Clostridium difficile infection
Terms in this set (20)
A gram-positive anaerobic, spore-forming bacillus often resulting in antibiotic-related diarrhea
Symptoms ranging from asymptomatic carrier states to severe pseudomembranous colitis caused by exotoxins (toxin A is an enterotoxin and toxin B is a cytotoxin)
Within 14 to 30 days of treatment, recurrence with the same organism possible in 10% to 20% of patients
The organism thrives in the colon; infection occurs when normal flora are disrupted and the organism is ingested.
Antibiotics may trigger toxin production.
Toxin A mediates alteration in fluid secretion, enhances inflammation, and causes leakage of albumin from the postcapillary venules.
Toxin B causes damage and exfoliation to the superficial epithelial cells and inhibits adenosine diphosphate ribosylation of Rho proteins.
Both toxins cause electrophysiologic alterations of colonic tissue.
Age older than 60
Antibiotics that disrupt the bowel flora
Gastric acid suppression
Contact with an infected person
Antineoplastic agents that have an antibiotic activity
C. difficile infection is most common in people who are hospitalized or in long-term care facilities.
It's one of the most common nosocomial infections.
It is more common in the elderly population.
Recent antibiotic therapy or hospitalization
Fever (severe cases)
Nausea and vomiting
Soft, unformed, or watery diarrhea (more than three stools in a 24-hour period) that may be foul smelling or grossly bloody
Abdominal tenderness, possible rebound tenderness
Diagnostic Test Results-Laboratory
Cell cytotoxin test may show toxins A and B.
Enzyme immunoassay may identify C. difficile; slightly less sensitive than cell cytotoxin test but has turnaround time of only a few hours.
Stool culture may identify C. difficile.
White blood cell count may reveal leukocytosis.
Serum albumin levels may be decreased with severe disease.
Serum electrolyte levels are altered with severe disease.
Diagnostic Test Results-Diagnostic procedures
Endoscopy may reveal raised, yellowish or white plaques on a reddened base and swollen mucosa.
Withdrawal of causative antibiotic
Good skin care
Increased fluid intake, if appropriate
Rest periods during acute phase
Probiotics (oral lactobacilli or saccharomyces)
Metronidazole, orally or I.V. as a first-line agent
Vancomycin as first-line agent for severe disease
If relapse and previous treatment was metronidazole, low-dose vancomycin may be effective
Nursing Considerations-Nursing Diagnoses
Imbalanced nutrition: Less than body requirements
Impaired skin integrity
Risk for deficient fluid volume
Nursing Considerations-Expected Outcomes
perform activities of daily living without excess fatigue or exhaustion
express feelings of comfort and report absence of pain
report a decrease in the number and frequency of stools
report an increased energy level
maintain normal electrolyte levels
demonstrate intact skin without signs and symptoms of irritation or breakdown
maintain adequate fluid volume.
Nursing Considerations-Nursing Interventions
Give prescribed drugs, such as metronidazole orally or I.V.; if the I.V. route is necessary, ensure patent I.V. access.
Admininster I.V. metronidazole over at least 1 hour; do not give by I.V. push.
Institute contact precautions for the duration of the patient's illness.
Wash your hands with an antiseptic soap after direct contact with the patient or his immediate environment.
Make sure reusable equipment is disinfected before it's used on another patient.
Provide meticulous skin care to the perianal area if the patient is experiencing profuse diarrhea.
Assess stool pattern including frequency, amount, and characteristics
Encourage fluid intake as indicated. Anticipate the need for I.V. fluid replacement. Check skin turgor and inspect mucous membranes for moisture.
Assess abdomen for distention and tenderness; auscultate bowel sounds for changes.
Cluster nursing activities to promote rest periods; encourage the use of energy conservation measures. Assist the patient with gradual increase in activity level as the patient's condition improves.
Obtain specimens for laboratory testing such as electrolytes as ordered.
Intake and output
Adverse effects of medication
Response to treatment
Amount and characteristics of stools
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
Fecal occult blood tests
Hyperthermia-hypothermia blanket use
IV bag preparation
IV bolus injection
IV catheter insertion
Intake and output assessment
Pressure ulcer prevention
Stool specimen collection, random
disorder, diagnosis, possible causes, and treatment, including medications
prescribed medications, including drugs, dosages, schedule of administration, duration of therapy (10 to 14 days), and possible adverse reactions, including those that need to be reported immediately
need to avoid the intake of alcohol, including over-the-counter medications such as cough syrups that may contain alcohol, while taking metronidazole and for 3 days after completing the course of therapy
proper hand-washing technique
proper disinfection of contaminated clothing or household items
importance of adequate fluid intake
signs and symptoms of dehydration
possible complications, including signs and symptoms of relapse and any that the patient should report to a practitioner immediately
measures for perianal skin care.
importance of adhering to follow up to ensure complete resolution of the disease.