Fundamentals of Nursing Q 441
Which goal is the most appropriate for clients with diarrhea related to ingestion of an antibiotic for an upper respiratory infection?
A. The client will wear a medical alert bracelet for antibiotic allergy.
B. The client will return to his or her previous fecal elimination pattern.
C. The client verbalizes the need to take an antidiarrheal medication PRN.
D. The client will increase intake of insoluble fiber such as grains, rice, and cereals.
Correct Answer: B. The client will return to his or her previous fecal elimination pattern.
Once the cause of diarrhea has been identified and corrected, the client returns to his or her previous elimination pattern. Diarrhea is a common adverse effect of antibiotic treatments. Antibiotic-associated diarrhea occurs in about 5-30% of patients either early during antibiotic therapy or up to two months after the end of the treatment. The frequency of antibiotic-associated diarrhea depends on the definition of diarrhea, the inciting antimicrobial agents, and host factors.
Option A: This is not an example of an allergy to the antibiotic but a common consequence of overgrowth of bowel organisms not killed by the drug. Antibiotic-associated diarrhea results from disruption of the normal microflora of the gut by antibiotics. This microflora, composed of 1011 bacteria per gram of intestinal content, forms a stable ecosystem that permits the elimination of exogenous organisms. Antibiotics disturb the composition and the function of this flora and enable the overgrowth of micro-organisms that induce diarrhea.
Option C: Antidiarrheal medications are usually prescribed according to the number of stools, not routinely around the clock. Managing diarrhea depends on the clinical presentation and the inciting agent. In mild to moderate diarrhea conventional measures include rehydration or discontinuation of the inciting agent or its replacement by an antibiotic with a lower risk of inducing diarrhea, such as quinolones, co-trimoxazole, or aminoglycosides. In 22% of cases of diarrhea related to C difficile, withdrawal of the inciting agent will lead to resolution of clinical signs in three days.
Option D: Increasing intake of soluble fiber such as oatmeal or potatoes may help absorb excess liquid and decrease diarrhea, but insoluble fiber will not. The key measure for preventing antibiotic-associated diarrhea, however, is to limit antibiotic use. Probiotics have proved useful in preventing diarrhea, but the number of clinical trials is limited, and further controlled trials using different probiotics are needed.