PDC Test - C. Diff. Beware!

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. Send your answer sheet to NCRA's Continuing Education Office, 8224 Old Courthouse Road, Vienna, VA 22182, and enclose a check for $40 (member) or $50 (non-member) to cover the processing fee.

C. diff! – Beware!

BY DAYETTE J. ZAMPOLIN

The first time I heard about C. diff was several years ago when I was providing remote CART services for a  laboratory technician student, while frantically translating the horrible side effects of it and its likelihood of recurrence. The next time I heard about this vicious bacteria was when my mom, who was 82 at the time, suddenly became violently ill. I never dreamed C. diff would affect my life so tragically.

It seemed as though my mom had the flu or a bad stomach bug. In the past 10 years since being diagnosed with congestive heart failure, she had been hospitalized several times with the same sort of symptoms, but this time was different.

Normally, upon her hospitalizations, she would be given IV fluids and would recover after some time. I would always rush to her side, but I had an upper respiratory infection this time and was told by her doctors not to come anywhere near her.

As always, I called her every day. Much to my chagrin — and I am sure hers — for some reason, she had a different room almost every day. Boy, did I panic the first time when an aide answered the phone after I kept letting it ring and ring, and she told me she was cleaning the room out because the person was no longer in the room! The aide was very nice and directed me to the nurses’ station. They assured me that they had moved my mom.

When I finally got her on the phone, my mom was really not well and seemed to be getting worse each day. I kept asking her why she was having so much trouble breathing. I thought perhaps the congestive heart failure was starting to take hold.

One of my brothers spoke to the bacteriologist after about six days into our mom’s hospitalization. This doctor said that the prognosis was good, and not only was she diagnosed with C. diff., but now they said she had salmonella and sepsis, too!

Like all good old court reporters, I went to the Internet for research, which did not make me optimistic at this point.

C. diff, or Clostridium difficile, is a bacteria. Bacteria can be fought with antibiotics, but viruses cannot. And there are only two very “heavy” medications which can be utilized in the fight to kill C. diff, metronidazole for first line and vancomycin, “vanco,” as a last resort. Lactobacillus Acidophilus, which is a “good” bacteria, is also used right away and also for continued treatment.

They were trying to give my mom vanco for a couple of days already, but she was not tolerating it. I drove to be by her side, despite my illness. Thank God I did.

On my other emergency visits, my mom would be there saying, “What did you drive all the way down here for? I will be fine.” Not this time.

I wished she could breathe enough to tell me I should not have come that day, but she was laboring so hard to breathe that I tried not to talk to her very much. There was only about a minute before Dr. Bruno, the nephrologist, came in. I knew about nephrologists. The nephrologist was the last doctor to approach my mom when my dad was hospitalized during a nurses’ strike, after he had a serious heart attack from which he did not recover.

But Dr. Bruno’s visit meant that her kidneys were in trouble. And this was the day after the bacteriologist said her prognosis was good!

Well, Dr. Bruno was trying to explain to her that she needed dialysis. She would not agree to that on a good day, but all she could say was, “I promise to drink more,” while trying so hard to breathe. You could hear her trying to breathe all the way down the hall of the busy hospital. And I had never seen anyone suffer so much. Her eyes, which were normally brown, were dark blue. I had also seen that before, and it was not a good sign. When Dr. Bruno was trying to tell her that drinking more would not help, she became terribly upset, so I asked Dr. Bruno to speak with us outside her room.

He said he had never seen anyone’s kidneys fail so fast. As there was no hope of recovery for my mom, I asked him what he would do if it was his mom. He said, “Make her comfortable,” which is what we did.

My mom was a very good Catholic her whole life, and Dr. Bruno even got the priest to come and give her what I still call Last Rites, and it was not too soon. As I prayed hard for my dad to send his chariot to pick her up, she hopped on, and they rode back to heaven together.

The shocking truth about my mom’s C. diff is that the day before she became ill, she was doing her normal daily routine. She had actually gone to the hairdresser. We think she contracted this killer bug from dirty utensils when she dined out on Friday evening. (And for all you triskaidekaphobes, it was Friday, the 13th!)

A doctor on television the other day was discussing problems with Prevasid. And guess what? Its prolonged use can allow the C. diff bugs to flourish in elderly patients! Then the news was that there is some kind of mushroom with an airborne bacteria, which is thriving and moving down into our country from Canada through the forests. It does not respond to known drugs. There is always a new killer on the horizon.

Normally, C. diff is seen in nursing home patients, especially if they have been on antibiotics for some time. But the incidence of C. diff is now on the rise in non-nursing home patients. And if the antibiotics don’t work, it causes toxic colon and sepsis, which are two of the conditions that took my mom’s life. Tasteless, scentless, invisible C. diff is not even on the CDC’s watch list, like MRSA or Strep. How I wish the CDC would start tracking it.

An interesting fact is that we all have bacteria in our bodies, good and bad. If humans are healthy, the bad ones cannot fight and win against the good ones. If humans have other illnesses, the devastating effects can be fatal.

After this tragic loss, I pondered a way to educate people to the horrors of C. diff. My dear friend, Monette Benoit, a regular contributor to the JCR, said, “Write an article.”

“Gee, how nice it would be for members to get some CEUs, too,” I thought. So, I write this for you, not only as a chance to earn some CEUs but also as a lasting tribute for my mom.

Please share my fear of C. diff with your loved ones. If this article can save just one person’s mother or grandmother, I am sure my mom will be looking down and smiling at us all. Remember to wash your hands frequently. I remember from the time I was very young, my mom was always telling us to wash up when coming in the door. So I know that she was always careful about that. That is one of the reasons her rapid demise from this demon bug was so shocking to us all.

And although the original symptoms seem flulike, watch for severe stomachaches and uncontrollable trips to the bathroom. While speaking about this is not pleasant, the consequences can be devastating, so get to the hospital immediately.

I really miss calling my mom every day. She lived longer than anyone in our immediate family and was the first person in the family to have the Internet. I remember how excited she was when she invited me to try it out! So think of her when you check out your favorite watering hole’s health records online. You may be unpleasantly surprised! Although C. Diff  won’t be specifically listed, you can judge the likelihood of cleanliness by the Board of Health ratings.

C. diff – beware!

Dayette J. Zampolin, RMR, CRR, CCP, is a reporter in Downsville, N.Y. The exam for this article is located on the NCRA Web site at http://ceusandtesting.NCRA online.org. By passing the exam, you can earn .2 CEU. The questions are based on the material in the article, but some may require additional research.

C. diff – Beware  exam

1. C. diff is:

A.   Clostridium difficile.
B.   Corynebacterium diphtheriae.
C.   Cholerae difficile.
D.   Clinical diffusium.

2.  IV stands for:

A.   Invertebrate.
B.   Intravenous.
C.   Ill-advised.
D.   Roman Numeral ten.

3.   Because they can be transmitted by animals to humans, Salmonella bacteria are:

A.   Zoonotic.
B.   Hypnotic.
C.   Psychotic.
D.   Hypertrophic.

4.  Bacteria can be treated with antibiotics?

A.   True 
B.   False

5.  Which of the following provides replacement for lost kidney function?

A.   Chemotherapy.
B.   Ablation.
C.   Dialysis.
D.   Homeostasis.

6.  Metronidazole and vancomycin are drugs used to treat C. diff.

A.   True.
B.   False.

7.   Nephrology is the branch of Medical Science dealing with:

A.   Heart.
B.   Lungs.
C.   Kidneys.
D.   Feet.

8.  Which drug is an antibiotic?

A.   Premarin.
B.   Metformin.
C.   Atenolol.
D.   None of the above.

9.  A first-line treatment drug means it is the only drug available.

A.   True.
B.   False.

10.  Lactobacillus acidophilus can be described as all of these except: 

A.   Acid-loving milk bacterium.
B.   Available over the counter.
C.   Homo-fermentative.
D.   Not a part of some normal human flora.

11.  One of the drugs used to treat C. diff is:

A.   Symbicort.
B.   Lipitor.
C.    Epinephrine.
D.   Metronidazole.

12.  There are two types of cells, prokaryotic and eukaryotic.    All bacteria are prokaryotic; therefore, C. diff is prokaryotic.

A.   True.
B.   False.

13.  Triskaidekaphobia is a fear of: 

A.   Taking medicine.
B.   People with brown hair.
C.   13.
D.   Spiders.

14.  As of the writing of this article in 2010, the Centers for Disease Control in their “Summary of Notifiable Diseases” tracks all but:

A.    MRSA.
B.    Swine Flu.
C.    Salmonella.
D.   Clostridium difficile.

15.  A patient cannot have a relapse or recurrence of C. diff.

A.   True.
B.   False

16.  A bacteriologist studies:

A.   Microorganisms.
B.   Hearing disorders.
C.   Animal species.
D.   Insect bites.

17.  A specialist who treats a patient with Congestive Heart Failure would be a (an):

A.   Otolaryngologist.
B.   Nephrologist.
C.   Oncologist.
D.   Cardiologist.

18.   Antiseptics are:

A.   Antimicrobial.
B.   Disinfectants.
C.   Applied to tissue and skin.
D.   All of the above.

19.  Which of the following is not a helpful medical information research site for humans?

A.   Mayo Clinic.
B.   Cleveland Clinic.
C.   ASPCA.
D.  MedMD
 
20.  Septicemia is a serious illness in which the bloodstream is overwhelmed by bacteria.
A.   True.
B.   False