NURS 4842: Health Concepts in Nursing - Diarrhea Case Study

This case study delves into the health concept of infant diarrhea, presenting a detailed analysis of a 5-month-old baby, Kiley Hastings, who presented with acute diarrhea. The paper begins by introducing the case and the associated symptoms, including lethargy, sunken eyes, and dehydration. It proceeds to explore the nursing diagnoses, focusing on fluid volume deficiency, imbalanced nutrition, and hyperthermia, explaining the rationale behind each. The study further discusses the background of diarrhea, its causes (including rotavirus), and the pathophysiology of the condition. The assessment of the patient is detailed, including vital signs and diagnostic findings. A literature review supports the analysis, referencing studies on diarrhea in infants and treatment strategies. The conclusion emphasizes the importance of fluid and electrolyte replacement, along with the need for antibiotic treatment in cases of suspected bacterial infection. The paper offers a comprehensive overview of the diagnosis, interventions, and management of infant diarrhea within a nursing context.

Running Head: HEALTH CONCEPTS IN NURSING
HEALTH CONCEPTS IN NURSING
Name of the Student:
Name of the University:
Author Note:

1HEALTH CONCEPTS IN NURSING
Introduction:
Health is one of the concepts that help in maintaining a balance between an individual
and the environment that the person survives usually. Diarrhoea is one of the most common
health issues that arise amongst all the age groups and can range from mild, temporary to a fatal
condition. The symptoms comprise of abnormal bowel movements along with the passage of
watery stools. The paper below discusses the case study of Kiley Hastings and the patient is seen
to be initially suffering from loose motions, thereby the nursing interventions in respect to the
diagnosis (Akbulut & Akpinar, 2017) of the patient and prioritising them. The paper also refers
to the discussion about the case study related to a 5-month-old baby girl and the treatment that
needs to be incorporated to make her get better.
Discussion:
The Case of Kiley Hastings:
Kiley Hastings, a five-month-old baby, was left with her baby sitter as her parents went
on a break to camp at the forest. It was observed that the baby has been had been suffering from
diarrhoea (Kotloff, 2017) since the day her parents had left and that on being taken to the
emergency department she was diagnosed of symptoms of being lethargic, displaying sunken
eyes. Her peripheral pulses were found weak and the refill in the capillaries was found to be
much delayed. Moreover, her skin appeared mottled and felt cold on being touched. The
temperature, blood pressure, respiration rate were all located on the high side and the heart rate
was very high as well. The condition of Kiley was determined to be a case of acute diarrhoea by
the initial diagnosis performed by the nurses at the emergency department.

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Nursing Diagnosis:
Rotavirus (Nirwati et al., 2016) is considered as one of the main reasons that cause
diarrhoea. Diarrhoea is considered as one of the diseases that causes an increase in the frequency
of bowel movements along with the amount of water and the volume of the waste that gets
excreted. The condition poses a severe threat to the patients if it persists for a more extended
period. The severe cases of diarrhea can lead to the condition of being water deprived, ultimately
leading to dehydration. Diagnosing the case for diarrhea, various criteria and parameters are
checked and ultimately concluding on the diagnosis.
The parameters can considered as the:
 Deficiency of Fluid Volume- Kiley’s mother when brought to the emergency department
reported that Kiley was having loose, watery, grainy stool for more than eight times and
that she had soiled many disposable diapers on as soon as being applied. Moreover, the
patient appeared weak and the vital signs appeared erratic with, temperature being 98.90
F, heart rate being very high and rapid 176, blood pressure being 90-58 and the
respiratory rate being 56 (Lopes et al, 2017). The vital signs were again assessed and the
observations of excessive dry and mottled skin was observed. The baby was observed to
be very lethargic as well and the eyes appeared to be sunken and the skin was too cool to
touch. In order to determine the condition of the baby further tests were performed,
which showed that the baby’s body was deprived of water and was dehydrated. The main
goal here was to maximize the fluid content of the baby’s body.
 Imbalance in nutrition less than body requirements- The condition is checked and the
baby was seen to be under inadequate intake of nutrition or breast milk (Teixeira et al,
2016). The baby was observed of being extremely lethargic and that there was an

3HEALTH CONCEPTS IN NURSING
inadequacy in the supply of nutrients that were taken by the baby. The baby was
diagnosed with the help of stethoscope and the bowel sounds were checked for any
auscultation. Encouraging the baby to rest before she is made to eat and measuring the
bodyweight each day also proved to help treat the baby correctly. The intestinal irritation
may lead to the intestinal hyperactivity leading to the decrease in the absorption rate of
the water and ultimately leading to the condition of diarrhoea. The parents were also
made to understand by providing an adequate amount of knowledge and information
regarding the needs of nutrition and the effectiveness is lastly checked post the
application of the theory. The main goal of the following intervention was to stimulate
the appetite of the baby.
 Hyperthermia: While speaking to the baby’s mother, it was revealed that the baby’s
fever was hiked and on further being investigated on her arrival at the emergency
department, it was reported to be 98.90 F (Noh & Lee, 2015). The main goal was to
make the baby return to a reasonable range of temperature. The vital signs were assessed
along with the body temperature regularly along with the application of warm
compresses on her body. The antipyretic drugs were incorporated along with her other
medications that were registered for improving Kiley’s condition. The main aim was to
determine the body temperature and aid in the healing process of the baby.
Background of the disease diagnosed:
Diarrhoea is one of the most common illnesses that is found in infants and children. As
per WHO, the condition is mainly defined as a bowel movement, resulting in liquid form for
more than three times in one day and usually tend to remain for more than two days. These
conditions ultimately lead to the patient getting dehydrated and included infections and food

4HEALTH CONCEPTS IN NURSING
allergies and has a higher need of getting treated as soon as possible or the persisting requirement
can lead to a fatal disease. Viral infections can cause diarrhoea by the invasion of rotavirus or by
bacterial infections such as Shigella or Salmonella or Escherichia coli. Food intolerance or
reaction to any medication can also lead to the occurrence of such type of condition. The
condition of diarrhoea can be defined by the reversal of the net absorptive status of the water and
the balance of the electrolyte absorption rate to the amount of water produced by the body. The
disorder caused can lead to the cause of an osmotic force and leads to a condition causing
intolerance in the body. The situation can also be developed if is caused by any bacteria that may
lead to the secretion of a bacterial toxin, which results in the increase of the chloride ions and the
amount of water into the intestinal lumen.
Assessment of the patient:
The evaluation can be done based on the change of texture in the stools. The faecal
matter would be watery in composition. During such symptoms, dehydration can become a
severe problem. On continuing the respective diagnostic protocol, it can be observed that the
baby had a normal body temperature of 98.9ºF. However, on the other hand it was found that the
heart rate of the patient was found to be very high at a range of 176, whereas the normal range
used to be at 98 to 168 beats/minute. A small hike in the blood pressure (BP) was also observed
as such where the BP observed was at a rate of 90/58. The normal range being 90/45, therefore
this became a cause of worry too. Although, respiration rate when checked was found to be in
the normal range with an estimated 56 RR. Thereby, assessment of diarrhoea needs to be done as
well by checking for various signs such as whether the child can eat or drink, whether they are
sluggish in nature. Pinching the skin below the abdomen might also help in checking whether the

5HEALTH CONCEPTS IN NURSING
child is hydrated or not. Watching out for the convulsions or having any difficulty in breathing
may also help in recognizing severe case of diarrhoea.
Literature review:
(Thiagarajah et al., 2018) states in his paper that Diarrhea is one of the most common
diseases that is seen to be occurring amongst the infants and if that gets to a chronic stage may be
caused due to various levels of allergies. The paper provides a revised approach on ways to
determine the multiple causes of diarrhoea amongst the children and that it can be resolved with
the help of stool analysis, bringing in change in the dietary modifications. (Rajbhandari et al.,
2017) projects light on a case study where a nine-day-old baby is seen to suffer from severe body
weight loss and diarrhoea. The infant girl had shown all the signs of severe diarrhoea and had
reported problems of swallowing or eating. The articles discuss all the course of stay of the
infant in the hospital. (Das, 2015) discuss the various types of dehydration that occurs in a baby
throughout suffering from diarrhoea. The review was done to help and chalk out a plan to orient
the healthcare officials to follow some norms to prevent the devastating consequences, which
leads to the fatal conditions in a neonate. The papers written by (Pleșea Condratovici, Bacarea &
Pique, 2016) presents an extensive study by administering Xylogluan and Gelatin tannate to
treat acute diarrhoea conditions. The results showed that efficacy and the safety of administering
these particular medicines. Out of the two, Xyloglucan was found out to be the most effective
one.

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Conclusion:
Reduction in the osmolality and aiding in the return of the rehydration of the baby might
help in the optimal management of Kiley Hastings. The replacement in the diet with the
application of fluid and electrolyte can be considered as the primary interventions for the
treatment of the condition. The suspicion of Kiley developing bacterial infection post her
admission into the emergency unit can provide a result to the application of required antibiotic to
treat the status of the baby. The case study here gave a more comprehensive view of the health
concept about diarrhoea occurring mainly in infants and the ways the diagnosis parameters need
to be framed and the interventions need to be incorporated. The paper lastly discusses the
pathophysiology of the diseases and that immediate treatment needs to be implied before leading
to any fatal condition.

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References:
Akbulut, G., & Akpinar, R. B. (2017). Determining Nurses' Knowledgeability of Nursing
Diagnoses. International Journal of Caring Sciences, 10(3), 1129-1135.
Guarino, A., Guandalini, S., & Vecchio, A. L. (2015). Probiotics for prevention and treatment of
diarrhea. Journal of clinical gastroenterology, 49, S37-S45.
Das, J. C. (2015). Hypernatremic dehydration in newborn infants. Ulutas Med J, 1(2), 22-5.
Kotloff, K. L. (2017). The burden and etiology of diarrheal illness in developing
countries. Pediatric Clinics, 64(4), 799-814.
Lopes, T. A. M. C., Monteiro, M. D. F. V., Oliveira, J. D. D., Oliveira, D. R. D., Pinheiro, A. K.
B., & Damasceno, S. S. (2017). Nursing diagnoses in hospitalized children.
Nirwati, H., Wibawa, T., Aman, A. T., Wahab, A., & Soenarto, Y. (2016). Detection of group A
rotavirus strains circulating among children with acute diarrhea in
Indonesia. Springerplus, 5(1), 97
Noh, H. K., & Lee, E. (2015). Relationships Among NANDA‐I Diagnoses, N ursing O utcomes
C lassification, and N ursing I nterventions C lassification by Nursing Students for
Patients in Medical‐Surgical Units in K orea. International journal of nursing
knowledge, 26(1), 43-51.
Pleșea Condratovici, C., Bacarea, V., & Pique, N. (2016). Xyloglucan for the treatment of acute
gastroenteritis in children: results of a randomized, controlled, clinical
trial. Gastroenterology research and practice, 2016.

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Rajbhandari, P., Mandelia, C., Janjua, H. S., Selvakumar, P. K. C., & Krishna, S. (2017). A 9-
Day-Old With Weight Loss and Diarrhea. Pediatrics, 139(5), e20162953.
Teixeira, I. X., de Oliveira Lopes, M. V., Martins, L. C. G., Diniz, C. M., de Menezes, A. P., &
Alves, N. P. (2016). Validation of clinical indicators of imbalanced nutrition: less than
body requirements in early childhood. Journal of pediatric nursing, 31(2), 179-186.
Thiagarajah, J. R., Kamin, D. S., Acra, S., Goldsmith, J. D., Roland, J. T., Lencer, W. I., ... &
PediCODE Consortium. (2018). Advances in evaluation of chronic diarrhea in
infants. Gastroenterology, 154(8), 2045-2059.