Outcome Evaluation

• Monitor the patient with diarrhea from the point of first contact until symptoms resolve, keeping in mind that most episodes are self-limiting.

• Question the patient to determine whether symptom resolution occurs within 48 to 72 hours in acute diarrhea.

• Monitor for the maintenance of hydration, particularly when symptoms continue for more than 48 hours. Look for increasing thirst, decreased urination, dark-colored urine, dry mucous membranes, and rapid heartbeat as suggestive of dehydration, especially when nausea and vomiting have been present.

• Monitor for symptom control in patients with chronic diarrhea.

• When antibiotics are used, monitor for completion of the course of therapy.

Patient Care and Monitoring for Diarrhea

1. Assess the patient's symptoms to determine if patient-directed therapy is appropriate or whether the patient should be evaluated by a physician. Determine the type of symptoms, severity, frequency, and exacerbating factors. Remember to inquire about recent foreign travel.

2. Determine if the patient is dehydrated.

3. Determine whether the patient has a history of disease that might be associated with diarrhea.

4. Obtain a thorough current history of prescription, nonprescription, and dietary supplement use. Remember to review the current therapy as a potential cause of diarrhea.

5. Determine if any diarrhea treatments have been attempted, including home remedies.

6. Medical referral is advised if the patient is pregnant, breast-feeding, younger than 3 or older than 70 years of age, or suffers from multiple medical conditions.

7. If home care is recommended, provide clear instructions about how to proceed if symptoms do not improve or new symptoms emerge.

8. Discuss the importance of maintaining nutrition by modifying the diet to include low-residue meals (low-fiber meals).

9. Educate the patient about: (a) the causes of acute and chronic diarrhea, (b) the possible complications of diarrhea, (c) the goals of treatment for diarrhea, (d) the an-tidiarrheal medication used to manage acute or chronic diarrhea, and (e) if appropriate, the circumstances when antibiotics are used to treat diarrhea.

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