single room if Clostridium difficile suspected.
• Obtain stool samples.
• Assess recent antibiotic use, use of stool softeners and opiates (all associated with increased risk of pseudomembranous colitis [PMC] caused by C. difficile. See Infection tab for more information about C. difficile).
• Ask about recently eaten meals (raw eggs, contaminated food, raw seafood) and travel history.
• Assess recent blood chemistries (electrolyte levels).
• Administer appropriate antibiotic/anti-infective agent promptly and on schedule.
• Avoid use of antimotility drugs (diphenoxylate, loperamide) or opiates if infectious diarrhea suspected.
• Monitor for relief of symptoms or complications (toxic megacolon if PMC, dehydration, electrolyte imbalance, skin breakdown).