Rapid Reasoning: Clostridium difficile Colitis
Chief Complaint/History of Present Illness:
Mindy Perkins is a 48-year-old woman who presents to the ED with 10-15 loose, liquid stools daily for the past two days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition to loose stools, she complains of lower abdominal pain that began two days prior. She has not noted any blood in the stool. She denies vomiting or fever/chills. She is on Prednisone for Crohn’s disease as well as Pantoprazole (Protonix) for severe GERD.
© 2012 Keith Rischer/www.KeithRN.com
Past Medical History:
· Crohn’s disease
· GERD
Your Initial VS:
WILDA Pain Scale (5th VS)
Words:
Crampy
Intensity:
7/10
Location:
Generalized throughout RLQ-LLQ
Duration:
Persistent since onset 2 days ago
Aggravate:
Alleviate:
None
Your Initial Nursing Assessment:
T: 100.2 (o)
P: 92
R: 20
BP: 122/78
O2 sats: 98% RA
Ortho BP’s: Lying: 122/78 HR: 92
Standing: 120/70 HR: 114
GENERAL APPEARANCE: appears weak and uncomfortable. Easily fatigued RESP: breath sounds clear with equal aeration bilat., non-labored
CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremities NEURO: alert & oriented x4
GI/GU: active BS in all quads, abdominal soft/tender to palpation in lower abdomen-no rebound tenderness or guarding
MISC: Lips dry, oral mucosa tacky with no shiny saliva present in the mouth
Nursing Interventions:
· Orthostatic BP’s (ED standing order)
· Establish PIV (ED standing order)
· Initiate enteric precautions (ED standing order)
Physician Orders:
· 0.9% NS 1000 mL IV bolus
· Hydromorphone (Dilaudid) 1 mg IVP
· Stool culture for C. difficile
· BMP, CBC
· Vancomycin 250 mg PO
o 1000 mg/20 mL…determine dosage to administer
· Admit to the medical unit
Lab/diagnostic Results:
· Stool culture for C. difficile: Positive
BMP
Current
High/Low
Sodium
132
Potassium
3.5
Creatinine
1.45
BUN
47
CO2
18
CBC
Current
High/Low
WBC
12.6
HGB
14.5
PLTS
188
Neuts. %
86
Lymphs %
10
1. What data from the chief complaint, VS & nursing assessment is RELEVANT that must be recognized as clinically significant to the nurse?
| RELEVANT data: Chief complaint:
VS/assessment: |
Rationale: |
2. What lab/diagnostic results are RELEVANT that must be recognized as clinically significant to the nurse?
| RELEVANT Diagnostic results: | Rationale: |
3. What is the most likely primary problem for this patient?
4. What is the underlying cause /pathophysiology of the primary problem?
5. What nursing priority will guide your plan of care?
6. What interventions will you initiate based on this priority?
| Nursing Interventions
1.
2.
3.
4. |
Rationale:
1.
2.
3.
4. |
Expected Outcome:
1.
2.
3.
4. |
7. What is the relationship between the following nursing interventions/physician orders and your patient’s primary medical problem?
| Nsg. Interventions/MD orders:
Orthostatic BP’s (ED standing order)
Establish PIV (ED standing order)
Initiate enteric precautions (ED standing order)
0.9% NS 1000 mL IV bolus
Hydromorphone (Dilaudid) 1 mg IVP
Stool culture for C. difficile BMP CBC Vancomycin 250 mg PO Admit to the medical unit |
Rat |
