Chapter 36: Diarrhea, Constipation, and Irritable Bowel Syndrome

Patient Care Process for Diarrhea

Collect

• Patient characteristics

• Patient medical, family, social history and dietary habits

• Current medications, including nonprescription

• Vital signs and weight

• Laboratory tests depending upon medical history and other presenting symptoms

• Thyroid function tests, complete blood count, glucose, serum electrolytes

Assess

• Underlying causes of diarrhea (see Table 36-2)

• Severity and duration of symptoms

• Patient preference for symptom resolution

• Ability/willingness to pay for treatment options

Plan

• Treat specific cause of diarrhea (i.e. diabetes, infectious, etc.)

• Increase fluid intake using oral rehydration solutions (Table 36-3)

• Antidiarrheal medication (Table 36-4)

• Monitor symptom resolution for efficacy, and pronounced constipation for safety

• Patient education regarding importance of prevention dehydration

• Referral to other providers when appropriate

Implement

• Educate the patient on all aspects of the treatment plan

• Schedule follow-up to monitor safety and efficacy of treatment plan

Follow-up: Monitor and Evaluate

• Determine resolution of diarrhea and related symptoms

• Evaluate for signs and symptoms of dehydration

• Assess for presence of adverse effects (e.g., abdominal pain, constipation)

• Assess patient adherence to treatment plan

• Re-evaluate periodically until resolution

Patient Care Process for Constipation

Collect

• Patient characteristics

• Patient medical, social, and family history including dietary habits

• Current medications, including nonprescription

• Vital signs and weight

• Laboratory tests depending upon medical history and other presenting symptoms

• Thyroid function tests, complete blood count, glucose, serum electrolytes

Assess

• Underlying causes of constipation (see Tables 36-5 and 36-6)

• Presence of alarm symptoms (Table 36-7)

• Severity of symptoms

• Patient preference for symptom resolution

• Ability/willingness to pay for treatment options

Plan

• Treat specific cause of constipation (i.e., thyroid dysfunction, etc.)

• Dietary modification to increase fiber

• Laxative or cathartic option if quick resolution desired and no contraindications (Figure 53-3; Table 53-8)

• Other pharmacologic therapy (Table 53-8)

• Monitor symptom resolution for efficacy, and pronounced diarrhea for safety

• Patient education regarding lifestyle and dietary modifications, drug-specific information, etc.

• Referral to other providers when appropriate (unresolved symptoms or alarm symptoms present)

Implement

• Educate the patient on all aspects of the treatment plan

• Schedule follow-up to monitor safety and efficacy of treatment plan

Follow-up: Monitor and Evaluate

• Determine resolution of constipation and related symptoms

• Assess for presence of adverse effects (e.g., abdominal pain, diarrhea)

• Assess patient adherence to treatment plan

• Re-evaluate periodically until resolution

KEY CONCEPTS

• Diarrhea is caused by many viral and bacterial organisms. It is most often a minor discomfort, not life-threatening, and usually self-limited.

• The four pathophysiologic mechanisms of diarrhea have been linked to the four broad diarrheal groups, which are secretory, osmotic, exudative, and altered intestinal transit. The three mechanisms by which absorption occurs from the intestines are active transport, diffusion, and ...