87 Gastrointestinal Disturbance: Diarrhea 40 Definition The passage of frequent, watery stools. The rapid movement of fecal matter through the in- testine results in poor absorption of water-nutritive elements and of electrolytes, producing frequent, watery stools. Causes include irritation of the intestinal mucosa from viruses, bac- teria, or chemical agents (gastroenteritis) food poisoning such medications as non-steroidal anti-inflammatory drugs, antibiotics, laxatives (overuse), antacids, gold compounds, and dig- italis hyperthyroidism and emotional disorders that cause increased peristalsis and in- creased secretion of mucus in the colon. Employees traveling to other countries can have increased incidents of diarrhea known as traveler’s diarrhea, with enteropathogenic Es- cherichia coli being the most common etiology. Characteristics Frequent and liquid bowel movements, abdominal cramps, and general weakness are usual symptoms. The stools might contain mucus and can be blood streaked. In all types of diar- rhea, there is rapid evacuation of water and electrolytes, resulting in a loss of essential sub- stances (e.g., potassium and sodium), which in turn produce acidosis and dehydration. Chronic diarrhea can lead to anemia and malnourishment. Policy Evaluate employee in the occupational health unit to determine severity and treatment op- tions for the condition. Refer immediately for medical treatment employee complaining of severe abdominal pain or bleeding. Objectives Clinical Assessments and Interventions Referral for Medical Action Signs of dehydration, bleeding, or severe abdominal pain. Judgment that antibiotics are warranted. Unrelieved symptoms for more than 24 hours accompanied by fever 101ºF. Follow-up Actions Counsel employee regarding nutritional intake. Consider the impact of stress or other emotional components of gastrointestinal disturbances. If stress related, consider EAP referral. Discuss travel precautions for employees traveling to high-risk developing countries or other at-risk areas. (See Guideline on Adult International Travel on pages Obtain a pertinent history. Institute sympto- matic treatment to relieve dehydration and electrolyte imbalances. Determine duration and severity of symp- toms and treatments the employee has insti- tuted. Black, tarry stools often indicate bleeding however, medicines containing bismuth subsalicylate (e.g., Pepto-Bismol, Kaopectate) or iron also can turn the stool black. Discuss medications that might contribute to or cause diarrhea. Obtain vital signs, including orthostatic vitals, to assess dehydration. Discuss diet and nutrition with employee. Recommend a bland diet and increased in- take of liquids at frequent intervals. A BRAT diet (bananas, rice, applesauce, and toast) can help in water absorption. Milk and fats should be avoided for several days. Yogurt can be substituted temporarily as desired. Administer kaolin-pectin compounds to relieve the symptoms per standing order. (Medications to decrease peristalsis and Guideline continues on next page
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