CHAPTER I

PRELIMINARY

A. Background
Diarrhea is often considered a common disease and is often considered trivial. In fact diarrhea
can cause systemic disorders or complications that are very dangerous for sufferers. Some of
them are fluid and electrolyte balance disorders, hypovolemic shock, disorders of various
organs, and if not handled properly can cause death. Thus it is important for nurses to find out
more about diarrhea, the negative impacts that are caused, as well as efforts to handle and
prevent complications.

In the case of fulfilling fluid and electrolyte balance disorders, there are actually nursing
diagnoses that may appear. But in this case the focus is on cases of diarrhea, so that nursing
actions are directed more at rehydrating patients, and it turns out that there are many that must
be considered and considered.

B. Formulation
The problem formulations that I use include:
1. What is diarrhea?
2. What is the etiology of diarrhea?
3. What is the pathophysiology of diarrhea?
4. What are the manifestations of diarrhea clinics?
5. How is the diarrhea diagnostic test?
6. How to prevent diarrhea?
7. How to manage diarrhea?

C. Purpose and Objectives

Based on the background and formulation above the writing of this paper aims to:
1. Knowing the meaning of diarrhea.
2. Knowing the etiology of diarrhea.
3. Knowing the pathophysiology of diarrhea.
4. Knowing the manifestations of diarrhea clinics.
5. Know diagnostic diarrhea.
6. Knowing how to prevent diarrhea.
7. Knowing the management of diarrhea.

D. Benefits
The benefits of writing this paper include:
1. Providing knowledge about the understanding of diarrhea.
2. Providing knowledge about the etiology of diarrhea.
3. Provide knowledge about the pathophysiology of diarrhea.
4. Providing knowledge about the manifestations of diarrhea clinics.
5. Provide knowledge about diarrhea diagnostic tests.
6. Providing 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 density and the character
of water feces and feces is issued three times or more per day (Ramaiah, 2007: 13).
Diarrhea occurs due to digestion of E.COLI bacteria to food. These bacteria are very
happy to be in human feces, dirty water, and stale food. To prevent the occurrence of
diarrhea, the food given to children must be hygienic. Don't forget to always wash your hands
thoroughly (Widjaja. 2005: 26).
Whereas according to Suriadi (2006: 80) states that diarrhea is excessive fluid and
electrolyte loss that occurs due to frequency of one or more times urinating in the form of
runny or liquid stool.
According to Suradi, and Rita (2001), diarrhea is defined as a condition where
excessive fluid and electrolyte loss occurs due to the frequency of defecating once or more
with a runny or liquid form.
Enteritis is an infection caused by viruses or bacteria in the intestinal tract (eg kholera,
amoebic dysentery). Psychogenic diarrhea is diarrhea that accompanies periods of nervous
tension / stress.
If you look at the definition, diarrhea is a symptom of defecation with the consistency
of stool (soft stool), or liquid, it can even be 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 throw big once or twice a day with the consistency of solid or hard feces.
So diarrhea can be interpreted as a condition, abnormal defecation that is more than 3 times a
day with the consistency of runny stool can be accompanied or without blood or mucus
accompanied as a result of an inflammatory process in the stomach or intestine.

B. Etiology of Diarrhea
According to Dr. Haikin Rachmat, MSc., The cause 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 malabsorption
3. Allergy.
4. Poisoning of chemicals or poisons contained in food.
5. Immunodeficiency is a decreased immune system.
6. Other causes.
Director of the Eradication of Direct Communicable Diseases (PPML), Directorate
General of Eradication of Communicable Diseases and Environmental Health (P2MPL)
Ministry of Health which is often found in the field is diarrhea caused by infection and
poisoning. After going through a laboratory examination, the source of transmission comes
from food or drinks contaminated with the virus. Concretely, cases of diarrhea are related to
environmental and behavioral problems. Changes from the dry season to the rainy season that
cause flooding, lack of clean water facilities, and less clean environmental conditions have
led to increased cases of diarrhea. The facts show that most of the patients turned out to live
in less clean and unhealthy areas.
When clean water supplies are very limited, people then use river water that is clearly
dirty by waste. Even a place to defecate. Obviously the water can't be used. Do not be
surprised if later people with diarrhea are very much because it uses water that has been
contaminated by germs and chemicals that poison the body. Behavioral problems can also
cause a person to experience diarrhea. For example, consuming food or drinks that are not
clean, polluted, and contain seeds of disease. If the immune system turns out to be weak, as a
result diarrhea will occur.
Diarrhea can be caused by environmental factors or from the food menu.
Environmental factors can cause children to be infected with bacteria or viruses that cause
diarrhea. Foods that are not suitable or can not be digested and received properly by children
and food poisoning can also cause diarrhea.
Sometimes it's difficult to know the cause of diarrhea. Diarrhea can be caused by an infection
of the stomach or intestine. Inflammation or intestinal infection by the causative agent:
1. Factors of infection: Bacteria, viruses, parasites, candida
2. Parenteral factors: infections in other parts of the body (OMA often occurs in children)
3. Malbabsorption factors: carbohydrates, fats, proteins
4. Food factors: stale, poisonous food, too much fat, undercooked vegetables, hand washing
habits
5. Psychological factors: fear, anxiety
C. Pathophysiology
This disease can occur due to direct contact with infected feces, such as:
1. Eating and drinking contaminated beverages, whether contaminated by insects or
contaminated by dirty hands.
2. Playing with contaminated toys especially in babies often put their hands / toys / anything
into their mouths. Because this virus can survive on the air surface for several days.
3. Use of contaminated water sources and do not cook water with the correct water.
4. Do not wash your hands thoroughly after you have finished defecating.
 The causes of acute gastroenteritis are 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 infection in cells, produce enterotoxins or cytotoxins which damage
cells, or attach to the intestinal wall in acute gastroenteritis.
The basic mechanism that causes diarrhea is an increase in bowel sounds and
secretion of intestinal contents as an attempt by the body to expel irritant agents or infectious
agents. Besides that, it causes interference from toxin secretions in the intestinal wall, so that
the secretion of water and electrolytes increases and diarrhea and absorption of water and
electrolytes occur. As a body homeostasis, as a result of the entry of an irritant agent into the
colon, there is an attempt to immediately remove the agent. So that the colon produces mucus
and excessive HCO3 which has an effect on intestinal mutility which results in
hyperperistaltic and hypoperistaltic. The result of diarrhea itself is loss of water and
electrolytes (dehydration) which results in acid-base disorders, nutritional disorders, and
blood circulation disorders.
The process of developing gastroenteritis can be caused by a variety of possible factors
including:
1. Factors of infection, this process can be initiated by the presence of microorganisms
(germs) that enter the digestive tract which then develop in the intestine and damage
intestinal mucosal cells which can reduce the intestinal surface. Furthermore, changes in
intestinal capacity eventually result in impaired bowel function in the absorption of fluids and
electrolytes. Or also said the presence of bacterial toxins will cause the active transport
system in the small intestine, cells in the intestinal mucosa experience irritation and increase
in fluids and electrolytes. Entering microorganisms will damage intestinal mucosal cells to
reduce intestinal surface area, intestinal capacity changes and disruption of fluid and
electrolyte absorption.
2. Malabsorption factor is a failure in absorbing which results in increased osmotic pressure
resulting in the shifting of water and electrolytes to the intestine which can increase the
intestinal cavity so that gastroenteritis occurs.
3. This food factor can occur if the existing toxin is not able to be absorbed properly. So that
there is an increase in peristaltic intestine which results in a reduction in the chance to absorb
food which then causes gastroenteritis.
4. Psychological factors can affect the increase in peristalticus which ultimately affects 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, olury, 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 the consistency of liquid or runny stools.
7. There are signs and symptoms of dehydration; poor skin turgor (decreased skin elasticity),
fontanel and sunken eyes, dry mucous membranes
8. Abdominal cramps
9. Fever
10. Nausea and vomiting
11. Anorexia
12. Weak
13. Pale
14. Changes in vital signs; rapid pulse and 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 result of diarrhea that
lasts long enough without adequate rehydration is death due to dehydration which causes
hypovolemic shock or biochemical disorders in the form of continued metabolic acidosis. A
person who lacks fluids will feel thirsty, lose weight, sunken eyes, dry tongue, cheekbones
appear more prominent, skin turgor decreases and the voice becomes hoarse. These
complaints and symptoms are caused by isotonic water depletion.
Because the loss of bicarbonate (HCO3), the comparison with reduced carbonic
acid results in a decrease in blood pH which stimulates the respiratory center so that the
frequency of breathing increases and goes deeper (Kussmaul's breathing)
Cardiovascular disorders in severe hypovolemic stages can be shock with rapid pulse
signs (> 120 x / minute), blood pressure decreases until it is not measurable. The patient starts
to get nervous, pale face, cold akral and sometimes cyanosis. Because potassium deficiency
in acute diarrhea can also arise cardiac arrhythmias.
Decreasing blood pressure will cause kidney perfusion to decrease until oliguria /
anuria arises. If this condition is not immediately resolved there will be a complication of
acute renal tubular necrosis which means a condition of acute renal failure.
E. Diagnostic Check
1. History of allergies to drugs or food
2. Stool culture
3. Examination of electrolytes, BUN, creatinine and glucose
4. Stool examination; pH, leukocytes, glucose, and the presence of blood
F. Prevention
Diarrhea can be prevented through (Widoyono, 2005: 151)
1. Using clean water
Clean water signs:
- Colorless
- No smell
- No taste
2. Cooking water until boiling before drinking to kill most germs.
3. Dispose of baby and children's feces properly.
Prevention of vomiting can be done by seeking a clean and healthy environment.
1. Try to always wash your hands before touching food.
2. Try to maintain the cleanliness of eating utensils.
3. We recommend that the water you drink meet the needs of standard sanitation in the living
environment. Cooked water is really boiling, clean, odorless, colorless and tasteless.
4. Close the food and drinks provided at the table.
5. Every time you leave, try to always wash your hands, feet and face.
6. Familiarize children to eat at home and not snack in any place. If you can bring your own
food when going to school
7. Make healthy basic sanitation facilities in the neighborhood, such as clean water and
latrines / toilets.
8. Making latrines must comply with standard sanitation requirements. For example, the
distance between latrines (also neighboring latrines) with wells or water sources of 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
Overcoming fluid deficiency is the first action in dealing with diarrhea patients.
Simple things like drinking lots of water or an oral rehydration solution (ORS) such as ORS
should be done quickly. This is given immediately if the symptoms of diarrhea have started
and we can do it ourselves at home. The mistake that often occurs is the administration of
ORS is only done after symptoms of dehydration appear.
In patients with diarrhea accompanied by vomiting, giving electrolyte solutions
intravenously is the main choice for replacing body fluids, or in other words needing
intravenous fluids. Problems can arise because there are some people who are reluctant to
care for sufferers, for various reasons, ranging from costs, difficulty in maintaining, fear of
getting worse after entering the hospital, and others. These many considerations cause the
response time to overcome the problem of diarrhea is getting 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, the patient can recover because the viral infection that causes diarrhea can be
overcome by the body itself (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 disinfect.
Because the most common causes of diarrhea are viruses that do not require antibiotics, then
symptom recognition and laboratory tests need 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. Perinfus rehydration
3. Appropriate antibiotics
4. Diit is high in protein and low in residue
5. Anti-cholinergic drugs to eliminate abdominal spasms
6. Tintura of opium and paregoric to treat diarrhea (or other drugs)
7. Transfusion if bleeding occurs
8. Surgery if a perforation occurs
9. Observing fluid balance
10. Prevent complications
 CHAPTER III
COVER

A. Conclusion
Diarrhea is an aqueous defect more than 3 times a day with or without blood or mucus
in the stool due to inflammation of the stomach or intestinal mucosa resulting in excessive
fluid and electrolyte loss.
As a result of reduced absorption of fluid and electrolytes in the large intestine,
several nursing problems arise from this diarrhea, including the presence of fluid and
electrolyte balance disorders; less than need and nausea.
From these problems, selected management measures, including:
a. Drink lots (ORS)
b. Perinfusion rehydration (isotonic crystalloid type)
c. Suitable antibiotics (eg ciprofloxacin and metronidazole)
d. Diit is high in protein and low in residue
e. Anti-cholinergic drug to eliminate abdominal spasms
f. Tintura of opium and paregoric to treat diarrhea (or other drugs), eg carboadorbent
g. Observe fluid balance and electrolyte levels
h. Prevent complications

B. Suggestions
1. Get used to always live a healthy life so that we do not get diarrhea.
2. Improve the health of both individuals and the environment, so as not to get sick.
3. Cook drinking water until boiling.
4. Wash hands before and after meals.
5. Defecation and defecation in the toilet
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