A patient with confirmed Clostridioides difficile infection (CDI) presenting with severe diarrhea and toxic megacolon requires immediate implementation of stringent isolation and clinical intervention to prevent healthcare-associated transmission and manage systemic toxicity.
Isolation and Infection Control
- Initiate Contact-Enteric Precautions immediately. Place the patient in a private room with a dedicated toilet or commode.
- Hand Hygiene: Mandatory use of soap and water for all individuals entering the room. Alcohol-based hand rubs are ineffective against C. difficile spores.
- Personal Protective Equipment (PPE): Don gown and gloves upon entry. Ensure proper doffing sequence to avoid self-contamination.
- Environmental Cleaning: Disinfect all high-touch surfaces with a sporicidal agent, such as a 1:10 dilution of sodium hypochlorite (bleach). Standard disinfectants do not kill spores.
Nursing Assessment and Monitoring
- Monitor for signs of systemic toxicity: fever, tachycardia, hypotension, and altered mental status.
- Assess abdomen frequently for worsening distension, rigidity, or rebound tenderness, indicating possible perforation.
- Strict intake and output monitoring to manage severe fluid and electrolyte losses from diarrhea and third-spacing.
- Monitor serum electrolytes, particularly potassium and magnesium, and replace aggressively per orders.
Collaborative Management
- Discontinue the offending antibiotic agent if possible, in consultation with the provider.
- Administer oral vancomycin or fidaxomicin as prescribed; note that antiperistaltic agents are contraindicated as they may precipitate toxic megacolon.
- Prepare for surgical consultation if the patient fails to improve or develops signs of perforation; subtotal colectomy may be indicated.
- Maintain strict documentation of stool frequency, consistency, and volume to evaluate treatment response.