E. Coli Infection

E. Coli Infection 3 Nursing Care Plans Diagnosis and Interventions

E. Coli Infection NCLEX Review Care Plans

Nursing Study Guide on Escherichia coli (E. Coli) Infection

Escherichia coli are a naturally occurring anaerobic bacteria found in the large intestine. They are normal flora in the colon that aid in the breakdown and digestion of food and nutrients. However, entry of the E. coli bacteria to other parts of the body may cause various intestinal symptoms and sometimes urinary tract infections.

This occurs by way of vehicles, or inanimate materials that may carry infectious agents. Common examples of vehicles of E. coli are food and water.

Nursing Stat Facts

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Nursing Stat Facts

The majority of individuals infected with E. coli start to develop symptoms three to five days after ingestion of the contaminated food/fluid. The illness is usually self-limiting, which means it does not require medications and only need supportive therapy.

The infection usually resolves within a week after the onset of symptoms. Severe infections, however, may require hospitalization as it may cause complications that can be fatal to the infected individual.

Signs and Symptoms of E. coli Infection

Symptoms of E. coli infection usually appear three to four days after exposure to the bacteria.

Types of E. coli based on Strains

  1. Shiga-toxin-producing E. coli (STEC). The shiga-toxin-producing E. coli is a collection of organisms with high virulence. These organisms produce what is called shiga toxins, which are responsible for systemic symptoms that occur in infected individuals. STEC’s can also destroy enteric cells in a process called effacement. This results in gut damage and lesions, leading to the characteristic bloody diarrhea.
  2. Enterotoxigenic E. coli (ETEC). The enterotoxigenic E. coli is a self-limiting strain. Infection by this strain of E. coli is characterized by watery diarrhea, nausea, vomiting, and low-grade fever episodes. While it is fatal for infants, it is treated only with hydration.
  3. Enteroinvasive E. coli (EIEC). Enteroinvasive E. coli is the causative agent of bacillary dysentery and is commonly confused with Shigella dysentery. This strain invades the colon’s mucosa and causes widespread destruction. This results in the presence of blood and mucus in the stool. Fever episodes are also characteristic of this strain. There is no specific treatment for this strain, only hydration therapy.
  4. Enteropathogenic E. coli (EPEC). This is a self-limiting disease characterized by profuse, watery diarrhea, fever, and vomiting. This strain is like the STEC strain as it causes effacement of the gut’s surface but does not produce a shiga toxin. This is treated with rehydration.
  5. Enteroaggregative E. coli (EAEC). This strain of E. coli is opportunistic and targets immunocompromised individuals such as young children, malnourished persons, and AIDS patients. It causes chronic diarrhea by stimulating mucus secretion in the gut.
  6. Diffusely adherent E. coli (DAEC). This strain is associated with urinary tract infections and acute diarrhea.

Causes and Risk Factors of E. coli Infection

Different strains of E. coli exist, many of which are particularly harmless. Transmission of this infection occurs via the fecal-oral route. Ingestion of products that are contaminated with feces, such as raw fruits and vegetables, undercooked meat, and unpasteurized fluids, can cause this infection.

The risk factors of E. coli infection include:

  • Age – Young children and older adults have a higher risk of contracting E. coli-related illnesses. Likewise, complications are more severe for this population.
  • Compromised immune system – People who are immunocompromised, such as cancer patients, AIDS patients, and patients undergoing immunosuppressive therapy are more likely to become ill from E. coli ingestion.
  • Diet – Foods that increase the risk of contracting this type of infection include undercooked meat, raw fruits and vegetables, and unpasteurized products.
  • Hygiene – Cross-contamination often occurs as a result of poor hygiene practices such as inefficient hand hygiene, and the use of contaminated water.

Diagnosis of E. coli Infection

  • Stool culture -This tests a sample of stool and determines the bacteria present.
  • Enzyme-linked immunosorbent assay (ELISA) – This is a blood test that is used to identify the presence of antibodies produced against certain infectious conditions.
  • Polymerase chain reaction (PCR) – This test is used to detect genetic material for specific organisms.

Complications of E. coli Infection

This diarrheal disease, if left untreated, may cause a variety of complications.

  1. Dehydration. Simple diarrhea may cause dehydration, fluid and electrolyte imbalances, blood clotting, and low blood pressure.
  2. Hemolytic anemia. A small percentage of patients develop what is called hemolytic uremic syndrome or HUS, a severe hemolytic anemia that may result in damage and eventual failure of the kidneys. In this complication, the STEC toxins travel to the bloodstream and destroy red blood cells and damage the kidneys. Manifestations include pale skin, easy bruising, light-headedness, decreased urination, and bloody urine.
  3. Other complications include septic shock, blindness, seizures, and stroke. These serious complications mostly occur in young children and older adults.

Treatment for E. coli Infection

  1. Supportive treatment. This involves:
    • Fluid replacement to prevent dehydration and fluid and electrolyte imbalance.
    • Rest to minimize fatigue and promote recuperation.
    • Dietary choices to avoid making diarrheal symptoms worse.
      • Drink clear liquids, including water, gelatin, and juices.
      • Choose bland, low-fiber foods such as toast and plain crackers.
      • Avoid caffeine, alcoholic beverages, dairy products, fatty and high-fiber foods, and seasoned foods.
    • Blood transfusions dilute the toxins in the patient’s blood.
  2. Medications. Several medications are used to manage E.coli infection. These include:
    1. Antibiotics are usually not given for this type of infection as it increases the risk of developing HUS or hemolytic uremic syndrome.
    2. Antimotility agents are also not given as this medication slows down the motility of the gastrointestinal tract, thereby prolonging the presence of E. coli and preventing it from being expelled from the body.
  3. Hygiene Practices
    • Efficient hand hygiene to minimize cross-infection.
    • Proper food preparation (cooking and washing) to prevent ingestion of contaminated food and water.
      • Rinse raw fruits and vegetables using cold water before eating them.
      • Cook meat well as heat is able to destroy the bacteria.
      • Boil tap water before drinking.

Nursing Care Plans for E. coli Infection

Nursing Care Plan 1

Nursing Diagnosis: Diarrhea related to infectious process secondary to E. coli Infection as evidenced by watery stools

Desired Outcome: The patient will have formed stools and negative stool cultures.

InterventionRationale
Assess the characteristics and frequency of stools and document in the patient’s stool chart. Also, assess the daily weight, input and output of the patient.To monitor the episodes of diarrhea and signs of dehydration.
Administer the prescribed antibiotics. Avoid antimotility agents.Antibiotics are the traditional choice of treatment for E. coli infections. The antibiotics and could be given for a course of 5 to 10 days.
Antimotility agents are also not given as this medication slows down the motility of the gastrointestinal tract, thereby prolonging the presence of E. coli and preventing it from being expelled from the body.  
Refer to the dietitian service. Encourage bulk fiber and probiotics as recommended by the dietitian.Dietary fibers and bulking agents tend to absorb fluid from the stool, thus thickening it.

Nursing Care Plan 2

Nursing Diagnosis: Deficient fluid volume related to active fluid volume loss as evidenced by frequent loose stools

Desired Outcome: Patient will have adequate hydration as evidenced by capillary return of less than two seconds and good skin turgor.

InterventionsRationales
Assess the characteristics and frequency of stools and document in the patient’s stool chart. Also, assess the daily weight, input and output of the patient.To monitor the episodes of diarrhea and signs of dehydration.
Encourage the patient to increase oral fluid intake, drinking about 1.5 to 2 liters per day, unless contraindicated. Administer IV fluids as prescribed.To promote adequate hydration.
Monitor serum electrolytes and administer electrolyte replacement therapy (orally or intravenously) as prescribed by the doctor.To replace the electrolytes and achieve body homeostasis.

Nursing Care Plan 3

Nursing Diagnosis: Hyperthermia related to E.coli infection as evidenced by temperature of 38.0 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

 Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

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 intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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