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Simmonds, Lorraine

Nov 19, 2020 at 00:48

Clinical Case of Acute Diarrhea

Lorraine Simmonds

NUR 504

November 19, 2020

Clinical Case of Acute Diarrhea

Specifically, subjective data such as past medical and epidemiological history are integral and key information that can enable the clinician to establish the correct clinical diagnosis and determine further management tactics. First, the health care practitioner should ask questions that relate to recent contact with others who have had symptoms of diarrhea, nausea or vomiting, and abdominal pain, as well as clarify the list of foods that the patient consumed before the onset of symptoms and establish whether there was a fact potentially substandard food (Dunlap & Patterson, 2020). Also, clinicians should ask the patient about possible drug exposure or recent use of antibacterial drugs, which are often the cause of diarrhea.

Physical examination is also one of the most important components of valuable diagnostic information, the results of which may determine the further purpose of diagnostic tests or therapeutic interventions. In this situation, the most important information is vitals (especially pulse and blood pressure), the patient’s body temperature, as well as skin turgor and moisture in the mucous membranes, which are indirect signs of the severity of dehydration and the need for urgent rehydration therapy (Acree & Davis, 2017). At the same time, potentially valuable information can be an additional examination of the skin for the presence of various rashes (which can be observed in the case of several infectious diseases), as well as the conjunctiva and sclera, which can have an icteric tint in the presence of such diseases as viral hepatitis. Which, in some cases, can also be accompanied by the diarrheal syndrome. They can also potentially be useful physical data such as delayed capillary refill time and an additional neurological examination with an assessment of the level of consciousness.

Based on the available clinical data, additional diagnostic laboratory tests may be required to make a differential diagnosis. The basic ones are the complete blood cell count (for assessing the leukocyte count and hematocrit), the level of electrolytes, creatinine, and urea in the blood serum (for assessing kidney function, since in the case of acute rehydration, the possible occurrence of acute damage to these organs), as well as a stool sample for conducting a microbiological study (possibly detecting bacteria, protozoa or helminths) and determining the level of antibiotic sensitivity in the case of bacterial infections (Riddle, DuPont, & Connor, 2016). It is also possible to conduct rapid tests for exclusion of rotavirus infection and serological tests to detect antibodies to microbial pathological agents such as Salmonella (Dunlap & Patterson, 2020). The above tests can identify the most common infectious causes of acute diarrhea and help the clinician formulate a management plan.

It is important for differential diagnosis that the patient has a watery (non-inflammatory) type of diarrhea. The list of the most probable causes should first turn off infectious agents. The first on this list are viruses (rotavirus, adenovirus, or cytomegalovirus), which are extremely common, especially affecting children; it is also possible in adults. If the patient had contact with people who had this infection, she could become infected by the fecal-oral route (Acree & Davis, 2017). We put a possible differential diagnosis of acute bacterial diarrhea, which may be caused by enteropathogenic strains of Escherichia colior other bacterial microorganisms that can also enter the gastrointestinal tract with poor-quality food that has been contaminated with these pathogens (Dunlap & Patterson, 2020). The third least likely diagnosis is parasitic diarrhea, which can be caused by pathogens such as Giardinia intestinalis, but is more likely for several reasons. Clinical symptoms such as watery liquid feces, a slight increase in body temperature, large stool volume, and abdominal pain are characteristic.

References

Acree, M., & Davis, A. M. (2017). Acute diarrheal infections in adults. JAMA, 318(10), 957-958.

Dunlap, J., & Patterson, S. (2020). Assessing acute diarrhea. Gastroenterology Nursing, 43(5), 390-393.

Riddle, M. S., DuPont, H. L., & Connor, B. A. (2016). ACG clinical guideline: Diagnosis, treatment, and prevention of acute diarrheal infections in adults. American Journal of Gastroenterology, 111(5), 602-622.