Nursing Report: Clostridium Difficile and Activities of Living

This report presents a detailed analysis of a nursing case study involving an 82-year-old male, Mr. James, admitted with Clostridium difficile (C-Diff), a bacterium causing severe diarrhea and inflammation. The report focuses on the impact of C-Diff on various activities of living (AOLs), including personal cleansing, elimination, and maintaining a safe environment. It explores the challenges Mr. James faces due to his symptoms, such as lethargy, abdominal pain, and loss of appetite. The report further examines the nursing care plan developed to address these challenges, outlining strategies for managing diarrhea, promoting hand hygiene, and ensuring safe discharge. The analysis emphasizes the importance of infection control, patient dignity, and providing a supportive environment to improve the patient's well-being and reduce the risk of transmission. The report also addresses the need for ongoing evaluation and education to manage C-Diff and its impact on daily life.

CLOSTRIDIUM DIFFICILE AND AOLs 1
Clostridium-difficile and AOLs
Name
Name of the Class
City and State
Instructor
Institution
Date

CLOSTRIDIUM DIFFICILE AND AOLs 2
Introduction
The rationale of this essay is to discuss the activities of living and provide a nursing care
plan following the case study of Mr. James, an 82-year-old male admitted to the medical ward
with Clostridium difficult. The patient’s symptoms include watery diarrhoea, the temperature of
380C, abdominal pain, loss of appetite and sudden weight loss and a pathological state of
unresponsiveness, inactivity and sleepiness (lethargy). Henceforth, this essay will discuss
maintaining a safe environment, eating/drinking, elimination and personal cleansing/cleaning as
activities of living related to the case study presented. It will also use a Nursing care plan to
identify an issue from each of the mentioned AOL's and even present solutions or strategies to
the above problems.
Clostridium difficile or C-Diff is a bacterium that infects a person’s bowel and causes
diarrhoea or severe inflammation of the colon (Abougergi et al. 2010). The use of systemic
antibiotics like penicillin causes a normal bacteria flora of the bowel to be affected. Specifically,
when the bacteria kill the competing bacterium in the colon, any left bacterium will have no
competition for either nutrients or space. The whole effect is to allow more growth than the
normal of a given bacteria, and C-diff is among them. Apart from proliferating in the bowel the
bacterium also produces toxins. However, without the absence of toxin A or B, the bacterium
may colonise the gut and may not necessarily lead to pseudo membrane colitis. Although the
infection usually occurs in areas where people take antibiotics and are close to each other, it has
been observed that strict infection control measures and nursing care plan can help reduce the
risk of contracting the disease (Archbald-Pannone et al. 2010).

CLOSTRIDIUM DIFFICILE AND AOLs 3
Activities of Living Related To the Case Study
1. Personal cleansing and grooming
Activities of daily living abbreviated as (AOL's) is a term used in the healthcare setting to
refer to a persons’ daily self-care activities (Boult and Wieland 2010). Doctors and others
healthcare experts use’s individual inability or ability to execute the AOL's as a measure of their
functional status, especially to people with injuries, disability or the elderly like for the case of
Mr. James. Ideally, children and people in critical condition usually require help either from a
nurse, a friend or a family member to perform such functions. According to de Vrese et al.
(2011), a way to think of the basic AOL's is that they’re the daily cues people do immediately
they woke up in the morning as well as get ready to go out of the house, dress, eat and groom to
mention just a few.
C-diff affects the activity of living of cleansing and grooming of the body that include care of
the nails, brushing, keeping neat /combed hair and cleansing of the skin to mention just a few.
According to Lucky et al. (2011), clothes are purposely made for protection as well as personal
adornment. Although Mr. James had been complaining of lethargy, it is evident that he may
hardly have any energy left for him to execute the operations of personal cleansing and
grooming. However, he should have a social mandate to keep his body and clothes clean as to
prevent the spread of infection as well as infestations. However, some of the issues that might
affect this private activity of living for the case of Mr. James include lack of privacy or facilities
for cleansing especially during diarrhoea, development of an illnesses or a chronic disease due to
fatigue, dressing apraxia where the client might have difficulties in dressing because of loss of

CLOSTRIDIUM DIFFICILE AND AOLs 4
ability to do purposeful movements as a result of lethargy. For the case of poor or lack of
cleansing and grooming, it can result to infestations such as body and head lice to the client.
However, regarding clothing, a nurse creates a set of questions that can be borne in mind
(Miyamoto et al. 2010). The questions cannot be necessarily asked when assessing the patients’
clothes such as are they clean from faeces, urine or bad odour, are they appropriate for the
environment temperature or are the clothes socially necessary. For the case of Mr. James, a
nurse should understand that both dignity and modesty are two nursing responsibilities for which
she should be accountable. However, in the clinical setup, she should familiarise with different
types of equipment as aids to the independence of personal cleansing and hygiene.
2. Eliminating
C-diff affects the AOL of elimination which has the mandate of eliminating waste
products such as urine and faeces (Peyrade et al. 2010). This activity plays an integral role in the
case of MR. James where it is evident that he had been having watery diarrhoea, so it would be
prudent for a nurse, a family member or a friend to ensure that the client is responding to the call
of nature. However, some of the factors that might affect this activity of living include omitting
to respond to bowel movements, reducing intake of fluids and fibre, immune deficiency
syndrome and food poisoning. Medications such as antibiotics and analgesics can also affect
eliminating activity. In the event of this activity, the nurse should be keen for the change in
colour, odour, frequency as well as the quantity of the faeces and urine. The nurse should be
aware of the normal bowel patterns as well as bladder function (Phillips et al. 2012). It would be
prudent to note whether elimination is consistent or inconsistent and the level of frequency. Most

CLOSTRIDIUM DIFFICILE AND AOLs 5
importantly, it would be significant to provide privacy for the client and Mr. James in our case
study to avoid embarrassment as well as preserve the client’s dignity.
3. Maintaining a safe environment
Clostridium difficile can also affect the AOL of maintaining a safe environment. As Rao
et al. (2013) assert, being able to avoid dangers is determined by knowledge, awareness of the
risks, and motivation to respond with a sensible precaution. People can be afflicted with the
diversity of disabling conditions such that any list of them can just be a tentative one. The
following are some of the aspects that interfere with the ability to create a safe environment for a
patient; poor vision, wax that can lead to conducive hearing loss and lack of balance due to
lethargy, a condition that Mr. James had been complaining of. Being on medications like
antibiotics, antidepressants, tranquillizers or insulin cal also interfere with the activity of
maintaining a safe environment (Trubiano et al. 2013). In the event of maintaining a safe
environment, the nurse should endeavour to lower environmental risks to which patients can be
subjected to. For the fire exits, alarms and extinguishers, they should be clear, accessible at any
time and they should be in working condition. The floors should be free from wax, spills and
extension Leeds plus any other substances that may lead to a fall of the client. Safe practices
should be practised in the washrooms, kitchen and dining areas and also when giving
medications. Weening-Dijksterhuis et al. (2011) hold that the applications of dressing s
especially when treating wounds and disposal of soiled ones, appropriate bed height, suitable
chairs and getting the patient out of bed are some of the safety measures that should be taken to
ensure a safe environment. These and other practices should be practiced on the patient in the

CLOSTRIDIUM DIFFICILE AND AOLs 6
case study since it is evident that the client has little energy to execute his normal functions
independently
Nursing care plan
This care plan should be used for the case of Mr. James who has Clostridium difficile as
per the activities of daily living. The plan should be used as a guide to reducing the risks of
transmitting C-diff to other people such as the carers, visitors, and other patients
Mr. James
problems/needs
Goal Relevant strategies Evaluation
Personal cleansing
and grooming
Issue: risk of
management of
persistent watery
diarrhoea
The goal would be
to identify the
status of C- diff
infection
 If the condition is
negative and diarrhoea
persists which is
highly suspicious of
clostridium difficile
based on colour,
consistency as well as
frequency, the nurse
will take a different
tool sample after two
days of the first
sample. It should be
noted that no
subsequent tests are
done especially when
the results comes
negative. However,
one should maintain
contact precaution for
the ongoing diarrhoea
that has not been
diagnosed.
 In the event the first
test toxins appear to be
positive, there would
be no need for further
tests.
 When stools are
formed or normalised
The patient did
remain free of
persistent watery
diarrhoea. Mr.
James would benefit
from further
evaluation as well
as education
concerning c-
difficile and
possible risk
factors. He has a
home nurse who
keeps a close eye
on his condition but
further education on
how to manage
clostridium difficile
could improve his
condition

CLOSTRIDIUM DIFFICILE AND AOLs 7
the nurse should
ensure that no resting
is done. This is
because the tests may
remain clostridium
difficule positive for
an extended period of
time after symptoms
have resolved
Eliminating
Issue: the issue of
diarrhoea
The goal would be
to find the
diagnosis of
clostridium
difficule
 The nurse will send a
tool specimen if the
client has:
 Acute onset of watery
diarrhoea that is three
or more
liquid stools within a day
with another etiology
 Liquid stool in this
instance can be
defined as that which
conforms to the shape
of a container that
holds it
 The nurse will make a
diagnosis of
clostridium difficule if
the patient has;
 Acute onset of watery
diarrhoea that is three
or more stools a day
without another
etiology
 And one of the
following;
 Diagnosis of toxic
megacvolon
 Diagnosis of typical
pseudo-membranes on
pathological diagnosis
of C-diff infection
 Laboratory
confirmation in a
sample taken on or in
the second day of
watery diarrhoea
Mr. James is going
through depression
over his condition
and cannot think
much ahead as well
as consider the
impact of his
current choice.
Henceforth, he
would highly
benefit from home
health as well as
education on how to
go about the issue
of diarrhoea.

CLOSTRIDIUM DIFFICILE AND AOLs 8
Encourage the
client with hand
hygiene
Treatment of
infection
 The nurse should
encourage hand
washing for patients,
visitors and the staff,
particularly after
visiting the washrooms
and before meals. In
such instances regular
had wash with soap
and plenty of water
would be
recommended by a
nurse.
 The nurse should teach
Mr. James the correct
way of washing hands
as well as when to do
the hand hygiene and
 Lastly, ensure the
clients information
leaflet where hand
hygiene is provided to
the client or visitors.
 A nurse or doctor
should coordinate a
treatment plan or may
even wish to discuss
with a microbiologist
or infection prevention
as well as control ID
physician.
 The nurse should
observe as well as
document progression/
recurrence of
symptoms in the
patients chart as well
as utilise the approved
tool chart for
standardisation needs
The patient was
able to adhere to
hand hygiene before
meals and after
visiting washrooms.
He also admitted
that his current
condition may have
been worsened by
poor hygiene
Although the client
may respond to
treatment of the
infection, I also
feel that he is older
enough and does
not have a lot of
desire to change.
Instead, he would
just live regardless
of the challenges he
is going through.
Maintaining a safe The goal would be The nurse may discharge The patient

CLOSTRIDIUM DIFFICILE AND AOLs 9
environment
Issue: the issue of
discharge
planning
to ensure discharge
of the patient (Mr.
James) is done in a
proper way to
ensure there is no
risk of transmitting
the infections.
Also, the receiving
facility should be
made aware of
MR. James
diagnosis
home or transfer the client to a
different facility and before
doing such she should ensure
to perform a couple of things
such as
 Informing the infection
control practitioner of
any discharges or
transfers
 Informing the
receiving agency or
care givers of others
precautions if
necessary as well as
the cause of treatment
and
 Lastly, inform the
transportation sector or
services of precautions
that may deem
necessary
conformed to the
idea of discharge
where he was
assigned a nurse to
be checking on his
progress. He also
admitted that he can
get help from his
wife or children
while at home for
the activities of
daily living such as
washing , eating and
maintaining a safe
environment
Other Evaluative Strategies for the Problems Associated With C-Diff
Over the past decades, C-diff has been a serious problem and pervasive in healthcare
centres. The bacterium causes symptoms such as diarrhoea and inflammation of the diarrhoea.
Older people that are admitted into either acute or long-term facility are usually infected with C-
diff and this occurs following the use of antibiotic therapy (Abougergi et al. 2010). However,
recent studies have shown an increased risk of Clostridium difficile not only to the elderly but
also to the younger and healthier people in the society. Although the client might understand the
teachings about his condition, it might also be possible that he is older enough and does not have
the urge to change and he would rather live a simple life each day despite the consequences.
Also, I am very curious regarding his future health.
The patient should also benefit from further evaluation as well as education concerning
C. Diff and the possible risk factors (de Vrese et al., 2011). As per Mr. James age and condition,

CLOSTRIDIUM DIFFICILE AND AOLs 10
he should have assistance like a nurse or a family member like his wife to help in daily cues like
washing, bathing and eating. The nurse can also be used to access his condition as well as
educate him on how to live a positive life with C. Diff. The patient might also experience severe
depression over his medical conditions and not be in a position to think much ahead as well as
consider the impact of his current choice; hence the only thing he can benefit from is education
and home health.
Conclusion
Overall incidences of Clostridium difficile have continued to increase across the globe
especially among the older adults. The disease has brought a myriad of complications to the
people such as loss of appetite and weight, watery diarrhoea that has led to severe dehydration
and fever among other serious complications that has rendered a person’s life impossible
especially when executing the activities of daily living such as maintain a safe environment,
personal cleansing and dressing, eating and drinking and elimination. The aforementioned
activities of living have been tremendously affected regarding the life of Mr. James hence
making it impossible to perform daily functions with the aid of a nurse or a family member
especially his wife or children who are not mentioned in the case study. As a result, proper or
good nursing care plan can through education and training can be used by healthcare
professionals to provide solutions to patients with C-diff.

CLOSTRIDIUM DIFFICILE AND AOLs 11
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