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:

Answer 1

Nursing Diagnosis	Assessment	Goal/Outcome	Nursing intervention and rationale	Evaluation
Impaired bowel pattern related to infection as secondary to Chron's disease as evidenced by loose stools Deficient fluid volume related to infection as evidenced by increased bowel movements	Subjective data Passing loose stools since last two days Objective data Diarrhea Increased peristalsis Dry lips and mucosa	To maintain normal fluid balance To maintain normal bowel patterns	Assess the bowel pattern to plan for care Administer antidiarrheal drugs to stop gastric motility Administer IVF to prevent fluid loss Assess the patient's sr.electrolyte level,there alteration occurs when there is continuous fluid loss Monitor vital signs ,to plan for care	The patient has a normal fluid balance Reduced gastric motility
Acute pain (abdomen) related to inflammation of the colon secondary to GERD	Subjective data Lower abdominal pain Objective data Tenderness in lower abdomen	To relieve pain	Assess the level of pain to plan for care Administer proton pump inhibitors to relieve discomfort Provide soft and bland diet to reduce gastric irritation Assess for any signs of bleeding	The patient is relieved from pain
Impaired thermoregulation related to infection as evidenced by elevated body temperature	Subjective data Weak Objective data T.100.2	To maintain normal body temperature	Monitor vital signs ,baseline data to plan for care Administer antipyretics to reduce temperature Provide tapid sponge to reduce body heat Provide good ventilation	The patient has a normal body temperature