Nursing Care Plan (NCP) for Vomiting / Diarrhea

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Outline

Pathophysiology

The forceful emptying of the stomach contents is known as throwing up (vomiting). Two or more loose, watery stools constitute diarrhea. Vomiting and diarrhea without fever are common in children. Vomiting and diarrhea often occur together but may happen independently of each other and at any time. The symptoms, while frustrating and worrisome, may serve as the body’s natural method to rid itself of the offending cause. Extended periods of vomiting or diarrhea may lead to dehydration.

Etiology

A child’s gastrointestinal system is sensitive and may react to certain medications or foods that are hard to digest, such as sweets or undercooked meats. Other causes of vomiting and diarrhea may be viruses, bacteria, or parasites. Viral gastroenteritis is the most common cause of vomiting and diarrhea, specifically Rotavirus and Norovirus.

Desired Outcome

The patient will have soft, formed stools; the patient will vomit less than 2 times in 24 hours; the patient will maintain adequate hydration

Vomiting / Diarrhea Nursing Care Plan

Subjective Data:

  • Abdominal pain
  • Nausea
  • Irritability (infants and toddlers)
  • Decreased appetite

Objective Data:

  • Vomiting
  • >2 loose, watery stools in 24 hours

Nursing Interventions and Rationales

  • Assess patient for the degree of vomiting: mild (1-2x/day), moderate (3-7x/day) or severe (8 or more or vomits everything consumed)
  Understanding the severity of symptoms can help determine the course of treatment.
  • Obtain history and information from the patient’s parent or caregiver
  Determine when symptoms began, any contributing factors, and if other families or household members are experiencing similar issues. This can help determine etiology and guide treatment. Other sick family members should be isolated from the patient.
  • Assess vital signs
  Monitor for fever or signs of dehydration including tachycardia and tachypnea. Rapid respiratory rate may indicate possible aspiration of emesis.
  • Assess for blood in stool or emesis
  The presence of blood in vomitus or stools may indicate a more severe infection or issue in the GI system.
  • Assess abdomen for distention, hyperactive bowel sounds  and cramping
  The patient may be guarding if unable to verbally express pain; note hyperactive sounds that may accompany diarrhea
  • Monitor Intake and Output
  Determine fluid balance and the need for rehydration intervention; prevent dehydration. Decreased wet diapers may be a sign of dehydration.
  • Obtain samples of stool for culture
  Determine if the cause of symptoms is due to a parasitic or bacterial infection; helps determine the course of treatment
  • Provide perineal care following diarrhea
  Help patient clean perineal area following stools to prevent skin breakdown and rash; apply barrier cream such as zinc oxide as needed
  • Encourage oral hydration; Administer oral rehydration solution (ORS) as necessary or IV fluids as appropriate
  Encourage parents to continue offering a normal diet. Patients are often more responsive to frozen juice bars, ice pops, and flavored gelatin. Supplementation of electrolyte solutions may be required. Breastfed infants should continue to breastfeed with ORS supplementation
  • Educate patient and family on BRAT diet (Bananas, Rice, Applesauce, and Toast)
  This diet is easy on the digestive system and helps to decrease diarrhea and replace nutrients lost. This is often still suggested even though research has not shown that this helps. This is not recommended for pediatric patients because of the low energy and lack of protein and fat content.  
  • Administer medications as appropriate
  Typically, antidiarrheal medications are not recommended, as diarrhea usually resolves spontaneously once the virus or bacteria has been flushed out of the body. Anti-nausea medication may be given depending on the severity of vomiting. Antibiotics may be given if symptoms are related to bacterial infection
  • Provide patient and family education to manage and prevent symptoms
  Encourage good handwashing to prevent the spread of infection. Avoid sugary or high-fat foods that can make diarrhea worse. Encourage older children (>2yrs old) to drink chicken broth or sports drinks to help rehydration

Writing a Nursing Care Plan (NCP) for Vomiting / Diarrhea

A Nursing Care Plan (NCP) for Vomiting / Diarrhea starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, let’s talk about some vomiting and diarrhea and putting this into a nursing care plan. First we have to collect all our data. That’s all the assessment pieces, so what your patient is saying and what we are observing. So subjective data is from the patient, so our patient is having some abdominal pain, right, nausea, they are maybe having a decreased appetite, right? No one wants to eat when all that’s going on. Our objective data includes the things we’re observing on the patient. Let’s say we’re noting that the patient has been vomiting a lot and they are having over two loose or watery stools in 24 hours, or even more than that. So, let’s take that data and let’s analyze it. So what’s the problem here? Well, our patient, if they’re having excessive vomiting and diarrhea, they probably have an electrolyte imbalance going on, right? We don’t have an imbalance and we don’t have good fluids, and we’re dehydrated, and this is all just because of the vomiting and the diarrhea. 

 

So, what needs to be improved? Well, we need to improve the vomiting and diarrhea to help fix this imbalance that’s happening and help fix the dehydration. 

 

What’s the priority? Well, for our patients, the priority is just going to be to hydrate and to reduce the excessive elimination, right, with all the vomiting and diarrhea happening. 

 

So, now we have to ask our “how” questions. How questions are going to help us to plan, implement and evaluate. How do we know this was a problem? This is where you are always going to link your data that you have collected and just link your assessment pieces. For our patient, we knew it was a problem because of all the vomiting and diarrhea. Maybe we could visualize the dehydration because we had low urinary output. They don’t have good filled veins to get lab work on. We’re seeing this patient is dehydrated. We’re seeing all the vomiting and diarrhea, we’re linking our data, and that’s how we knew it was a problem. How are we going to address it? So for this patient, we can do some IV hydration, some medications, and some anti-nausea medications to help. How am I going to know if it gets better? Well, we’re going to have an improved hydration status, which Is going to be awesome. If we can improve that, maybe we will have the vomiting stop and that would also be an added benefit, right, or diarrhea, stopping, slowing down, whatever it is, that’s how we’re going to know it’s going to be better. 

 

So translating gets us our high level concepts. This patient has fluid and electrolyte imbalance problems that we need to look at as a priority. We have elimination that we can deal with and some nutrition. 

 

Let’s put this into a care plan. So first, when you are doing your care plan, you’re going to have your problems and your priorities. This is your subjective and objective data, so just those assessment pieces, this is your intervention. What you are going to do to help fix the assessment that you have, and then the rationale is the why. Why are you doing this intervention? And what do we expect to see happen? First we’re going to start with our fluid and electrolyte balance. So, our patient is showing us on some lab work that maybe the electrolytes don’t look good, because they are super dehydrated and they are having low urinary output. Our intervention. We are going to replace those fluids. So, probably for this patient, if they are excessively vomiting, we’re going to do IV, but of course, we could also do PO if they can keep it down. Our rationale, well, it’s going to fix the hydration status and improve lab work because we’ll have that improved vascular volume. Our outcome, we expect to see improved labs and adequate urinary output. 

 

So for elimination, our data collection shows that the patient’s having some vomiting and having diarrhea. So, our interventions are going to be Zofran and stool samples. The Zofran to help, right, and the diarrhea to get a stool sample. Our why, is because Zofran is an anti-nausea medication, right, so it’s going to hopefully reduce the nausea and reduce the vomit and then a stool sample, because this can assess for any blood in the stool or the infection type of leave a parasitic infection, or what exactly is causing all of this. Our expected outcome is that this will decrease the vomiting and then we’ll have a diagnosis perhaps from this school sample for better treatment to improve the elimination. Let’s look at nutrition. So nutrition for this patient, our data we’ve collected is we have some diarrhea and we have an upset stomach happening, so we need to improve their nutrition to hopefully fix this. 

 

Let’s look at our interventions. We can give some bland diet education to help them. Hopefully they can tolerate foods and different things to help their stomach. So this is going to be our why. It’s going to help the stomach to get the nutrition for the body, to get the nutrition from whatever can be tolerated. And as always, with our education and giving this education for nutrition, the patient will verbalize and demonstrate education and hopefully keep the foods in their body that they need, and not continue to be dehydrated and malnourished because they are vomiting and have diarrhea so much.

 

All right, our key points. So, when you are collecting your information, that’s your data, that’s your subjective and objective assessment pieces. So, you get that and then we’re going to analyze it, and that’s going to help to diagnose and prioritize. We are going to ask how that’s going to help to plan, implement and evaluate. We’re going to translate that. So, our concise terms or concepts, and then we’re going to transcribe that. Use whatever form you prefer, just get your care plan down on paper. 

 

Alright, that was it for our vomiting and diarrhea care plan. Check out all the care plans that we have available for you on NURSING.com as well as the videos and extra resources. We love you guys. Now, go out and be your best selves today and as always, happy nursing!

 

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