HEALTH TALK

• NAME OF THE STUDENT - JOSY BINTO

• TOPIC - DIARRHOEA

• NUMBERS OF MOTHER - 10

• TEACHING METHODS - LECTURE METHOD

• TEACHING AIDS - POSTERS, CHARTS, LEAFLETS

• DATE TIME AND DURATION OF -

TEACHING

• PLACE - RURAL AREA

• PREVIOUS KNOWLEDGE OF - ---------------------------

MOTHERS
Genral objective:
At the end of the health talk all mothers will be able to gain in depth knowledge on home management on diarrhoea.

Specific objective:
At the end of the teaching all mothers will be able to
• Introduction on diarrhoea
• Define on diarrhoea
• Types of diarrhoea
• Describe causes of diarrhoea
• Enumerate sign and symptoms of diarrhoea
• Diagnosis of diarrhoea
• Medical management of diarrhoea
• Enumerate the purposes of home management
• Describe the preparation of ORS in home management in diarrhoea
• Mother’s role in diarrhoea
Time Specific Content teacher’s Learning A.v. aids Evaluation
objectives activity activity

According to the World Health

Organization (WHO) and UNICEF, there are about two
Introduction billion cases of diarrheal disease worldwide every year, and
1.9 million children younger than 5 years of age perish from
diarrhea each year, mostly in developing countries. This
amounts to 18% of all the deaths of children under the age of
five and means that more than 5000 children are dying every
day as a result of diarrheal diseases. Of all child deaths from
diarrhea, 78% occur in the African and South-East Asian
regions.
Diarrhoeal disease is the second leading cause of death in
children under five years old. It is both preventable and
treatable. And the intestine is mostly affected in diarrhoea. Each
year diarrhoea kills around 525 000 children under five.A
significant proportion of diarrhoeal disease can be prevented
through safe drinking-water and adequate sanitation and
hygiene.
Globally, there are nearly 1.7 billion cases of childhood
diarrhoeal disease every year.
Diarrhoea is a leading cause of malnutrition in children
under five years old.
 Diarrhoeal disease is the second leading cause of death in
children under five years old and is responsible for killing
around 525 000 children every year. Diarrhoea can last several
days and can leave the body without the water and salts that
are necessary for survival. In the past, for most people, severe
dehydration and fluid loss were the main causes of diarrhoea
deaths. Now, other causes such as septicbacterial infections
are likely to account for an increasing proportion of all
diarrhoea-associated deaths. Children who are malnourished or
have impaired immunity as well as people living with HIV are
most at risk of life-threatening diarrhoea.
.

Diarrhoea is defined as the passage of three or more loose or

Definition liquid stools per day (or more frequent passage than is normal
for the individual). Frequent passing of formed stoolsis not
diarrhoea, nor is the passing of loose, "pasty" stools by
breastfed babies.

Types of 1. ACUTE DIARRHOEA - Is an episode of diarrhoea

diarrhoea that lasts less than 14 [Link] watery diarrhoea
causes dehydration and contributes to malnutrition.
The death of a child with acute diarrhoea is usually
due to dehydration.
2. PERSISTENT DIARRHOEA - If an episode of
diarrhoea that lasts for 14 days or more. (Up to 20%
of episodes of diarrhoea become persistent, and this
 often causes nutritional problems and contributes to
death in children)
3. DYSENTERY - Diarrhoea with blood in the stool,
with or without mucus. The most common cause of
dysentery is Shigella bacteria. Amoebic dysentery is
not common in young children. A child may have
both watery diarrhoea and dysentery.
4. CHRONIC DIARRHEA: Diarrhea that lasts for more
than four weeks or comes and goes regularly over a
long period of time is called chronic diarrhea.

Causes Normal causes of diarrhoea –

 Allergies to certain foods

 Diabetes
 Diseases of the intestines (such as Crohn's
disease or ulcerative colitis)
 Eating foods that upset the digestive system
 Infection by bacteria (the cause of most types of food
poisoning) or other organisms
 Laxative abuse
 Medications
 Overactive thyroid (hyperthyroidism)
 Radiation therapy
 Some cancers
 Surgery on chid’s digestive system
 Trouble absorbing certain nutrients, also called
“malabsorption”
 Poor hygiene
  Acute diarrhoea - viral infections
including rotavirus, norovirus, and viral gastroenteritis
 bacterial infections, including Salmonella and E. coli
 parasitic infections
 intestinal diseases
 a food intolerance, such as lactose intolerance
 an adverse reaction to a medication
 gallbladder or stomach surgery

chronic diarrhoea –
Food allergies, lactose intolerance, fructose intolerance, and
sucrose intolerance are common causes of chronic diarrhea.
Milk, milk products, and soy allergies are the most common
food allergies that affect the digestive tract in children. Food
allergies usually appear in the first year of life.
Feco-oral route is mode of transmission in diarrhoea.

Sign and Normal diarrhoea –

symptoms Sign - ♦ Sunken eye ball
♦ Dry tongue and ducal mucosae
♦ Poor skin turgor
♦ Low blood pressure
♦ Lethargy
♦ Weight loss
Symtoms- ♦ Passage of loose stool
♦ Increased frequency of passage of stool
♦ Loose, watery consistency of stool
♦ Low urine out put
♦ Increased volume of stool
♦ Vomiting

Acute dirrhoea-
 Abdominal cramps or pain.
 Bloating.
 Nausea.
 Vomiting.
 Fever.
 Blood in the stool.
 Mucus in the stool.
 Urgent need to have a bowel movement.

Chronic diarrhoea-
The main symptom of chronic diarrhoea is loose or watery
stools that persist for weeks. These stools may or may not be
accompanied by a sense of urgency. You may have other
symptoms as well, such as: abdominal cramps.

DEHYDRATION - Dehydration is a loss of body fluids, which

are made up of water and salts. When sick children
vomit or have diarrhoea, they can lose large amounts ofsalts
and water from their bodies, and can become
dehydrated very quickly. Dehydration can be very
dangerous, especially for babies and toddlers.
All the acute effects of watery diarrhoea result from the lossof
water and electrolytes from the body in liquid stool.
Additional amounts of water and electrolytes are lost when there is
vomiting, and water losses are also increased by fever. These
losses cause dehydration (due to the loss of water and sodium
chloride), metabolic acidosis (due to the loss of bicarbonate), and
potassium depletion. Among these,dehydration is the most
dangerous because it can cause decreased blood volume
(hypovolaemia), cardiovascular collapse, and death if not treated
promptly. Three types of dehydration are considered below.

Isotonic dehydration

This is the type of dehydration most frequently caused by

diarrhoea. It occurs when the net losses of water and sodiumare in
the same proportion as normally found in the ECF. The principal
features of isotonic dehydration are:

 there is a balanced deficit of water and sodium;

 serum sodium concentration is normal (130-150
mmol/l);
 serum osmolality is normal (275-295 mOsmol/l);
 hypovolaemia occurs as a result of a substantial lossof
extracellular fluid.

Isotonic dehydration is manifested first by thirst, and
subsequently by decreased skin turgor, tachycardia, dry
mucous membranes, sunken eyes, lack of tears, a sunken
anterior fontanelle in infants, and oliguria. The physical signs
of isotonic dehydration begin to appear when the fluid deficit
approaches 5% of body weight and worsen as the deficit
increases. As the fluid deficit approaches 10% of body weight,
dehydration becomes severe and anuria, hypotension, a feeble
and very rapid radial pulse, cool and moist extremities,
diminished consciousness, and other signs of hypovolaemic
shock appear. A fluid deficit that exceeds 10% of body weight
leads rapidly to death from circulatory collapse.

Hypertonic (hypernatraemic) dehydration

Some children with diarrhoea, especially young infants,

develop hypernatraemic dehydration. This reflects a net lossof
water in excess of sodium, when compared with the
proportion normally found in ECF and blood. It usually
results from the ingestion during diarrhoea of fluids that are
hypertonic (owing to their content of sodium, sugar, or other
osmotically active solutes, such as lactose in whole cow's
milk) and not efficiently absorbed, and an insufficient intakeof
water or other low-solute drinks. The hypertonic fluids create
an osmotic gradient that causes a flow of water from ECF into
the intestine, leading to a decrease in the ECF
volume and an increase in sodium concentration within the
ECF (see Figure 2.3, B). The principal features of
hypernatraemic dehydration are:

 there is a deficit of water and sodium, but the deficitof water

is greater;
 serum sodium concentration is elevated (>150
mmol/l);
 serum osmolality is elevated (>295 mOsmol/l);
 thirst is severe and out of proportion to the apparentdegree
of dehydration; the child is very irritable;
 seizures may occur, especially when the serumsodium
concentration exceeds 165 mmol/l.


Hypotonic (hyponatraemic) dehydration

Children with diarrhoea who drink large amounts of water orother

hypotonic fluids containing very low concentrations ofsalt and other
solutes, or who receive intravenous infusions of 50% glucose in
water, may develop hyponatraemia. This occurs because water is
absorbed from the gut while the lossof salt (NaCl) continues,
causing net losses of sodium in excess of water. The principal
features of hyponatraemic dehydration are:

 there is a deficit of water and sodium, but thedeficit

of sodium is greater;
 serum sodium concentration is low (<130
mmol/l);
 serum osmolality is low (<275 mOsmol/l);
  the child is lethargic; infrequently, there areseizures.

- Coma
- Death

Diagnosis 1. Blood test. A complete blood count test, measurement of

electrolytes and kidney function tests can help indicate the severity
of your diarrhea.
2. Stool test. ...
3. Hydrogen breath test. ...
4. Flexible sigmoidoscopy or colonoscopy. ...
5. Upper endoscopy.

Management Medical management - 4 key interventions to manage a caseof

childhood diarrhoea are as follows.

1. Rehydrate the child with ORS solution. Stop

rehydration once diarrhoea stops.
2. Administer Zinc dispersible tablets for 14 days, evenafter
diarrhoea stops.
3. Continued age appropriate feeding.
4. Rational use of antibiotics - For parenteral therapy ofdiarrhea,
ceftriaxone or ciprofloxacin may be considered, as both are
effective against Gram- negative bacteria. In children with
chronic conditions,metronidazole provides an alternative
option, as it is also effective against Cd. Oral metronidazole
can be considered for sequential therapy after parenteral
administration. Oral metronidazole is used for
 prolonged diarrhea, although there is little evidenceof
efficacy of antibiotics
5. Co-trimoxazole is still largely used in theantimicrobial
therapy of diarrhea.

Ors – In simple terms, ORS is nothing but a mixture of salts

and sugar. When diarrhea occurs, water and electrolytes
(sodium, chloride, potassium, bicarbonate, etc.) are lost from
the body through the body. If the fluid and electrolyte
balance in the body is not maintained by replacing the lost
salts and water, dehydration occurs. To prevent dehydration,
ORS is recommended. The salt and sugar mixture in ORS
stimulates water and electrolyte absorption fromthe gut
thereby aiding in the replacement of the lost salts in case of
diarrhea and vomiting.

Home management –
The 4 Rules of Home Treatment are

1. Give Extra Fluid as much as the child will take

o If the child is exclusively breastfed : Breast feed
frequently and for longer at each feed. Ifpassing
frequent watery stools:
 For less than 6 months age give ORS
and clean water in addition to breastmilk
  If 6 months or older, give one or more of the
home fluids in addition to breastmilk.
o If the child is not exclusively breastfed : Give one or
more of the following home fluids; ORS solution,
yoghurt drink, milk, lemon drink, rice or pulses based
drink, vegetable soup, green coconut water or plain
clean water
2. Give Zinc Supplements (age 2 months up to 5 years)for 14
days
3. Continue Feeding, Handwashing and Toilet use
4. When to Return to the health facility
o Child becomes sicker
o Not able to drink or breastfeed
o Drinking poorly
o Develops fever
o Blood in stool

 Give one teaspoon of ORS to the child. This should be

repeated every 1 - 2 minutes (An older child who can drink it
in sips should be given one sip every 1 - 2minutes).
 If the child vomits the ORS, wait for 10 minutes andresume
giving the ORS but this time more slowly than before.
 Breast fed babies should be continued to be givenbreast
milk in between ORS.
 Any ORS which is left over after 24 hours should bethrown
away.
  After about 4 hours of giving ORS, reassess the childfor
dehydration. If the child is no longer dehydrated, give home
available fluids the same way as ORS wasgiven.
 Begin feeding the child even if dehydration persists,
continue ORS. If the child is still dehydrated, please visit the
health facility. On the way, continue to give ORS to the
child.
 Fluid to be given in addition to the usual fluid intake:
o Upto 2 months: 5 spoons after each loose stool
o >2 months to 2 years: 50 – 100 ml after eachloose
stool
o 2 years or older: 100 – 200 ml after each loosestool
 If ORS packets are not available you can prepare it athome
as well. Take 1 L (5 cupful; each cup about 200ml) of clean
water. Add 6 level teaspoons (1 teaspoon = 5grams). Now
add Salt - half level teaspoon. Stir the mixture till sugar
dissolves. The home-made solution is adequate in most cases
and is very effective for rehydration. Be very careful to mix
the correct amounts.

You can even make ORS at home to restore salt and sugarbalance
in the body.
– Take a cup (200 ml) of the clean water. Make sure the water is
boiled and cooled down/filtered or bottled water. Donot use tap
water as it carries a high risk of contamination
which in turn can worsen the condition.
 – To this, add a teaspoon (5 gms) of sugar and a pinch ofsalt.
– Stir to mix all the ingredients properly and ensure thesugar is
dissolved completely.

Mother’s role The mother should bear in mind the following messages:-

a. The three rules for home treatment of diarrhea , these are:

• Give more fluid continuously to a child with diarrhea
including food based ORT according to the recipe

• Continue breast feeding and giving other supplementary foods

specially more fluid diet to a child with diarrhea • Take the child
immediately to the nearest health institution ifhe/she has fever,
vomiting, convulsion, refusal to drink or drowsiness with diarrhoea

b. Get your child immunized for measles

c. Dispose the human waste (including children’s excreta)and

other wastes properly

d. Avoid bottles for feeding of children and infants. Insteaduse cup

& spoon.

e. Keep the hygiene of your house and compound

f. Keep the hygiene of drinking water both at the collectionsite, and
storage levels until it is served.

g. Keep the hygiene of food during preparation, storage andduring

serving.

h. Exclusively breast feed children up to 4-6 months basedon their

demands

Tell the mother: • Breastfeed frequently and for longer ateach feed

• If the child is exclusively breastfed, give ORS/cereal basedORT or

clean water in addition to breast milk.

• If the child is not exclusively breastfed, give one or more of the

following : ORS/, food-based fluids (such as soup, gruel(Atmit), rice
water and yogurt drinks), or clean water. Itis especially important to
give ORS/ Cereal Based ORT at home when;

ƒ The child has been treated with plan B or plan C duringthis visit

ƒ The child cannot return to a clinic if the diarrhoea getsworse.

♦ Teach the mother how to mix and give ORS. Give themother
2 packets of ORS to use at home.
 ♦ Show the mother how much fluid to give in addition to theusual
fluid intake: Up to 2 years 50 to 100 ml after each loose stool 2 years
or more 100 to 200 ml after each loose stool

♦ Tell the mother to: ƒ Give frequent small sips of fluidfrom a

cup.

ƒ If the child vomits, wait 10 minutes. Then continue, butmore slowly

ƒ Continue giving extra fluid until the diarrhoea stops.

complication Complications of Diarrhea Acute

• Electrolyte imbalance (sodium, potassium depletion)

• Dehydration, Hypovolemia, shock and Acidosis In case of

Bacillary dysentery

• Toxic mega colon

• Hemolytic uremic syndrome

• Reactive arthritis

Chronic • Malnutrition
INSTITUTE OF NURSING EDUCATION
HEALTH TALK ON
DIARRHOEA

SUBMITTED TO SUBMITTED BY
DR SONAL TAMBE MS JOSY BINTO
HOD COMMUNITY HEALTH NURSING 2ND YEAR MSC NURSING
I.N.E MUMBAI -03 I.N.E MUMBAI -03