NUR2488: Mental Health Nursing
Rapid Reasoning: Clostridium difficile Colitis
Chief Complaint/History of Present Illness:
Mindy Perkins is a 48 year old woman who presents to the ED with 10-15 loose, liquid stools daily for the
past 2 days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition
to loose stools, she complains of lower abdominal pain that began 2 days ago as well. She has not noted
any blood in the stool. She denies vomiting or fever/chills. She is on Prednisone for Crohn’s disease as
well as Pantoprazole (Protonix) for severe GERD.
Past Medical History:
• Crohn’s disease
• GERD
Your Initial VS:
WILDA Pain Scale (5th VS):
Description: Crampy
Intensity: 7/10
Location: Generalized throughout RLQ-LLQ
Duration: Persistent since onset 2 days ago
Aggravating factors: None
Alleviating factors: None
T: 100.2 (Orally)
P: 92
R: 20
BP: 122/78
O2 sats: 98% RA
Orthostatic BP’s: Lying: 122/78 HR: 92
Standing: 120/70 HR: 114
Your Initial Nursing Assessment:
GENERAL APPEARANCE: appears weak and uncomfortable. Easily fatigued
RESP: breath sounds clear with equal aeration bilat., non-labored
CARDIAC: pink, warm & dry, S1, S2 present, no edema, pulses 3+ in all extremities
NEURO: alert & oriented x 4
GI/GU: hyperactive BS in all quads, abdomen soft/tender to palpation in lower abdomen, no rebound
tenderness or guarding
MISC: Lips dry, oral mucosa tacky with no shiny saliva present in mouth
Dependent Nursing Interventions:
• Orthostatic BP’s (ED standing order)
• Establish PIV (ED standing order)
• Initiate enteric precautions (ED standing order)
, Current Physician Orders:
• 0.9% NS 1000 mL IV bolus administer over 4 hrs.
o Calculate the flow rate in mL/hr
250 mL/hr
• Hydromorphone (Dilaudid) 1 mg IV Q 6 h prn pain
• Stool culture for C. difficile
• BMP, CBC
• Vancomycin 250 mg po Q 12 h
o Available: Vancomycin 1000 mg/20 mL - Determine dosage to administer
5 mL
• Admit to medical unit
Lab/diagnostic Results:
• Stool culture for C. difficile: Positive
CBC Current High or Low?
WBC 12.6 High
HGB 14.5 Normal
PLTS 188 Normal
NEUTS % 86 High
LYMPHS % 10 Low
BMP Current High or Low?
Sodium 132 Low
Potassium 3.5 Normal
Creatinine 1.45 High
BUN 47 High
CO2 18 Low
Rapid Reasoning: Clostridium difficile Colitis
Chief Complaint/History of Present Illness:
Mindy Perkins is a 48 year old woman who presents to the ED with 10-15 loose, liquid stools daily for the
past 2 days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition
to loose stools, she complains of lower abdominal pain that began 2 days ago as well. She has not noted
any blood in the stool. She denies vomiting or fever/chills. She is on Prednisone for Crohn’s disease as
well as Pantoprazole (Protonix) for severe GERD.
Past Medical History:
• Crohn’s disease
• GERD
Your Initial VS:
WILDA Pain Scale (5th VS):
Description: Crampy
Intensity: 7/10
Location: Generalized throughout RLQ-LLQ
Duration: Persistent since onset 2 days ago
Aggravating factors: None
Alleviating factors: None
T: 100.2 (Orally)
P: 92
R: 20
BP: 122/78
O2 sats: 98% RA
Orthostatic BP’s: Lying: 122/78 HR: 92
Standing: 120/70 HR: 114
Your Initial Nursing Assessment:
GENERAL APPEARANCE: appears weak and uncomfortable. Easily fatigued
RESP: breath sounds clear with equal aeration bilat., non-labored
CARDIAC: pink, warm & dry, S1, S2 present, no edema, pulses 3+ in all extremities
NEURO: alert & oriented x 4
GI/GU: hyperactive BS in all quads, abdomen soft/tender to palpation in lower abdomen, no rebound
tenderness or guarding
MISC: Lips dry, oral mucosa tacky with no shiny saliva present in mouth
Dependent Nursing Interventions:
• Orthostatic BP’s (ED standing order)
• Establish PIV (ED standing order)
• Initiate enteric precautions (ED standing order)
, Current Physician Orders:
• 0.9% NS 1000 mL IV bolus administer over 4 hrs.
o Calculate the flow rate in mL/hr
250 mL/hr
• Hydromorphone (Dilaudid) 1 mg IV Q 6 h prn pain
• Stool culture for C. difficile
• BMP, CBC
• Vancomycin 250 mg po Q 12 h
o Available: Vancomycin 1000 mg/20 mL - Determine dosage to administer
5 mL
• Admit to medical unit
Lab/diagnostic Results:
• Stool culture for C. difficile: Positive
CBC Current High or Low?
WBC 12.6 High
HGB 14.5 Normal
PLTS 188 Normal
NEUTS % 86 High
LYMPHS % 10 Low
BMP Current High or Low?
Sodium 132 Low
Potassium 3.5 Normal
Creatinine 1.45 High
BUN 47 High
CO2 18 Low
