Clostridium difficile aka C. diff Nursing Care Plan

C. Diff nursing care plan

Clostridium difficile aka C. diff Nursing Care Plan

Clostridium difficile (C.diff) is starting to become more and more common in the healthcare facilities. This bacterium causes symptoms that range from diarrhea to life threatening inflammation of the colon.

Older patients that are admitted into long term or acute care facilities usually become ill with C.diff. C.diff usually occurs after the use of antibiotic therapy. In recent studies, there seems to be an increase of C.diff in persons not usually considered high risk, examples include younger and healthier people without any current antibiotic use or recent hospitalizations.

Signs and Symptoms

While some patients have the C. diff bacterium in their colon, they may never become ill. That being said they can still spread the illness to others. It is important to note that C. diff will usually develop within a few months of taking antibiotics.

Mild to moderate C. Diff infection will consist of abdominal cramping, tenderness and watery stools for 2 or more days.

Severe C. diff infection is when the bacterium causes colitis (colon becomes inflamed), this may form areas of raw tissue that can produce pus (pseudo membranous colitis) or bleed. The following may be seen with severe infection:

  • Pus or blood in stool
  • watery stool 10-15 times per day
  • dehydration requiring hospitalization
  • fever
  • abdominal pain
  • cramping
  • loss of appetite
  • weight loss
  • renal failure
  • CBC show increased white count

Click here for our full article on C. Diff

Nursing Diagnosis

1. Deficient Fluid Volume related to active fluid volume loss AEB frequent loose stools

Desired outcomes:

With 4 hours of intervention, patient will exhibit adequate hydration by exhibiting good skin turgor, capillary refill less than 2 seconds.

InterventionsRationals
InterventionsRationals
Assess weight on admission and daily on the same scale at the same time. Notify physician for abnormal weight lossUtilizing same scale at the same time of day gives more accurate results. Weight is a beneficial factor in assessing fluid balance.
Measure vital signs q 4 hours, or more often if outside of normal parameters for the patient.HR is usually elevated in loss of fluid from the body. Sign of dehydration must be monitored carefully as the patient can go into shock.
Replace fluid orally or via IV as ordered by physicianThis will endure that the patient is staying hydrated and will also help the body maintain homeostasis.

2. Risk for impaired skin integrity related to moisture AEB loose liquid stools

Desired outcomes:

The patients skin will remain intact throughout hospital stay.

InterventionsRationals
InterventionsRationals
Assess perianal and perineal area q 4 hours or more often for signs and symptoms of irritation. The sooner the stool is detected, the sooner that pericare can be done to help maintain the skin integrity.
When cleansing sacrum, gently pat (do not rub) with warm water. Avoid the use of soap if possible.Watery stools are extremely irritating to the skin. Rubbing the skin will irritate the area even more. Soap tends to dry out the skin and removes moisturizing skin oils increasing the chances of skin breakdown.
Unless contraindicated, apply protective skin ointments after pericare.This will protect the skin from further irritation.

3. Risk for Infection related to Clostridium difficile and lack of knowledge about prevention and transmission.

Desired outcomes:

Following intervention family members are free from indicators of C. Diff.

InterventionsRationals
InterventionsRationals
Instruct patient and family members on proper hand washing techniqueThis is the best defense against spreading and contracting infection.
Implement standard precautions and transmission based precautions as indicted for infection control.Standard precautions will decrease the risk on spreading infection. Wear other personal protective equipment as maintained in current infection control guidlines.
Use alcohol based cleaners for cleaning tables, bed rails, sinks, toilets, etc.Clostridium Difficile spores can survive for weeks or months on surfaces. Alcohol based cleaners are effective again these spores.

Disclaimer:

Please follow your facilities infection control guidelines. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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