A patient who has experienced five to seven liquid stools for 3 days is seen in the clinic by the primary care NP. The patient reports having had fever, mucoid stools, and nausea without vomiting
The patient has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should prescribe: a. diphenoxylate (Lomotil).
b. attapulgite (Kaopectate).
c. bismuth subsalicylate (Pepto-Bismol).
d. loperamide hydrochloride (Imodium).
C
Bismuth reduces symptoms through antidiarrheal and antibacterial properties and can decrease nausea and vomiting. Opioid antidiarrheals should be given after the cause of infectious diarrhea is treated; these can actually prolong symptoms because they slow transit of the causative organisms through the gut. Attapulgite can be used because it binds bacteria and toxins in the gastrointestinal tract, but bismuth is a better choice in this case because it helps to treat nausea. The patient is drinking Gatorade and is getting electrolyte replacement.
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