The medical world uses a diagnostic framework focusing on underlying pathology, such as gastroenteritis. Nursing, however, employs a distinct classification system to focus on the patient’s holistic response to health problems. This response-focused approach is formalized through nursing diagnoses, which guide professional care planning and intervention. The North American Nursing Diagnosis Association International (NANDA-I) standardizes this nomenclature globally. Within this system, “Diarrhea” is explicitly recognized as a formal, stand-alone nursing diagnosis.
Defining Diarrhea as a Formal Nursing Diagnosis
The NANDA-I taxonomy assigns the code 00013 to the nursing diagnosis of Diarrhea, defining it as the passage of loose, unformed stools. This diagnosis concentrates on the altered pattern of bowel elimination rather than the cause of the alteration. The World Health Organization specifies this as the passage of three or more loose or liquid stools within a 24-hour period, providing a measurable benchmark for assessment.
A nurse confirms this diagnosis by identifying specific defining characteristics, which are the observable signs and symptoms present in the patient. These characteristics include a subjective report of abdominal pain and cramping. Objectively, the nurse may note a distinct urgency to defecate and the physical appearance of loose or liquid stools. Auscultating the abdomen often reveals hyperactive bowel sounds, indicating increased intestinal motility.
Identifying Related Factors and Etiologies
The nursing diagnosis includes a “related to” component, which identifies the contributing factor for the patient’s response. This differs from a medical etiology, as it points to factors the nurse can address or manage.
One common related factor is the presence of an infectious process, which can be viral, bacterial, or parasitic. The inflammation caused by these pathogens increases fluid secretion and motility within the intestines.
Other frequent contributing factors include the adverse effects of certain medications, particularly antibiotics, which disrupt gut flora, or the overuse of laxatives. Patients receiving enteral tube feedings may experience diarrhea due to the formula’s high osmolarity or rapid infusion rate. Conditions causing malabsorption, such as celiac disease or inflammatory bowel disorders, also commonly precede this diagnosis. Psychological factors, including high levels of anxiety or acute stress, can also trigger increased intestinal motility.
Nursing Interventions and Outcome Planning
Once the nursing diagnosis of Diarrhea is established, the nurse initiates a plan of care focused on managing symptoms and preventing complications. A primary assessment priority is monitoring the patient’s fluid status, which involves tracking intake and output, monitoring vital signs for hypotension or tachycardia, and checking for dry mucous membranes. Serum electrolytes are monitored closely to detect imbalances in sodium, potassium, and chloride caused by excessive fluid loss.
Interventions are tailored to address the physical and physiological impact of the condition. Nurses encourage the intake of oral rehydration solutions to replace lost water and electrolytes, or they administer intravenous fluids for severe dehydration. Dietary modifications are implemented, often involving bland foods to rest the bowel and avoidance of irritants like high-fiber, fatty, or spicy foods. Meticulous perianal care is performed after each loose stool to prevent skin breakdown and irritation caused by frequent exposure to acidic fecal matter.
The goal of the care plan is to achieve measurable patient outcomes that demonstrate resolution. A common outcome is that the patient will report a reduction in the frequency of bowel movements to a normal pattern, specified as fewer than three loose stools per day within 24 to 48 hours. The patient should also verbalize relief from abdominal cramping and demonstrate techniques for maintaining adequate hydration and skin integrity.
Distinguishing Diarrhea from Related Nursing Diagnoses
The nursing diagnosis of Diarrhea must be accurately differentiated from other related diagnoses to ensure appropriate interventions are selected.
Constipation
The diagnosis of Constipation (NANDA-I code 00011) represents the opposite end of the spectrum, defined by a decrease in the normal frequency of defecation and the passage of hard, dry stool. While Diarrhea involves hyperactive bowel sounds and urgency, Constipation is characterized by hypoactive sounds and straining with defecation.
Bowel Incontinence
Bowel Incontinence (NANDA-I code 00012) focuses on the involuntary passage of stool due to an inability to control the anal sphincter. While chronic diarrhea can lead to incontinence, the core issue of incontinence is a neurological or muscular control problem, whereas Diarrhea is fundamentally a problem of stool consistency and increased frequency.
Deficient Fluid Volume
The diagnosis of Deficient Fluid Volume (NANDA-I code 00027) is a potential consequence of Diarrhea, not a substitute for it. Diarrhea describes the cause of fluid loss through the gastrointestinal tract, while Deficient Fluid Volume describes the result—reduced intravascular, interstitial, and/or intracellular fluid. The defining characteristics of Deficient Fluid Volume include systemic signs of dehydration, such as decreased urine output, poor skin turgor, and hypotension, which require a focus on fluid replacement.