Discussion Questions on Clinical Nursing
1. The cephalosporins are a family of bactericidal antibiotics structurally related to penicillin which were first derived from the fungus, Cephalosporum acremonium.
Cephalosporins are the most frequently prescribed class for antibiotics (eMedexpert, 2011). This class’ mode of action is similar to other beta-lactam antibiotics, such as penicillins and cephamycins. Every form of bacteria cell has a certain cell wall for protection. Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell walls, which makes the bacteria cell walls break down and the bacteria eventually die (eMedexpert, 2011). One intravenous (IV) drug under this class is cefazolin. For adults, dosage for mild infections should range from 250 to 500 mg every 8 hours; dosage for moderate to severe infections should be 500 to 1,000 mg every 6 to 8 hours; and dosage for life-threatening infections should be 1,000 to 1,500 mg every 6 hours (Ekle and Sibley, 2010). For children, mild to moderate infections require a daily dose of 25 to 50 mg/kg, while severe infections require 100 mg/kg.
Some adverse effects may occur from cefazolin. This includes the GI tract. Nausea, vomiting, diarrhea, abdominal pain, anorexia, flatulence, and pseudomembranous colitis (this is a potentially dangerous disorder) are reported to be with cefazolin (Aschenbrenner and Venable, 2009). Furthermore, for nursing considerations, using cefazolin should be of great caution in patients having impaired renal function or a history of GI disease, such as colitis (Ekle and Sibley, 2010). And to prevent unintentional overdose, cefazolin for injection USP and dextrose injection USP must never be used in children having less than the required dosage for adults.
2. Cyril is a 54 yr old man transferred yesterday from CCU following an episode of unstable angina and an MI 5 days ago. He is currently on nasal prong oxygen @ 2L/min. He is on bed rest with toilet privileges. Cyril has had a restless day and as you settle him for the evening he tells you he is not feeling well.
In such situation, wherein the patient’s pain is persistent and/or he/she requests analgesic, the nurse in-charge should have a quick assessment through a set of subjective and objective data. The data on the nature of acute pain should be collected. This includes the following: location of pain, intensity of pain, time of its appearance, its duration, its frequency, the migraine factor, and some other factors that could increase or relieve the pain (Georgaka, Michalopoulou and Alichanidou, 2010). Additional objective information would include the following: the patient’s demographics (sex, age and weight); past history relevant to coronary artery disease (e.g. history of stroke, prior angina, etc.); risk factors (e.g. smoking status, history of hypertension, etc.); and physical diagnosis including heart rate, blood pressure, etc. (CARDS CCU/ACS Expert Committee, 2004). This is important since these factors be significant contributors to the patient’s condition.
Following the MEWS information, with the base line Blood Pressure of 130, “T 36.5 deg. C, HR 80, RR 16, BP 130/70, GCS 15, urine output satisfactory” means an increased frequency of observation of the nurse in-charge. “T 37 deg. C, HR 96, RR 22, BP 140/80, GCS 14, urine output satisfactory” calls for urgent notification of the medical team for primary responsibility for the patient (Healthcare Consulting, 2009). “T 35.8??C, HR108, RR 24, BP 160/90, GCS 13, urine output satisfactory” is the worst and nearest to life deterioration; this implies the need for a rapid response team.
3. A. If the tracheostomy tube fell out when dressing, there should be no panic. First, reassure the patient that the track will not close especially when the tube has been in place for 5 days already. Second, apply oxygen via facial mask. Third, let the patient breathe via the stoma. Fourth, replace the tube – leaving two finger-spaces between ties and the patient’s neck (Carpen, 2005).
B. A sizes of tracheostomy tube can be customized to accommodate patients with large/deep necks or patients with tracheal anomalities (Johnson, 2012). A tube with smaller size in the bedside is necessary so that there is assurance that it will certainly fit into the patient’s neck during the tube change.
C. Prior to tracheostomy tube suctioning, the patient’s chest should be auscultated and his/her mental and respiratory condition – including the respiratory and cardiac rate and pattern/rhythm – should be assessed (Cape Fear Community College, n.d.).
D. The air flow must be humidified since it is no longer filtered, warmed, and moistened as when air passes through one’s nose and mouth.
E. In terms of pain or discomfort, it is normal for the patient to feel it for about 1 week after the procedure.
4. Acute abdomen refers to the situation wherein a sudden change in the condition of one’s intra-abdominal organs, usually related to inflammation or infection, requires immediate and accurate diagnosis and treatment (Zierler, 2013). Clinical assessment of such condition is mostly difficult since the findings during physical examinations are often non-specific (Hodler, 2010). Nevertheless, there are three imaging technique medical systems have adopted so far to address this. First is the computed tomography (CT), which is proved to be excellent at revealing solid-organ injuries (Aghababian, 2010). The liver, pancreas, appendix, etc. are well visualized in CT scan. The second imaging technique is ultrasonography (US), which is the initial choice for patients suspected of acute cholecystitis or acute gynecological abnormalities (Hodler, 2010). Lastly, the most recent imaging technique for acute abdomen treatment is the magnetic resonance imaging (MRI). Although it has limited use to patients having abdominal pain for some time, it is now used for pregnant women, having abdominal pain, who have had negative US examination (Hodler, 2010). Beside, recent studies have already proved that MRI results are promising for acute lower abdominal pain assessments, and are effective particularly for biliary diseases and/or pancreatitis.
5. Congenital absence of vas deferens (CAVD) is a syndrome, wherein a portion or all of the reproductive ducts are missing (Basu, 2011). The most common cause of this syndrome is cystic fibrosis; the ejaculatory duct is often absent with an absent vas deferens yet the seminal vesicle may become cystic/rudimentary (Bisset, 2008). Clinical manifestation found in patients with this condition includes “low ejaculate volume, and normal testis size and hormonal profile” (Sabanegh, 2011, p. 27). Moreover, there is dilation of the head of the epididymis. For nursing management, CFTR gene testing should be initially taken. But if there is no mutation detected, renal ultrasonography is recommended because of the association with some renal anomalies (Sabanegh, 2011). Also, a foregoing genetic testing is a recommended alternative. Furthermore, if a patient having CAVD fathers a child, surgical sperm retrieval is required, and the best method – which could be PESA, MESA, TESE, or TESA – may vary depending on the surgeon and the preferences of the laboratory (Sabanegh, 2011).
6. When handed a unit of blood for transfusion from the head nurse, the nurse in-charge should do certain preparations. First and foremost, verify that the client has signed a blood administration consent form and that the consent matches what was prescribed by the client/patient (White, Duncan, and Baurnle, 2012). Second, identify the gauge of needle to be used in the transfusion. Third, ensure the patency of the existing IV site. Fourth, establish vital signs baseline data (e.g. temperature, skin conditions, etc.). Fifth, the label on the blood component should be verified with the client’s blood type before implementation. Some even require nurses to make sure the client’s name and blood type is the same with the tag in the blood bag. Lastly, the client’s age and physical condition should be assessed (White, Duncan, and Baurnle, 2012). Throughout the transfusion process, additional information should be taken, which includes the time the transfusion started and ended, the patient’s vital signs before and after the procedure, the flow rate, etc (Holmes, 2007). There could be allergic reaction such as urticaria. When this happens, epinephrine, corticosteroids, and vasopressor support should be given (Smeltzer, Bare, Hinkle and Cheever, 2010). For future reactions, antihistamines can be given before transfusion.
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