Question

1. How is clostridium difficile treated initially? How about for a severe infection?

2. What medication can cause “red mans syndrome?” How is this treated?

3. What organs can be affected by aminoglycosides?

4.     What are some nursing teaching points for the patient being prescribed Tetracycline?

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Answer 1

ANSWER 1: Clostridium difficile is a Gram-positive, spore-forming anaerobic bacillus. Clostridium difficile, often called C. difficile or "C. diff," is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities.

It can be treated initially by:

• prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection-control guidelines.
• Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses that aren't helped by these drugs.
• Hand-washing. Health care workers should practice good hand hygiene before and after treating each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers don't effectively destroy C. difficile spores.
• Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness.

• Antibiotics. Ironically, the standard treatment for C. difficile is another antibiotic. These antibiotics keep C. difficile from growing, which in turn treats diarrhea and other complications. Your doctor may prescribe vancomycin (Vancocin HCL, Firvanq) or fidaxomicin (Dificid).

  Metronidazole (Flagyl) may be rarely used if vancomycin or fidaxomicin aren't available.

• Prevent dehydration and provide adequate fluids, Take interventions to prevent fluid volume deficit such as daily check weight, IV fluids, skin care etc.

• Good nutrition. If you have watery diarrhea, eat starchy foods, such as potatoes, noodles, rice, wheat and oatmeal. Other good choices are saltine crackers, bananas, soup and boiled vegetables.

If infection become more serious and complicated:

• Fecal microbiota transplant (FMT). Also known as a stool transplant, FMT is emerging as an alternative strategy for treating recurrent C. difficile infections. FMT restores healthy intestinal bacteria by placing another person's (donor's) stool in your colon through a colonoscope or nasogastric tube
• Probiotics. Probiotics are organisms, such as bacteria and yeast, and are available over the counter.
• In patients with severe complicated CDI, the recommended treatment is intravenous metronidazole with high-dose vancomycin 250 to 500 mg 4 times daily orally or, if oral administration is not possible, via a nasogastric tube or via an enema.
• For patients with colonic perforation and/or systemic inflammation and deteriorating clinical condition despite antibiotic treatment, total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended.

ANSWER 2: Red man syndrome Red man syndrome is the most common adverse reaction to the drug vancomycin (Vancocin). It’s sometimes referred to as red neck syndrome. The name comes from the red rash that develops on the face, neck, and torso of affected people.

SYMPTOMS:

• rashes
• hypotension (low blood pressure)
• shortness of breath
• dizziness
• headache
• chills
• fever
• chest pain

MANAGEMENT:

• stop vancomycin treatment immediately
• give an oral dose of an antihistamine to help manage your symptoms.
• severe cases, hypotension can occur, you may need IV fluids, corticosteroids, or both.
• administer the rest of your dose at a slower rate to reduce your risk of another reaction.

ANSWER 3: MAJOR SIDE EFFECTS OF AMINOGLYCOSIDES ARE ON FOLLOWING ORGANS:

• kidney cause acute kidney injury
• ears cause hearing impairment and vestibular toxicity, trouble in balance
• muscles cause skeletal paralysis

ANSWER 4: NURSING EDUCATION TO A PATIENT ON TETRACYCLINE MEDICATION ARE:

• Tetracycline should be taken on an empty stomach, at least 1 hour before or 2 hours after meals or snacks
• Drink a full glass of water with each dose of tetracycline
• Do not take tetracycline with food, especially dairy products such as milk, yogurt, cheese, and ice cream
• Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

• Take tetracycline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

• tell your doctor and pharmacist if you are allergic to tetracycline, minocycline, doxycycline, demeclocycline, any other medications, or any of the ingredients in the tetracycline capsule

• tell your doctor if you have or have ever had lupus (condition in which the immune system attacks many tissues and organs including the skin, joints, blood, and kidneys), or kidney disease

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking tetracycline, call your doctor immediately. Tetracycline can harm the fetus.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Tetracycline may make your skin sensitive to sunlight. Tell your doctor right away if you get a sunburn.
• it can cause the teeth to become permanently stained. Tetracycline should not be used in children under age 8 unless your doctor decides it is needed.

• Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

• Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light and excess heat and moisture (not in the bathroom).

• Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to tetracycline.

• - Report onset of diarrhea and Reduce incidence of superinfection