Nursing care

As a nurse it is important to put the patient on contact isolation and teach the patient, family, and visitors about the importance of hand hygiene. Prevention is the best medicine, but if your patient has C. diff, he/she is t greater risk of getting a second round of C. Diff.

Here is a video approved by W.H.O. about how to properly wash your hands. 

CDC has published a report setting up clinical guidelines for the management of C. diff. While not nursing specific here are some of the key points that related to nursing

1. Testing is done on diarrheal stool
2. Infection management: 
• Appropriate hand hygiene for healthcare workers and visitors
• Contact precautions while awaiting for results and continued if C. diff positive
• Appropriate cleaning of supplies -- Bleach must be used
3. Minimize antibiotic use
4. Do not use probiotics

Here is the link for the full report

Here is the right contact isolation sigh for patients with C. Diff: 

Nursing Diagnosis

This week I will be talking about nursing diagnosis. Here are some of 5 nursing diagnosis I think are the most important and relevant:

1. Diarrhea related to side effects of antibiotics & c. diff infection
2. Acute pain related to inflammation and abdominal cramping
3. Deficient fluid volume related to excessive losses through normal routes (this can be evidenced by frequency of artery stools) 
4. Imbalanced nutrition due to insufficient intake and excessive output
5. Risk for secondary infection related to broad antibiotic medicatio

In an acute setting the priorities of the nurse would be to manage the pain and excessive diarrhea and the side effects of the diarrhea (poor nutrition and fluid deficits) while preventing further or second infection of the C. diff.  Fluid management can be maintained through I.V. fluids, while appropriate nutrition can be managed through high caloric food options, such as Ensure. Pain can be managed through I.V. meds (meds by mouth may not be absorbed in the intestines). Also consider non-pharmaceutical options such as warm compress on the abdomen or positional changes.

Here I elaborate on the the third nursing diagnosis:

Deficient Fluid Volume

Rapid propulsion of intestinal contents through the small bowels may lead to a serious fluid volume deficit. The body would want to expel the foreign objective as much as possible thus it doesn’t undergo its “normal” speed, with that, the digestive system organs are not able to absorb the excess fluids that are usually absorbed by the body.

Assessment

Patient may manifest

• passage of loose watery stool
• vomiting
• abdominal cramping
• dehydration
• nausea
• fatigue
• weakness
• nervousness
• confusion
• weight loss
• decreased skin turgor
• decreased urine output
• dry mucous membrane
• fever

Outcomes

• Patient will report understanding of causative factors for fluid volume deficit
• Patient will maintain fluid volume at functional level AEB well hydrated, intake is equal as output, and normal skin turgor.

Nursing Interventions	Rationale
Maintain adequate hydration, increase fluid intake.	To prevent dehydration & maintain hydration status.
Provide frequent oral care	To prevent from dryness
Administer Intravenous fluids as prescribed	To deliver fluids accurately and at desired rates.
Determine effects of age.	Very young and extremely elderly individuals are quickly affected by fluid volume deficit
Restrict solid food intake, as indicated	To allow for bowel rest and to reduced intestinal workload.
Discuss individual risk factors/ potential problems and specific interventions	To prevent or limit occurrence of fluid deficit.

The nursing diagnoses information can be found for more information here