The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8°C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider?

Question

The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8&deg;C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient&rsquo;s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider?

Accepted Answer

Metronidazole 500 mg IV q8h. Treatment for diverticulitis involves oral and IV antibiotics, which can cause depletion of the protective gut microbiota; this allows pathogenic bacteria such as Clostridium difficile to invade. This causes the patient&rsquo;s severe colitis. It is treated primarily with PO vancomycin, not IV vancomycin, because IV vancomycin is not excreted into the intestinal lumen. Intravenous metronidazole is also used to treat C. diff. colitis. The patient is in shock and requires fluid resuscitation with isotonic fluid such as 0.9% NaCl, not hypotonic 0.45% NaCl. Loperamide is an antidiarrheal medication that is not used to treat C. diff. because it impairs the body&rsquo;s ability to dispel the C. diff. toxins.

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