FOURTH CLINICAL CASE STUDY 1

Clostridium Difficile

Joida Mae Esper I. Canono 22030085

Nursing Practicum I

Clinical Instructor Sharon Grawbarger, RN

November 28, 2022

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Past Medical History

1. COPD

2. CAD with MI 2010

3. Hypertension

4. Dyslipidemia

5. Gout with +++ gouty tophi

6. BCC to upper back, excised 2020

Social History

 He resides with his dementia-afflicted wife

 He has no family in the area

 Nurse only visits once a month

Pathophysiology

The patient, an 87-year-old man, was referred to Sault Area Hospital on October 16,

2022, with the primary complaint of weakness. The paramedics say that this patient hasn't left his

house in two to three months. They don't have any family in the community, and he lives with

his dementia-affected wife. A nurse checks on him and takes his vital signs about once a month

when she visits. He was given medicines for around three weeks for an infection in his left

middle finger, where a gouty tophi had perforated the skin. He has experienced approximately

four episodes of diarrhea every day since starting antibiotics. Over the course of the day, he had

intermittent vomiting. The patient has not experienced fever, stomach pain, shortness of breath,

or chest pain. He has been bedridden for at least three weeks, only getting out of bed to use the

restroom. His wife called the paramedics when he went to the bathroom, had diarrhoea, and then

collapsed while attempting to get back to his bed due to weakness in his legs. The patient's vital
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signs when they arrived at the hospital were BP 69/46, T-36.7C, HR 110bpm, RR-15, and SPO2-

97%. The client has had COPD, a MI in 2010, hypertension, and pretty severe gout in the past.

Patient has several gouty tophi over his fingers, swelling around his left middle distal finger, and

rashes underneath his axilla. His heart sounds are regular without an apparent murmur. His

respiratory exam shows no crackles, wheezes, or accessory muscle use.

By releasing two toxins, toxin A (an enterotoxin) and toxin B (acytotoxin), the gramme

positive, spore-forming, anaerobic bacteria Clostridium difficile causes infectious diarrhoea. The

majority of C. diff illnesses happen while taking antibiotics or shortly after stopping them. Other

risk factors include age 65 or older, a recent hospital or nursing home stay, having a weakened

immune system, such as HIV/AIDS patients, cancer patients, or organ transplant recipients

taking immunosuppressive medications, and having had three prior infections with C. diff or

knowledge of the germs. After taking antibiotics, symptoms like diarrhoea, fever, stomach

soreness or pain, loss of appetite, and nausea could appear within a few days (Centers for

Disease Control and Prevention, 2019). C. difficile's pathogenesis starts with the virulence strain

and host susceptibility elements required for the emergence of clinical symptoms. The C.

difficile acid resistant spores can withstand the acidity of the human stomach after consumption.

In susceptible individuals, the spores develop into the vegetative form in the small intestine and

eventually invade the large intestine (e.g. recent history of antibiotic administration with

antibiotic-induced disruption of the normal GI flora). In contrast, the healthy patient's natural GI

flora inhibits the growth of C. difficile (a process known as colonisation resistance), and

sufficient immune responses eliminate the infection even before clinical symptoms appear.

However, among vulnerable people, the infectious damage is severe and leads to colitis and

diarrhoea. Host immune responses following the onset of clinical manifestations may be
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sufficient, resulting in complete remission of the infection, or insufficient, resulting in recurrence

of clinical manifestations. If at all possible, discontinuing the administration of antibiotics for

other conditions and/or receiving metronidazole or vancomycin treatment are the conventional

treatments for C. difficile infections. The most effective technique to stop the spread from person

to person is to wash with soap and water (Lim et al., 2020).

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References

Castagliuolo, I., & LaMont, J. T. (1999). Pathophysiology, Diagnosis and Treatment of

Clostridium difficile Infection. The Keio Journal of Medicine, 48(4), 169–174.

https://doi.org/10.2302/kjm.48.169

Lim, S. C., Knight, D. R., & Riley, T. V. (2020). Clostridium difficile and One Health. Clinical

Microbiology and Infection, 26(7), 857–863. https://doi.org/10.1016/j.cmi.2019.10.023

Public Health Agency of Canada. (2010). Clostridium Difficile: Infection prevention and control

guidance for management in acute care settings - Canada.ca. Canada.ca.

https://www.canada.ca/en/public-health/services/infectious-diseases/

nosocomialoccupational-infections/clostridium-difficile-infection-prevention-control-

guidancemanagement-acute-care-settings.html