Branching Exercise: Common Diseases And Disorders Discussion Paper
- Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
- Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed. Branching Exercise: Common Diseases And Disorders Discussion Paper
PLACE YOUR ORDER HERE NOW
The Assignment:
- Using the required admission orders template attached.
- Develop a set of orders as the admitting provider.
- Be sure to address each aspect of the order template
- Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
- Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
- Make sure the order is complete and applicable to the patient.
- Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
- Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
- A minimum of three current (within the last 5 years), evidenced based references are required.
BACKGROUND
A 68-year-old female is brought to the hospital from the acute rehabilitation facility with complaints of shortness of breath and productive cough for 1 week. She was started on ciprofloxin 3 days ago, but her symptoms have continued to worsen. Her past medical history includes hypertension, hypothyroidism. She underwent a right knee replacement 2 weeks ago. Current medications include lisinopril 10mg, levothyroxine 75mcg, rivaroxaban 10mg daily and ciprofloxacin 500mg Q12. Her current symptoms include fever, chills, productive cough with purulent green sputum, and worsening shortness of breath. She is allergic to morphine. The patient is a full code.
EXAM
- Current vital signs T 102.6 HR 92. RR 22 BP 128/82. O2 saturation is 96% on 4L of O2
- Chest x-ray shows consolidation in the right lower lobe
- CBC and CMP are all within normal limits
DECISION POINT ONE
HOW WOULD YOU MANAGE THIS PATIENT’S ANTIBIOTICS? Branching Exercise: Common Diseases And Disorders Discussion Paper
Answer:
Discontinue the ciprofloxin
Initiate piperacillin/tazobactam 4,5 g IV every 6 hours,
tobramycin 5 mg/kg IV every 24 hours,
and vancomycin. 15 mg/kg every 12 hours
RESULTS OF DECISION POINT ONE
Correct!
This patient meets the criteria for hospital acquired pneumonia (HAP) due to her surgery 2 weeks ago and inpatient stay at the rehabilitation facility. She is at risk of drug resistant bacteria and MRSA. . A three drug combination for broad spectrum coverage is indicated until culture and sensitivity report on her sputum is available and antibiotic deescalation can occur.
The patient’s culture and sensitivity report for sputum and blood culture is now available. Staph aureus grew from the sputum culture. Utilizing this information, what adjustments to the patients’ antibiotics would you make for admission?
DECISION POINT TWO
Answer:
Discontinue the Tobramycin and Vancomycin
and continue the piperacillin/tazobactam
RESULTS OF DECISION POINT TWO
Correct!
The sensitivity report indicates that the bacteria in the sputum and blood is sensitive to piperacillin/tazobactam. Continuing it and discontinuing the other antibiotics will still provide good coverage for this infection. Branching Exercise: Common Diseases And Disorders Discussion Paper
DECISION POINT THREE
Answer:
The patient should be admitted to the hospital and placed a PICC line.
Guidance to Student
Correct!
The patient is requiring oxygen to maintain her O2 saturation at the low normal range. The safest option for the patient is to admit her to make sure her oxygen requirements do not need increasing with further intervention. A PICC can be placed for antibiotic therapy. Branching Exercise: Common Diseases And Disorders Discussion Paper
