Question

In: Nursing

The patient, Suzanne Morris, is a 43-year-old white female presenting with complaints of increasing abdominal cramps,...

The patient, Suzanne Morris, is a 43-year-old white female presenting with complaints of increasing abdominal cramps, stomach ache, and diarrhea that started 4 days ago. Ms. Morris arrived by private vehicle and has been here for 1 hour.

Ms. Morris was diagnosed 10 days ago with peptic ulcer disease and prescribed triple combination therapy of amoxicillin, clarithromycin, and pantoprazole for H. pylori. She has been consistently taking the medications. Ms. Morris does not have any other significant previous medical or surgical history.

Ms. Morris is awake and alert but complains of cramping, stomachache, and diarrhea. Her last set of vital signs was: BP: 101/61 mmHg, HR: 114/min, RR: 17/min, and SpO2 at 95% on room air. I started a 20-gauge IV in her right arm and gave her a 500 mL normal saline bolus at arrival per provider’s orders as her systolic blood pressure was less than 100 mmHg. Normal saline is now running at 100 mL/hr. I have also taken a blood sample and a stool sample to confirm suspected C. difficile infection. It has been sent to the lab.

The provider put orders in the patient’s chart based on the initial assessments. The patient is due for vital signs and other assessments that you will need to implement. You should keep an eye on her blood pressure and call the provider if her systolic pressure drops to less than 100 mmHg. Also, be aware that she is on contact precautions

What medication treatment would you recommend for the treatment of CDIFF?

The bolus to increase her BP is not working. What medications do you suggest to the Dr to increase her blood pressure?

Expert Solution

CDIFF also called as Clostridioides difficile is a bacterium that can cause symptoms ranging from diarrhoea to life threatening inflammation of the colon.
Mostly affect older adults.
Treatment:

Vancomycin or Fidaxomicin or metronidazole

For mild / miderate disease

Oral metronidazole (500mg) -30 tabs

1 tab ×3times / day for 10 days

Patient for whom oral treatment is inappropriate:

Fidaxomicin is used

Patient with severe CDIFF

Vancomycin (125mg) -40 tab

1 tab × 4 times/ day for 10 days

May be increased to 50 mg QID

Or

Fidaxomicin (200mg) - 20tabs

1 tab×2times/day for 10 days

To increase Blood pressure:

Fludrocortisone :

Steroid drug
Belong to class of corticosteroid
Helps in retaining enough salt to function well
0.1 mg orally per day

Maintenance dose 0.1 mg orally 3 times a week to 0.2 mg orally per day.

2. Midodrine:

Vasopressors or antihypotensive drug
Given as 10mg 3 times a day during day time hours when the patient need to be upright.

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