Nursing Management of Patient with Clostridium Difficile
Alyssia R. Twigg
Submitted in partial fulfillment of the requirements for
NURS 342: Nursing Medical Surgical
Shepherd University
Department of Nursing
April 8, 2015
Nursing Management of Patient with Clostridium Difficile
A 55 year old patient was admitted to the inpatient unit from a hospice facility at 4:00 in the afternoon on April 1st, 2015. The patient has end stage pancreatic cancer with liver and bone metastasis. The unit nurse noted foul smelling loose stools upon the patient’s arrival. After 24 hours and three loose stools, a Clostridium toxin assay test was performed and the patient has tested positive for Clostridium difficile toxin (Elsevier, 2015). Today,
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Often patients encompassing with Clostridium difficile have no symptoms or they may express symptoms of mild diarrhea, pseudomembranous colitis, and inflammation of the colon causing pain (Mitchell, 2014). Clostridium difficile is a bacterial infection of the intestine and it may occur in patients who are immunocompromised or taking broad-spectrum antibiotics. Walter (2014) explains that the most important risk factor for CDI continues to be recent administration of antibiotics. The infection occurs from depression of the normal flora of the bowel through the administration of antibiotics. The depression of the normal flora increases the number of C. difficile bacteria within the intestines. The overgrowth of C. difficile causes diarrhea. Abdominal cramps, fever, and leukocytosis are noted in most patients. Symptoms usually begin 4 to 10 days after the initiation of antibiotic therapy (Elsevier, …show more content…
The SMART goal for the patient’s diagnosis of diarrhea is that the patient will defecate formed, soft stool every 1 to 3 days and will express relief of cramping with little or no diarrhea. The intervention to meet this smart goal is the administration of fidaxomicin, a narrow spectrum antibiotic, to treat the infection of Clostridium difficile (Sears, 2013). Another nursing intervention for the treatment of diarrhea is assessing the patient for sodium and potassium loss, as well as explaining the prevention methods to avoid the spread of excessive diarrhea (Mitchell, 2014). The nurse must also provide proper skin integrity care to the peritoneal are and make the environment safe and easy for access to the bathroom. The SMART goal for the patient’s diagnosis of acute pain is that the patient will state relief of pain in abdominal area after treatment with opioids in a 24hr period. The nursing intervention for acute pain is the administration of opioids as well as positioning to keep patient in as much comfort as possible and take pressure off of the abdominal area. The nurse must also assess the patient’s vital signs and pain level
Clostridium difficile, otherwise known as C. diff, is a species of spore-forming, anaerobic, gram-positive bacteria that is known to cause watery diarrhea. 1 The genus name, Clostridium refers to the spindle shape of the organism while Difficile means difficult in Latin due to the fact that this organism thrives in unfavorable conditions and is very difficult to isolate.4 The incidence of getting CDI has increased over the years due to new strains of increased toxin production of the bacteria and increased resistance to antibiotics.2 It is a gastrointestinal infection, and the most common cause of infectious diarrhea.1 C. difficile was first identified in the feces of healthy newborns back in the 1930’s and by 1935, it was considered normal flora. 2 During 1974, researchers conducted that about 21% of patients that were treated with an antibiotic called clindamyacin reported diarrhea and about 10% of them reported to have conducted pseudomembranous colitis as a side effect of this treatment. 2 It was in 1978 where C. diff had been known to cause anti-biotic associated diarrhea and pseudomembranous colitis. 2 It is known to form spores that resist many disinfectants; it also survives for several months on different surfaces.1 It is a common form of a nosocomial infection and the prevalence of becoming infected with C. diff is about 0-15% in a health care setting. 3 The spores survive well in environments such as soil, water and animals and is distributed worldwide. 4 CDI produces two toxins (Toxin A and B), which are cytotoxic and cause tissue necrosis.4
A common hospital acquired condition that nurses see now days is clostridium difficile. This bacterium usually invades patients who have been on long-term antibiotics that have killed off bacteria that protect them from infection. C. diff is passed from host to host by both direct and indirect contact making it readily moved from patient to patient in hospital settings (Mayo, 2013, 1). Nurses can use the QSEN competencies and KSAs to help treat and prevent hospital acquired conditions such as C.diff.
The general idea of, K, is that a nurse must have knowledge in the diversity of cultures, ethics, and education. The significance of this faction being that if the nurse is cognizant of the patient 's culture, beliefs, family values, support systems, and education level, a more thorough and comprehensive plan of care can be formulated. The premise of, S, is that a nurse must be skilled in the ability to communicate with and advocate for the patient, assess for and properly treat pain, and incorporate the needs and concerns of the patient and their family. The significance of this group and development of these skills include the achievement of pain control, increased rehabilitation periods, and an increase in patient/family satisfaction. The theme of, A, requires that a nurse maintains an open attitude toward the patient and to respect and validate the nurse-patient relationship, which will aid in a positive nurse-patient
The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety issues surrounding PCA use include infusion pump programing errors, basal infusion dosing, and proxy errors when using PCA by proxy (Ladak, Chan, Easty, & Chagpar, 2007). Therefore, the purpose of this report is to examine the benefits and risks of patient-controlled analgesia and how it relates to nursing practice.
Among hospitalized patients around the world, Clostridium difficile is the primary source of infectious diarrhea. Previously, continuously unbalanced intestinal microbiota, usually due to antimicrobials, was deemed a precondition of developing the infection. However, recently, there have been alterations in the biology from virtually infecting the elderly population exclusively, wherein the microbiota in their guts have been interrupted by antimicrobials, to currently infecting individuals within of all age groups displaying no recent antimicrobial use. Furthermore, recent reports have confirmed critical occurrences among groups previously assumed to be of minimal risk—pregnant women, children, and individuals with no previous exposure to antimicrobials, for instance. Unfortunately, this Gram-positive, toxin-producing anaerobic bacterium is estimated to cost US critical care facilities $800 million per year at present, suggesting the need for effective measures to eliminate this nosocomial infection (Yakob, Riley, Paterson, & Clements, 2013).
Pain Management Nursing, 10(2), 76-84.
At some point of life, virtually everyone experiences some types of pain. Despite the availability of standardized pain management methods such as using analgesics and opioids, patients might inadequately managed for pain if pain assessments are done inefficiently. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Getting a thorough pain assessment occasionally hard for nurses with the patients whom cannot collaborate. For example, pain in infants and children can be difficult to assess.
For CSF, 6 of 62 MS patients, and 1 of 40 controls, were positive for ETX immunoreactivity. For the analysis of sera, 6 of 56 MS patients, and 0 of 60 controls were seroreactive to ETX.
Description Clinical rotation for spring 2018 started off at the recovery unit at the General Hospital, it was quite a slow start to my day. The task began with 66-year-old G.L, male who entered the recovery room at 10:35 am from his haemorrhoidectomy. After, Mr. G. L we had several other patients who came to the recovery room from operating theatre, which all the patient underwent different procedures, from D&C to Laparotomy just to name a few. Although the nurses and ward manager stated that we choose a slow day to do our clinical rotations, we made the best of our days. The patient was G.L. 66-year-old male who was diagnosed with Prolapse Hemorrhoid.
Tetanus: acute infectious disease of the central nervous system caused by the toxins of Clostridium Tetani.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
This piece of work will be based on the pre-assessment process that patients go through on arrival to an endoscopy unit in which I was placed in during my second year studying Adult diploma Nursing. I will explore one patient’s holistic needs, identifying the priorities of care that the patient requires; I will then highlight a particular priority and give a rational behind this. During an admission I completed under the supervision of my mentor I was pre-assessing a 37 year old lady who had arrived to the unit for an upper gastrointestinal endoscopy. During the pre-assessment it was important that a holistic assessment is performed as every patient is an individual with unique care needs as the patient outline in this piece of work has learning disabilities it was imperative to identify any barriers with communication (Nursing standards 2006).
ANA describes “The Scope of Nursing Practice (as) the “who,” “what,” “where,” “when,” “why,” and “how’ (8).’ In other words, it is the responsibility of the nurse to know who their patient is, what the patient’s diagnosis and treatment are, where it is they will be delivering treatment, the rationale behind their actions, and how they will deliver the care. By following the scope of practice, nurses reduce avoidable errors and are aware of the liability their actions entail. The ANA also puts forth a nursing process to guide nurses in treatment. The constantly evolving process is currently assessment, diagnosis, identification of outcomes, planning, implementation, and evaluation (ANA 9). Though this method has dramatically improved nursing care, it may be necessary to repeat steps to adapt to a patient’s changing needs and pathologies. By following guidelines set by the ANA, nurses are able to better connect with their patients and instill the image of professionalism to the public while also optimizing safety
The nurse should educate the patient of the importance of pain control and how controlling pain is essential to a patient’s wellbeing and recovery. It needs to be a balance of what the patient says and what the nurse observes and interprets while always respecting the wishes of the patient. Nurses have a variety of assessment tools available to assess pain in their patients. One dimensional pain scales such as visual analog scale, verbal descriptor scale, numeric pain intensity scale and the combined thermometer scale all measure the intensity of the pain (Jensen, 2011). Other pain scales such as McGill pain questionnaire, brief pain inventory, and brief pain impact questionnaire take into account aspects beyond intensity (Jensen 2011). There are additional pain assessments specialized for children, older adults, patients who are unable to respond, and patients with opioid tolerance (Jensen, 2011). The nurse should be familiar with these methods of pain assessment and know the appropriate use of each. Incorrect medication and treatment choices due to inaccurate or poor pain assessment cause patient suffering (Jensen,
A medical ward round is, according to the Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) guidelines “a complex clinical process during which the clinical care of hospital inpatients is reviewed” . Unfortunately, the importance of ward rounds for achieving good medical care is often underestimated by healthcare professionals . While their real life application varies from one clinical setting to another, ward rounds have several important purposes. These include aspects that directly influence the patient’s medical care, such as establishing or reassessing the patient’s diagnosis, creating a management plan, and arranging for their discharge, while communicating this to the patient in appropriate terms. The ward round should also function as a point where the multidisciplinary team (MDT) responsible for the patient can communicate and coordinate their efforts towards holistic treatment.