Patient admitted after her qualifying hosp stay for Dx. Of ankle fracture and cdiff in on 10/23
PT deferred gait training on day one due to NWB status for 6 weeks.
Resident was on flagyl in hospital for 1 week, still tested positive so they put her on vanc for 2 weeks and sent her to us.
12/12 therapy was plateauing, f/u ortho appt resulted in additional 6 weeks of NWB(1/8/15 f/u date). resident still required more assistance with ADLs then family able to provide..so family decided to keep LTC until weight bearing changes and requires less assistance.
We did RNP with last tx day 12/18. During that time resident was treated for mild uti and was retested for the cdiff = still positive. So MD placed on abt for uti and back on flagyl for cdiff a week.
Antibiotic therapy for both ended 12/19. No nurses documentation of any complications. Continued loose stool,but no s/s dehydration,n/v, poor pointake,lethargy,gi pain or distress.
F/u cdiff test today= still positive. Orders for 2 weeks of vanc q6hrs then 2 weeks of vanc bid.
Resident has had cdiff per MD over 4 months, same back n forth treatment. Resident has not needed IV fluids, has not c/o nausea in over 2 months, actually denies loose stools but she has a bit of STM , with cnas and nursing says she has loose BMs everyday. They state the BMs do not affect daily activities and resident continues to eat/drink the same every day.
MD does not want f/u is as the culture did not indicate it per MD and nursing does not report the s/s.
Would you continue to skill the resident for the cdiff and vanc observation? Is the Dx of cdiff and contact isolation(res. Leaves room due to loose stools are controlled per Risk manager) orders strong enough to justify skilled daily services? Nursing is always documenting "no s/s n/v,no adverse reactions,adequate po intake, no c/o abd pain, vitals WNL, and etc"
Right.. I never click isolation unles I meet all requirements.. Which I Will never be able to most likely due to our corporate policy states they can cohabitate long as the roommate has no open wounds. ...thought CDC said only if they have the same Dx...but I'm told that if it's in our policy then we do it.
, with cnas and nursing says she has loose BMs everyday. They state the BMs do not affect daily activities and resident continues to eat/drink the same every day.
TigerxLiLy
139 Posts
Right.. I never click isolation unles I meet all requirements.. Which I Will never be able to most likely due to our corporate policy states they can cohabitate long as the roommate has no open wounds. ...thought CDC said only if they have the same Dx...but I'm told that if it's in our policy then we do it.