Mapping Care Using Standardized Terminology

Answer

Mapping Care Using Standardized Terminology

Introduction

The nursing process involves assessment, diagnosis, care planning, implementation, and evaluation. Without a common language and definition of conditions, nurses would have difficulty in communicating the conditions of their patients to another nurse. Communication is an essential tool in patient care to avoid medical errors and other hospital-acquired conditions. Therefore, the American Nursing Association invented the Standardized Nursing Language systems that nurses can use to refer their actions and communicate to others. The ANA recognizes the NIC, NOC, and NANDA-1 as key Standardized Nursing Languages for use in the US. This paper is purposely documented to determine the applications of the NANDA-I classification system, NOC, and NIC in the control and prevention of diarrhea.

Overview of Diarrhea

NANDA-I provides a standardized system of diagnosis and nursing language. The NANDA-I nursing diagnosis of interest is diarrhea under domain 3 of Elimination and Exchange. The actual diagnosis would be a deficiency in body fluid volume related to water loss through diarrhea as evidenced by thirst. Diarrhea entails passage of loose stool three or more times in a day. All the nursing languages developed by the American Nursing Association recognizes diarrhea as one of the major causes of morbidity among the younger populations. The interest in developing a standardized care plan for diarrhea develops from the high mortality from diarrhea. Diarrhea is the second cause of mortality among infants accounting for 16% of the infants’ death. According to the United Nations, 0.7 million children below 5 years died from infectious diarrhea i9n 2011 while approximately 250 million lost their school days (Messaoud, Jroundi, Nezha, Moraleda, Tligui, Seffar, & Ruiz, 2014). Therefore, it would be important to develop a standardized care map for diarrhea to improve patient outcomes and prevent the spread of infectious diarrhea. The use of Standardized Nursing Language would ensure that the nursing process for controlling diarrhea including nursing diagnoses, interventions, and outcomes are well explained in an organized system (North American Nursing Diagnosis-Association, 2012). Therefore, nurses would provide standardized interventions in the treatment of diarrhea.

The nursing care would also be communicated appropriately among nurses and other healthcare professionals. The quality of the treatment would also be evaluated based on standardized outcome measures. The data element sets would be important in organizing health records that can be used in research to identify the various interventions nurses make to treat diarrhea. Finally, standardization of care for diarrhea patients would promote nursing professional development whereby all the nursing would do a literature research on the standardized care plan and learn new approaches to diarrhea.

NANDA Nursing Diagnoses

• Actual diagnosis: Body fluid volume deficiency related to the excessive fluid loss through the loose stool as evidenced by nausea, thirst, weight loss, and dryness of the mucous membrane of the mouth.
• Risk diagnosis: Risk of malnutrition related to lose of water and digested food through diarrhea evidenced by anemic conjunctiva and muscle weakness.
• Health promotion diagnosis: Readiness for an enhanced level of sanitation related to the discomfort experienced during diarrhea as evidenced by the client’s positive attitude towards health-seeking behavior. However, the patient has a low understanding of the use of laxatives and antidiarrheal drugs.
• Syndrome diagnosis: Irritable bowel syndrome related to persistent diarrhea evidenced by abdominal cramping.

Definition

Herdman (2011) opines that the NANDA-I definition of diarrhea states that it is the passage of loose and unformed stools. According to NANDA-I Taxonomy, the defining characteristics for diarrhea include abdominal pain and cramping, hyperactive bowel sounds, bowel urgency, and passage of loose stool more than three times a day. The American Nursing Association defines nursing in terms of weight of feces, fecal impaction, incontinency, and frequency. The terms related to diarrhea is defined below;

• Frequency: the number of stools passed per day.
• Urgency: the inevitable desire and sensation in the lower abdomen of the need to defecate.
• Incontinency: the uncontrollable stool passage at socially unacceptable locations and time. The stool, in this case, can be either liquid or solid.
• Fecal impaction: the case where the lower colon is loaded with soft or hard stool that can lead to spurious diarrhea.

Classification

The NANDA-I Taxonomy of 2015-2017 classifies diarrhea in Domain 3. Elimination and Exchange with the nursing diagnosis code 00013. Diarrhea is found in class two under the process of secretion and excretion of the end products of digestion.

Nursing Interventions Classification

• Management of diarrhea

Appropriate Nursing interventions from the Nursing Interventions Classification System (NIC)

According to Bulechek, Butcher, Dochterman, & Wagner (2013), the NIC code for diarrhea management is DIARR whose definition is prevention and alleviation of diarrhea. The nursing interventions under the code DIARR that are appropriate in management of diarrhea are;

Body fluid volume deficiency

• The nurse should assess the patient for the history of diarrhea.
• The nurse should request the patient to give a stool sample for culturing and sensitivity test if diarrhea persists.
• The nurse should evaluate the medication profile of the patient for any gastrointestinal adverse effects.
• The nurse should educate the patient on how to use antidiarrheal drugs appropriately.
• The nurse should instruct the carers to record color, frequency, volume, and consistency of the stools.

Risk of malnutrition

• The nurse should evaluate the recorded nutritional content intake.
• The nurse should encourage the patient to consume a small amount of food and add bulk to food gradually.
• The nurse should teach the patients how to eliminate gas-forming and spicy foods from their diet.
• The nurse should help patients to eliminate lactose-containing foods
• The nurse should identify the aggravating factors such as tube feedings, medications, and bacteria that contribute to diarrhea.
• The nurse should carefully monitor for the signs and symptoms of diarrhea.
• The nurse should instruct patients to notify any care team member of any occurrence of diarrhea.
• Nurses should observe the skin turgor of patients regularly.
• Nurses should assess and monitor skin in the perianal region for ulceration and irritation.

Irritable bowel syndrome

• Nurses should measure and record diarrhea output for further interventions.
• All the patients must be weighed regularly to evaluate evidence of weight loss attributed to fluid imbalance.
• Nurses should notify physicians in a time of any increase in the pitch of bowel sounds.
• Nurses should consult physicians if diarrhea persists.

Low understanding of use of laxatives and antidiarrheal drugs

• Patients should be educated to take high-protein, low-fiber, and a high-calorie diet.
• Nurses must instruct older patients to natural means of treating low intestinal motility and avoid the use of laxatives.
• The patients and their families must be taught how to follow diet dairy.
• Nurses should teach patients the techniques used to reduce stress and assist the patients in performing the stress-reduction techniques.
• The nurse should monitor food preparation methods to ensure they are safe.
• Nurses can also assist patients to perform bowel-resting actions such as liquid diet intake.

Summary of the outcomes

Body fluid deficiency

• Water balance in both extracellular and intracellular compartments.
• Adequate water in both extracellular and intracellular compartments.
• At least 2liters of water fluid taken after every 24 hours.

Risk of malnutrition

• Adequacy of the usual pattern of nutrient intake.
• Sufficient ability to contain food in the intestine for more time for digestion to complete.
• Adequate energy for metabolic functions and movement of the patient.

Poor knowledge about antidiarrheal medications

• Adequate knowledge about antidiarrheal drugs for self-administration.
• Easy acceptability to use antidiarrheal medications.
• Improved capacity to adhere to and self-administer antidiarrheal administrations.

Irritable bowel syndrome

• Ability to control the passage of stool from the bowel.
• The capacity of the intestine to form and evacuate stool.
• Reduced abdominal pain to the scale of 0/10.

Diarrhea is one of the diseases with high infant mortality rates. Therefore, a standardized system of care would be indispensable to save this age group. The standardized care is applicable to both adults and children suffering from diarrhea. The nurse should expect best patient outcomes after the interventions mentioned above are made. The NOC opines that diarrhea patients should have outcomes such as hydration, fluid balance, electrolyte and acid-base balance, and bowel elimination. Therefore, the patient should be able to control the passage of food from the bowel with a bowel capable of formation and evacuation of stool. For hydration, patients should have adequate water in both extracellular and intracellular fluid compartments of the body. Additionally, the patient would increase the fluid intake to at least 2000ml per day and show no signs and symptoms of body dehydration.

Conclusion

In summary, the NANDA-I Taxonomy provides an easy way of identifying and classifying nursing diagnoses. Nurses need a common language like this classification system so that all patients can receive a standardized care globally. Diarrhea is found in Domain 3 in the NANDA-I system and the NIC provides vivid interventions that can be used to control and prevent diarrhea. Therefore, any healthcare provider can base the selection of an intervention on the NANDA-I system criteria to provide the high-quality healthcare.

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