A Medical Question:

[GLORIAmunchkin72]

If a resident has had diarrhea (for 2 days), can the doctor prescribe an antidiarreal without first doing a culture? I realize that logic tells you to do the culture first and then TX but in the meantime the poor patient is suffering as he has no orders for antidiarrheal.

[RobCPhT]

The medical director at our facility usually has orders for loperamide on everyone's chart prn just in case. I would say you can give it w/o culture.

[VivaLasViejas, ASN, RN]

Of course the MD can prescribe an antidiarrheal without having obtained a culture, but that's not always wise. Simple diarrhea caused by gastroenteritis usually resolves on its own within 2-3 days anyway, and you don't really WANT to treat it because the body is ridding itself of the causative organism naturally. (Obviously, supportive care, including fluids to prevent dehydration and topical ointments to soothe inflamed peri-anal tissues, would be in order.)

Profuse diarrhea caused by, say, C. diff., goes on for much longer than your average case of Montezuma's Revenge, and once you have a diagnosis, Imodium or another antidiarrheal medication may be appropriate. But I usually won't give it (or ask for an order) until after a culture's been obtained and the cause established, unless of course the diarrhea is so frequent and caustic that the skin is breaking down, or the resident is showing signs of dehydration.......in which case, he or she probably should be admitted to the hospital and/or given IV fluids. JMHO.

[GLORIAmunchkin72]

No. Not even a PRN for Imodium. I hope for his sake that he "flushed out the irritants". I just thought that people that age and that frail cannot afford too many days of the runs. They don't drink that well.

The medical director at our facility usually has orders for loperamide on everyone's chart prn just in case. I would say you can give it w/o culture.

[leslie :-D]

i've read in extreme c-diff cases, giving an antidiarrheal created toxic megacolon, then perforation then peritonitis.

there are conditions where it would be contraindicated.

leslie

[VivaLasViejas, ASN, RN]

No. Not even a PRN for Imodium. I hope for his sake that he "flushed out the irritants". I just thought that people that age and that frail cannot afford too many days of the runs. They don't drink that well.

No one said that frail elderly patients should be allowed to go on having loose stools indefinitely, or that they should be left to their own devices to take in sufficient fluids. It's just that diarrhea, in general, tends to be over-treated---we tend to mask the symptom, rather than deal with the cause or let the body in its wisdom rid itself of the offending substance. Then, when the case is severe and meds are really needed, they often don't work.

Where I work, we usually give a new complaint of diarrhea 24 hours to resolve; in the meantime, we take 8 oz. of water to the resident every 2 hrs. and vigorously encourage them to drink at least two glasses with meals. We also treat any nausea or fever they may be having, and if the "ring of fire" develops, we take care of that too. Naturally, if there is vomiting along with the loose stools and they can't keep even clear liquids down, we don't wait---we notify the MD that same day with a heads-up, or send them to the local urgent care center.

[GLORIAmunchkin72]

Thank you all for your inputs!

No one said that frail elderly patients should be allowed to go on having loose stools indefinitely, or that they should be left to their own devices to take in sufficient fluids. It's just that diarrhea, in general, tends to be over-treated---we tend to mask the symptom, rather than deal with the cause or let the body in its wisdom rid itself of the offending substance. Then, when the case is severe and meds are really needed, they often don't work.

Where I work, we usually give a new complaint of diarrhea 24 hours to resolve; in the meantime, we take 8 oz. of water to the resident every 2 hrs. and vigorously encourage them to drink at least two glasses with meals. We also treat any nausea or fever they may be having, and if the "ring of fire" develops, we take care of that too. Naturally, if there is vomiting along with the loose stools and they can't keep even clear liquids down, we don't wait---we notify the MD that same day with a heads-up, or send them to the local urgent care center.

[Nurseterr7, ASN, RN]

I have also heard of Pro-biotic use in cases of c-diff. . I had a pt. with c-diff and the GI Doc ordered Saccharomyces Boulardii along with some other types of Lactobacillus. (Eat your yogurt) Anyhow, I also read the article in the GI magazine he had that said (basically in simple terms) the SB competes with the c-diff for intestinal wall membrane sites. Just thought you guys might find that interesting . I did. Have any of you run across this type of treatment.