Do NOT self-treat diarrhea with OTC products for which groups of patients?
Added by Laurie C.
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Step 1: Identify the groups of patients who should not self-treat diarrhea with over-the-counter (OTC) products. Show more…
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Which medicine should not be used by children recovering from chicken pox or flu-like symptoms
Amy P.
Chriscelle, a 25-year-old nursing student with asthma and a documented penicillin allergy, developed a dry cough that tends to get worse at night. She felt fatigued and lost her appetite. She decided that she probably just had a cold. About three days after her initial symptoms had developed, Chriscelle experienced an increasing tightness in her chest that made breathing difficult. Her boyfriend reminded her that as an asthmatic, she really shouldn't put off being seen for her respiratory symptoms. Chriscelle reluctantly agreed and went to the nearby urgent care center, where the doctor prescribed her azithromycin—a "Z-Pack"—to treat what was probably walking pneumonia caused by Mycoplasma pneumoniae. Within a few days, Chriscelle felt much better. Although she did have some asthma flare-ups, she never missed attending her nursing school rotations at the hospital. About a week after finishing the Z-Pack, Chriscelle woke up at about midnight with flu-like symptoms and terrible abdominal cramping. She ended up vomiting, and she suffered diarrhea every hour throughout the night. By 9:00 a.m., she was exhausted and feeling worse; she was running a fever and was dehydrated. She knew from her training that it was time to be seen for her symptoms. Her boyfriend drove her to the emergency room. Based on Chriscelle's patient history, the ER doctor suspected a C. difficile infection. A stool sample was taken, and then Chriscelle was started on vancomycin and admitted to the hospital. The next day she was informed that rapid screening methods on the stool sample had confirmed a C. difficile infection. A couple of days later, Chriscelle was released from the hospital. She was careful to stick to her vancomycin dosing and finished her whole 10-day prescription. She took things a bit easier than usual, but she was concerned about falling behind at school. Within a month, Chriscelle was back at the ER with the same symptoms. Rapid screening tests confirmed a C. difficile relapse, and she was once again prescribed vancomycin. She was discharged after a couple of days, and again she diligently took her vancomycin prescription at home. Fortunately, her nursing program faculty and the program director were able to work with Chriscelle to help her get back on track and graduate just one semester behind her original cohort. What aspects of Chriscelle's patient history made the ER doctor suspect C. difficile, and why were they clues for her diagnosis? - Chriscelle is nauseous and vomiting. - Chriscelle is experiencing abdominal cramps. - Chriscelle is a young adult (age 25). - Chriscelle has severe diarrhea. - Chriscelle is a woman. - Chriscelle is asthmatic. - Chriscelle works in a medical setting. - Chriscelle is manifesting a fever and flu-like symptoms. - Chriscelle has a recent history of taking broad-spectrum antimicrobial drugs.
Madhur L.
CASE 23 The patient was a 4-year-old who presented to her pediatrician in early summer with a 3-day history of vomiting and bloody, mucus-flecked diarrhea. She had several episodes of vomiting and approximately 10 bowel movements/day. Her bowel movements were described as painful, and the parents reported that the patient had moderate abdominal pain. She also had fevers to 40°C with chills. The patient had decreased fluid input and urine output. She had no recent travel or camping history, no recent change in diet, no one at home with a similar illness, and no history of exposure to "bad" food; she was cared for at home. On physical examination she was alert with vital signs within normal limits. She had normal skin color and turgor, and her skin was warm and dry. There was no lymphadenopathy. Her abdominal examination was within normal limits, with normal bowel sounds and no organomegaly, guarding, or rebound. A stool was guaiac positive and was sent for culture. She tolerated a "popsicle" challenge and was tolerating oral liquids when she was discharged home. Three days later the laboratory reported that a non-lactose-fermenting, nonmotile, H2S-negative organism was growing on MacConkey agar from the patient’s stool specimen. When the father was called, he reported that the diarrhea had completely resolved. 1. What is your clinical impression of this child? 2. What is a stool guaiac test? Do you think it had any influence on the clinician’s decision to perform a stool culture? Explain.
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