FACTORS ASSOCIATED WITH THE OCCURRENCE OF DIARRHEA AMONG CRITICALLY ILL PATIENTS

Abstract

Diarrhea is common in the acute care setting, particularly among critically ill patients. Factors that cause diarrhea are usually multifactorial; some of the most common include medications, hyperosmolar or rapidly delivered . tube feedings, atrophy of intestinal epithelium or ischemic bowel, short bowel syndrome, pseudomembranous colitis, infection (Salmonella and Shigella species), opportunistic infections in patients with acquired immunodeficiency syndrome and severe hypoproteinemia. Nursing responsibilities and contributions in the collaborative assessment and clinical management of diarrhea are also explored.

Nosocomial diarrhea is a troublesome and costly condition, its reported complications include increased length of stay and higher costs and it is associated with considerable morbidity and mortality. Diarrhea may translate to physical pain, psychological distress and a failure to meet the extraordinary metabolic and nutritional demands of sickness or injury. Therefore, the aim of this study to identify factors associated with the occurrence of diarrhea among critically ill patients. Exploratory research design was used to conduct this research .This study was carried out in trauma ICU, postoperative ICU and the general ICU in Assiut Main University Hospitals

The sample of this study consisted of 60 adult patients, admitted to ICU and having diarrhea during their stay in ICU. Tool used in this study consisted of an assessment sheet developed by the researcher for identifying factors associated with the occurrence of diarrhea among critically ill patients. This tool comprised five main parts: Part !:-assessment of the patients profile. Part II: - this part consisted of two mairi categories as follows:­ A- Assessment for gastrointestinal system B-Medications. Part III: -Assessment of fluid balance. Part IV:- Assessment hemodynamic state. Part v: laboratory tests findings The tool was tested for content related validity by 7 experts in the field of anesthesia and critical care medicine and critical care medicine and critical care nursing from Alexandria and Assiut Universities. A pilot study was conducted on I 0 patients from three ICUs in order to test the clarity and applicability of the tool and necessary modifications were done.

The main results: The results of this study revealed that most common factors associated with diarrhea were age, most of the studied patients were found to be 35-45 years. Concerning feeding, 86.7% of the studied patients used enteral feeding. While 78.3%of patients had hypoalbuminemia. The length of hospital stay varies from 5- 45 days. The mean stay was 17 days. There were association observed between diarrhea and patients receiving certain pharmacological medications as antibiotics consumptions and antacids. On the other hands, receiving a combination of 2 or more antibiotics was also related to a greater incidence of diarrhea. A stool culture was performed on fecal specimens from diarrhea patients.80% were positive culture distributed as 41.4% Klebseilla, 16.6% MRSA and 13.33%staphylococcus