ICU: A Case Study

A.C. is a 79-year-old man living in a long-term care facility. He has had multiple medical diagnoses, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and stroke. He is bedridden and receiving enteral tube feedings. He has chronic diarrhea thought to be related to his tube feedings. He receives digoxin (Lanoxin) and furosemide (Lasix) to manage his CHF.

The primary problem is the patient is having severe dehydration due to excessively having loose liquidly stools for the past two days caused by C. Diff.

Clostridium difficile infection is a suprainfection cause by prolong use of antibiotics. Board spectrum antibiotic such as Penicillins, clindamycin, and cephalosporins are the antimicrobial drugs most commonly associated with C difficile colitis. According to Owens, in his research, C. difficile is primarily acquired in hospitals. Spread by spores, it can colonize a patient’s gut after helpful gut bacteria are killed by antibiotics. Its toxins can cause severe diarrhea and colitis, and it can be fatal (Owens 2013). On the other hand Kim in his research agreed clostridium difficile infection has been considered a hospital-acquired infection. However, a recent population-based study found 41% of CDIs were actually community acquired. It is becoming apparent that community acquired CDI affects populations previously thought to be at low risk; younger patients and patients who had no exposure to antibiotics in the 12 weeks before the infection. Thus, it is necessary to advocate and teach patient about

Also, I see that the SAE (Acute Upper Gastrointestinal Hemorrhage) that caused this hospitalization on was reported on 13Apr2017, but the event occurred 05Mar2017 to 14Mar2017 were you aware of this hospitalization prior to the patients week 24 visit on 12Apr2017, as SAEs need to be

While stewardship is extremely important to slow the rate of resistance, we must also make sure that patients in need of antimicrobial therapy receive the treatment they need. Price of medication and overly cautious prescribers are two of many barriers that patients may experience; as clinicians it’s important that we do our part to promote appropriate and affordable treatments. Ideally, prescribers could determine the exact pathogen using a swab or culture of the infected tissue. This would prevent misdiagnoses and reduce unnecessary costs to the

Group-A (Surgery group) consisted of 894 patients. Out of those only 45 (0.05%) had documented C. difficile infections. Furthermore, this subset of patients was broken down further to 7 (0.16%) having C. difficile infection upon their admission, 5 (0.11) who underwent emergent surgery and were excluded from the study. 18 (0.4%) other patients also underwent a subtotal colectomy for fulminant colitis and were also exluded. Of the remaining 3 patients, 2 (0.04%) had small bowel obstruction and 1 (0.02%) was treated with antibiotics days to weeks prior to admission, and so these patients were also excluded. This left us with 12 (27%) patients who actually qualified for our study. This group was broken down to 9 (0.2%) patients who were diagnosed with C difficile infection past the 30-day grace period, and 3 (0.07%) patients that were diagnosed within the 30-day grace period. This data suggests that out of the 861 patients examined, only 12 (0.01%) were diagnosed with C. difficile infection

difficile based on the presentation and assessment findings of watery, loose stools, and the presence of nausea and vomiting. The nurse should prepare to administer certain medications including an antibiotic such as imipenem, cefepime or ertapenem, if the patient has ESBL (Munoz-Price & Jacoby, 2015). It is important to note that if the patient does have ESBL, cephalosporins should not be used (Munoz-Price & Jacoby, 2015). If the patient has VRE the most common antibiotic that will be used is linezolid, daptomycin, oritavancin, tigecycline, teicoplanin, and many others (Murray, 2014). In the case of a patient with VRE it is also common for a combination of many different drugs to be used in order to cover the range of the illness (Murray, 2014). The nurse should also prepare to put the patient in contact isolation precautions. In any case, either of these diseases would result in the transmission being via contact and not an airborne disease (Anderson, 2014). The patient will be put in contact isolation precautions because they are at risk of transmitting their disease via the loose stools, as well as via any other bodily fluid that may be released from the body (Anderson, 2014). If the patient has C. difficile, they should receive vancomycin or metronidazole in order to treat their infection (Kelly & Lamont, 2015). The nurse should have a plan of care including isolation precautions, monitoring vital signs, and

The study subjects were gathered from various ICU centers at various institutions, which is appropriate for study given the study objective and what the study was aiming to examine and determine (using a study drug vs. placebo in an ICU environment). Inclusion criteria were appropriate to assess the effects of the anti-pyretic acetaminophen due to their specificity of including those patients who were febrile with an infection that had been initiated with antimicrobial therapy. The exclusion criteria was extensive and included patient characteristics and disease states that may have skewed the true effect of acetaminophen. It was appropriate to limit these patients with the exclusion criteria from receiving treatment since their comorbidities

Symptoms of CDI may start while the patient is on antibiotic therapy or 5 to 10 days after stopping the antibiotics; infrequently, as late as 10 weeks later. The median incubation period from C difficile acquisition to CDI to be < 7 days. CDI presents as a mild to moderate diarrhea accompanied by lower abdominal pain, and fever. This presentation is often resolved by discontinuing the responsible antibiotics. On the other hand, CDI can produces very severe colitis with or without pseudo-membrane production. This presentation is often associated with low to high-grade fever, abdominal pain and distention. Approximately 3 % of CDI cases present with acute and fulminant colitis with toxic megacolon. In addition, patients with severe disease may develop ileus and present with abdominal distention without diarrhea that may put patients at high risk of colon

Diagnostic studies such as, endoscopy, CT scan, abdominal ultrasound, lack intolerance, celiac disease and blood test to rule other symptom cause. Patient can be test for food allergy, bacteria and parasite. Surgery for obstruction and video assist endoscopy. Treatment is individualizes, fibers, antidiarrheal, antispasmodic (reduce muscle) anti-constipation (regulate bowel) sedative and antidepressant (relief anxiety and mood swing) can be used for both IBS and IBD. Similar treatment used in UC can be used in CD to make a differential diagnosis. Stool culture check for infection. Mesalamine products (5-aminosalicylic acid) is treatment of choice. Corticosteroids and immunosuppression to reduce inflammatory process. Severe disorder requires resting and placing the patient on TPN (malnutrition). Surgery if necessary in severe cases of total proctocolectomy, with end ileostomy, ileorectal anastomosis or ileal pouch anal anastomosis for obstruction, hemorrhage and perforation.

The use of antibiotics had discontinued due to adverse effects that presented in the patient, such as abdominal cramping, nausea, increase temperature, or rash. The results of the study concluded that when patients received a systemic antibiotic, S. Boulardii did not prevent ADD within the adult, hospitalized population. The experiential group and the intervention group were treated equally. The trial medication or a matching placebo was administered twice daily. Each group would start in phase one, and would receive the dose concurrently with the antibiotic. The duration of administration of the trial drug varied. When the antibiotic was discontinued, phase two of the study commenced and the drug as given for an additional seven days. If an antibiotic was reinitiated, then phase one would be restarted. After phase two ended, the participants in each group where monitored for a total of six weeks. The consistency of stool was documented by the participant in the study and then the data was gathered each week by the researchers. This lead to complications within the study since it was found that the participants were not consistent on how they kept the records of their stool amount and consistency or simply forgot. A total of one hundred and eighty-five participants did not document their daily bowel movements. The study also concluded that the frequency of loose stools per day was increased in the

Mild UC is characterized by occasional rectal bleeding with mucus discharge, mild diarrhea, tenesmus, constipation, and some abdominal pain. Moderate UC, in contrast, presents with up to 10 bloody, loose stools each day, mild fever, abdominal pain, and mild anemia. Patients with severe UC will have more than 10 bloody loose stools per day, severe abdominal pain, high-grade fever, quick weight loss, and anemia due to blood loss.Garud Patients with severe disease may require a colectomy. This review will analyze clinical trials that included patients with mild or moderate disease. FMT is not yet a therapy considered for severe UC. The symptoms described above may lead to a very poor quality of life for some patients with chronic disease. It has been postulated that, similar to a C. diff infection, there is spore formation in the mucosal surfaces of the colon and rectum of patients with UC. Spores are more resistant than non-spore forming bacteria. This may contribute to the chronicity of UC and may explain why antibiotic treatment will not fully eliminate these spores associated with chronic

Our plan of care must be based on patient teaching and instruction to help resolve the persistent gastrointestinal conditions. This patient’s treatment is going to be divided in: non-pharmacological measures (lifestyle changes) and pharmacological measures.

More than half of physicians (59%) was prescribed antibiotics for 25% of the patients with URTI. The majority of the physicians (70.9%) were prescribed Amoxicillin to URTI patients.

PDN understands the many challenges of coding for gastroenterologists, especially for those employed in-office, accustomed to working with prior CPT and ICD-9 codes. The new demands created by ICD-10 for increased documentation and specificity require an advanced knowledge base with regard to anatomy and terminology, and a more complete understanding and awareness of gastroenterology diagnoses and procedures. For instance, the ICD-10 has nine different coding options related to colon