develop a care plan for a patient that has a Clostridium difficile Colitis. Plea

Question

develop a care plan for a patient that has a Clostridium difficile Colitis. Please use the provided format for building your care plan. You will need to use your nursing reference materials as you build this care plan.

Mindy Perkins is a 48 year old woman who presents to the ED with 10-15 loose, liquid stools daily for the past 2 days. She completed a course of oral Amoxacillin seven days ago for a dental infection. In addition to loose stools, she complains of lower abd. pain that began 2 days ago as well. 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 Pantaprazole (Protonix) for severe GERD. Past Medical History: ? Crohn’s disease ? GERD Your Initial VS: 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 Your Initial Nursing Assessment: 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, abd. soft/tender to palpation in lower abd-no rebound tenderness or guarding MISC: Lips dry, oral mucosa tacky with no shiny saliva present in 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 medical unit Lab/diagnostic Results:

Explanation / Answer

CARE PLAN: Clostridium difficile colitis
Name of the patient: Ms. Mindy Perkins
?Age; 48years/female
?Present complaint: Loose liquid stools- 10 to 15 times daily for past 2 days..
Vomiting and chills
Past Medical History: Dental infection seven days ago and completed Amoxacillin oral
? On prednisone for crohn's disease and pantaprazole for severe GERD
Vital signs:
Temperature: 100.2(oral)
Pulse: 92
Respiration: 20
Blood presssure: 122/78
Oxygen sat: 98%
RA ortho BP's by lying: 122/78 ,Heart rate: 92
Standing: 120/70, Heart rate 114
?Initial nursing assessment:
General appearence: WEak and uncomfortable,fatigued
Respiration: Breath sounds clear with equal aeration bilateral,non-labored
?Cardiac: Pink,warm and dry,s1,s2,no edema,pulses 3+ in all extremities.
Neuro: alert and orientedx 4
?GI/GU: Active bowel sound in all quads,abdomen soft/tender to palpation in lower abdomen- no rebound tenderness or guarding
?Misc: Lips dry,oral mucosa tacky with no shiny saliva present in mouth
Nursing interventions;
   - Assess patient weight on admission.
   - check vital signs every 4 hourly
   -check the patient dehydration level and replace the fluid orally or via IV as per physician advise.
? - Assess perianal and give perianal care
? - Instruct the patient and family about proper hand wash technique.
- Follow standard precautions to prevent infection and contamination
Orthostatic BP's(ED standing order): Orthostatic hypotension
?PIV(ED standing order)
?Initiate enteric precaution
Physician orders:
?    0.9% NS 1000ml IV bolus
? Hydromorphone 1mg IVP
Stool culture for c.difficile:
?BMP,CBC
?Treatment:
   Vancomycin 250mg per oral
1000mg/20ml
1ml=15drops
20ml=300drops/min
300drops/60sec=5drops/sec
Lab results:
?Stool culture: positive c.difficile toxins
?BMP: sodium-132,potassium-3.5,creatinine- 1.45, BUN- 47, Co2-18
?CBC: WBC-12.6,HGB-14.5, PLTS- 188,NEUTS: 86%,LYMPHS-10%..

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