Acute rehabilitation facility
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
RESULTS OF DECISION POINT ONE
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. Changing her antibiotic from one Fluoroquinolone to another would not provide enough antibacterial coverage for the HAP. A three drug combination for broad spectrum coverage should be initiated 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?
Antimicrobial chart of sputum and blood
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.
Rubrics
The order set includes an accurate and correct diagnosis.The order set includes an accurate description / plan for condition, code status, and admission location.The order set includes an accurate description / plan for allergies, activity level, and diet.The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.Written order set is complete, addresses all the needs of the patient, and are based on current literature.
References
Chastre, J., Dela Cruz, C. S., Douglas, I. S., Ecklund, M., Evans, S. E., Evans, S. R., Gerlach, A. T., Hicks, L. A., Howell, M., Hutchinson, M. L., Hyzy, R. C., Kane-Gill, S. L., Lease, E. D., Metersky, M. L., Munro, N., Niederman, M. S., … Weiss, C. H. (2020). Antibiotic stewardship in the intensive care unit. an official American Thoracic Society Workshop Report in collaboration with the AACN, chest, CDC, and SCCM. Annals of the American Thoracic SocietyLinks to an external site., 17(5), 531–540. https://doi.org/10.1513/annalsats.202003-188st
Eyler, R. F., & Shvets, K. (2019). Clinical pharmacology of antibiotics. Clinical Journal of the American Society of NephrologyLinks to an external site., 14(7), 1080–1090. https://doi.org/10.2215/cjn.08140718
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaignLinks to an external site.. Critical Care Medicine, Publish Ahead of Print. https://doi.org/10.1097/ccm.0000000000005337
Centers for Disease Control and Prevention. (2021, July 22). STI treatment guidelinesLinks to an external site.. Centers for Disease Control and Prevention. Retrieved October 20, 2021, from https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
Paper Format: APA
Number of pages: 2
Answer preview to Acute rehabilitation facility
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