APPENDIX - III

STRUCTURED TEACHING PROGRAMME

Topic : Management and prevention of Diarrhoea

Group : Mothers of under five children
Place :

Instructor :
Time :

Method of Teaching : Lecture Cum Discussion

Teaching Aids : Charts, Hand outs, flash cards, Phamlets.

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GENERAL OBJECTIVES :
Help the Women will be able to understand, gain adequate awareness regarding the definition, Risk factor and causes of
diarrhoea, Pathophysiology, signs and symptoms of diarrhea, management of diarrhea and prevention of diarrhea.
CONTRIBUTORY OBJECTIVES :
The women after going through the teaching programme will be able to
 define diarrhea
 list out the risk factors and causes of diarrhea
 discuss the pathophysiology of diarrhea
 explain about signs and symtoms of diarrhea
 state about management of diarrhea
 explain about preventive measure of diarrhea.

Introduction :

I am a nurse who has come to discuss regarding meaning of diarrhea, causes and mode of transmission of diarrhea, sings and

symptoms of diarrhea, management of diarrhea and prevention of diarrhea. Because the diarrhea most important causes of death

among under five children. It is important for us to reduce morbidity and mortality. Now I will explain all the things.

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Sl.No. Time Contributor Content Teacher Learners
Objectives Activity Activity
1 2 Mints Definition of diarrhea Diarrhea is defined as the passage of
loose, liquid (or) watery stool. These Teaching Learning
liquid stools are usually Passed more
than three times a day.

Causes:
2 5 mints List out the risk
factors and causes Viral Causes - Rota Virus Teaching Learning
of diarrhoea. Enteric Virus
Adenovirus
Norvovirus
Astrovirus

Bacterial Causes : Vibro

Salmonella
Campylobactor jejuni
Psudomonus
Aerovonas

Parasitic Causes ; Giadia Lamblia

Entameba Histolytica
Cryptospordium.

Sl.No. Time Contributor Content Teacher Learners

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 Objectives Activity Activity
Predisposing Factor:

Age- Children below five

years. Socio Economic :

Status : Poverty, malnutrition, Personal
hygiene

Human habits, water and soil pollution,

lack of education, quality of life.

Food Intake ; Intake of uncleaned and

spoiled food leads to diarrhea, unhygienic
methods of preparing food also leads to
diarrhea.

Seasonal Change ; Higher frequency

of diarrhea seen in summee month.
3 6 Mins Discuss the Teaching Learning
pathophysiology of Patho physiology :
diarrhoea. Pathogen ( Virus, Bacteria, Parasites )
Causes tissue damage and inflammation
by entotoxin.

The exdotoxin stimulates mucosal lining

of intestine.
It leads to greater secretion of water
and electrolytes in to intestinal lumen.

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Sl.No. Time Contributor Content Teacher Learners
Objectives Activity Activity
The active secretion of chloride
and bicarbonate ion will inhibits
sodium reabsortion.

To balance the excessive sodium,large

amount of protein rich food are
secreted in bowel.

Over whelming of large bowel inability to

reabsorb the fluid electrolytes and roduce
diarrhea.

Pathogens also causes damage and

inflammation by invading destroying
mucosal lining of bowel.

It tends to bleeding and ulceration.

Finally integrity of GI tract is impaired,

its ability to carryout digestion and
4 8 Mins explain the signs absorption function affected.
and symptoms of Teaching Learning
diarrhoea Signs and Symptoms :
- Loose, watery stool more than
3 times a day.
- Hyerthermia.

Sl.No. Time Contributor Content Teacher Activity Learners

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 Objectives Activity
- Nausea
- Vomiting
- Abdominal Cramps
- Signs of dehydeation
- Intestinal rubling
- Anorenia
- Thrist
- Painful, Sparmotic contraction of
anus.
-
5 7 Mins Explain the Diagnostic Evaluation : Teaching Listening
diagnostic evaluation History Collection
of diarrhoea Stool examination – Stool microscopy –
Fecal
Leckocyte count 10/hpt
Stool culture,
-Blood examination
-Blood gas analysis
-Serum electrolytes,
Renal function test.

ASSESSMENT OF DEHYDRATION:
Sl.No. Signs Score1 1 2
1. Appearance Normal Restless Semicoma
2. Eyes Normal Custerless Sunken
Eyes with
Cloudy
Cornea and
Starting

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 3. Anterior Normal(or) Moderately Well
Fontanelle Slightly Sunken (or) Depressed
Sunken Demonstrabl Cranial
y Suture
Depressed Standing
Out.
4. Tongue and Moist Moist Very dry
Mouth And water lips
5. Skin Turgor Skin pinch Skin Pinch Skin pinch
Goes back Goes back Goes back
Quickly Slowly Very slowly
6. Pulse rate Normal Rapid Rapid &
130-10 b/m 160-180 Thready
b/m 180 b/m
7. Extremities Warm Warm Cold and
Clammy
8. Urine output Normal Oliguria No Urine
For 12-2
hrs
9. Muscle Tone Normal Normal (or) Flaccid
Increased
10. Thirst Thirsty Extreme Not
Thirsty Apparent b/c
Of poor
General
Condition.
Decode No signs of Has 2 (or) 2 (or)
Dehydration Dehydration More signs more Signs
Status There is Severe
some dehydeation
Dehydeation
Treatment Plan Plan-A Plan-B Plan-C

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 T Listening
6 7 Mins explain about Management and control of diarrhea disease e
the PRINCIPLES OF TREATMENT : a
management General assessment of diarrhea Assessment of c
of diarrhoea hydration status Correction of electrolytes and acid h
base Imbalance. i
Proper feeding to provide normal nutritional requirements. n
Treatment of associated problem like dysentery Nutritional g
rehabilitation.
Health education.

Treatment an A for child with diarrhea. There are

treatment Plan A when there is no dehydration.
Give the child more fluids than usual to prevent dehydration.
1. Use recommended home fluid.
Give as muc of fluids as the child will take continue giving
these fluids until the diarrhea stops.

2. Give the child plenty of food to prevent under nutrition.

Take the child to the health worker if the child does not get better in
three days (or)

Develop any of the following :

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Many watery stools
Repeated vomiting
Marked thirst
Eating (or) drinking poorly
Fever
Blood in the stool.
Treatment Plan B for child with mild dehydration.

- For mild dehydration treatment

- Plan B is advocated.
- ORS fluid should be given
- 100 to 200 ml clean water should be given to
an infant under six month who are not breast
fed.
- If the mother wants to leave before
completing treatment. The instruction must
be given.
Treatment Plan C for child with Severe dehydration;

When the child has severe diarrhea/dehydration

treatment plan C is advocated.
The mother should be given ORS packet to give
ORS solution 5ml/kg of budy weight.
When diarrhea accompanied fever paracetamol should be
given.

Ingredient Quality
Bicarbnate :
Sodium chloride 3.5 gm
Sodium Bicarbenate 2.5 gm

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Composition of ORS

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Pottasium Choloride 1.5 gm Learning
Glucose 20 gm
Potable water 1 Litre Teaching
Composition of ORS citrate

Sodium Chloride 3.5 gm

Trisodium citrate 2.9 gm
de Potassium 1.5 gm
chloride Glucose 20.0 gm
Potable water 1 Ltr

ORS solution to be given according the guidelines for oral

rehydration therapy ( for all ages ) during the first four
hours.
Age ORS solution (M1)

Under 4 month 200ml – 400ml

1-2 years 400ml – 600ml
2-4 years 600ml – 800ml
5-14 years 1200ml - 2200
ml 15 years and more 2200ml - 4000ml
Based on weight : Patient weight x 75
Health Education :

 Health education regarding environmental

Sanitation
 Importance of personal hygiene

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  Proper disposal of solid waste.
 Importance of use of sanitary latrine
 Educate them importance of hand washing
 Before taking food and after defecation.
 Sterilization of feeding bottle.
 Importance of exclusive breast feeding for first
4 month.
 Educate them about clean drinking water.
 Importance of ORS to treat the diarrhoea
 Importance of immunization.

Conclusion :
Health is fundamental importance to every human being during all the spheres of life. The
children’s are special events in the life time. So care of children is very important to make the
healthy nation.

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 APPENDIX – VI
HAND OUT
MANAGEMENT OF DIARRHOEA
Meaning :
Diarrhoea is defined as the passage of loose, liquid (or)

watery stool. These liquid stools are usually passed more than

three times a day.

Courses of diarrhoea
Viral causes : Rota virus
Enteric virus
Adenovirus
Norrovirus
Asbovirus
Backterial : Vibro
Salmonella
Psudomonus

Parasitic causes : Giadia lamblia

Entameba Kistolytica
Crytospordium

Measures to prevent the diarrhoea

 Drink safe water ( Boiled water, Chlorinated water )
 Wash the fruits and vegetables before consumption
 Cover all the food items properly to prevent condemnation
with flies.
 Avoid bottle feeding.
 Wash the hands with soap and water before taking food.
 Wash the hands with the soap and water after urination
and defecation.

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 Cut short the nails regularly.
 Maintain personal hygiene’s
 Maintain good environmental hygiene’s
 Use toilet for urination and defecation

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