Report bloody or black stools, high fever, or severe abdominal pain/distension.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client receiving long-term clindamycin therapy develops frequent watery stools. Which is the priority nursing action?
Answer: A. New-onset frequent watery diarrhea on clindamycin may signal Clostridioides difficile-associated colitis, a known complication. The priority is to notify the prescriber and hold the drug pending evaluation, and to implement contact precautions. Encouraging antidiarrheals such as loperamide can worsen C. difficile colitis and is contraindicated; ignoring it or simply increasing fiber is unsafe.
Keep the streak going with more questions like these, each with a full rationale.
What is loperamide?
It does not cross into the CNS at normal doses, so it does not cause typical opioid effects. It is used for acute and chronic noninfectious diarrhea.
Key points to remember
- Slows gut motility to reduce stool frequency and fluid loss.
- Should be avoided in infectious or bloody diarrhea and high fever because slowing motility can trap pathogens and cause toxic megacolon.
- Avoided in C. difficile and other invasive infections for the same reason.
- High doses or abuse can cause serious cardiac dysrhythmias and QT prolongation.
- Can worsen or precipitate ileus and abdominal distension if overused.
- Watch for dehydration and electrolyte loss from the underlying diarrhea.
Nursing priorities
- Assess stool for blood, frequency, and signs of infection before giving.
- Monitor hydration status, intake and output, and electrolytes.
- Hold and notify the provider if fever, bloody stools, or abdominal distension occur.
- Reinforce that the drug controls symptoms but does not treat the cause.
- Educate against exceeding the labeled dose because of cardiac risk.
Labs & values
Patient teaching
- Stop and call your provider if you see blood in the stool or develop a high fever.
- Do not take more than the package directs; high doses can harm the heart.
- Drink oral fluids to replace what was lost from diarrhea.
- Seek care if diarrhea lasts more than 2 days or worsens.
Red flags: report now
- Report bloody or black stools, high fever, or severe abdominal pain/distension.
- Report palpitations or fainting that may signal dysrhythmia from overdose.
- Never use in suspected infectious diarrhea, C. difficile, or to treat diarrhea longer than 48 hours without improvement.
References
Clinical references for this topic
