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Walden UniversityNURS 6560Week4 iHuman

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Primary Diagnosis: Acute Bacterial endocarditis (Infective endocarditis) Status/Condition: Critical Code Status: FULL Allergies: NKDA Admit to Unit: ICU Activity Level: BR Diet: NPO IVF: 18g IV... L x 2 NS@50ml/hr Critical Drips (If ordered, include type and rate. Do not defer to ICU Protocol): n/a Respiratory: Oxygen (if ordered, include type and rate), pulmonary toilet needs, ventilator settings: O2@2-4L via NC PRN for sats less than 92%. Medications: (include ALL, tx of primary condition, underlying conditions, pain, comfort needs etc. dose and route) Vancomycin 1g IV NOW and then Q12H (after blood cultures collected) Nafcillin 2g IVPB NOW then Q4H (after blood cultures collected) *Once sensitivity report is back, will adjust ABT accordingly. Tylenol 650mg PO Q4-6H PRN fevers. Max 4g in 24H Lorazepam 1 mg IVP CIWA score 8-10; 2mg IVP CIWA score greater than 10 PRN. Notify MD prior to administering. May consider nicotine patch 21mg/d. Remove at bedtime. Ondansetron 4 mg Q6h PRN N/V Morphine 2 mg IV Q4h PRN pain Pantoprazole 40mg IVP over 2 min QD Nursing Orders: vital signs, skin care, toileting, ambulation etc. VS-Q15min (obtain 2 sets of BC for T>101) Maintain SBP greater than 90, heart rate less than 100 and greater than 60. Monitor for s/s of sepsis (increased heart rate, decreased BP, decrease in respiratory and mental status) Notify physician immediately. Continuous telemetry monitoring Strict I/Os CIWA Q4h -Notify MD for scores greater than 8. SCD’s DVT prophylaxis Maintain patient on unit Obtain consent for PICC insertion (once cleared by ID) Follow Up Lab tests : CBC daily, Blood cultures x 2 sets Q48h, ESR, BMP daily, U/A & C/S, Daily EKG, LFT, lactic acid, Rheumatoid factor, Cardiac enzymes now and then every 4 hr X3, then every 8 hr X3 Diagnostic testing (CXR, US, 2D Echo, etc…) Include indication for test, for example CXR to evaluate pneumonia): CXR-r/o infectious process, pneumonia, cardiac abnormalities TEE-further evaluate mitral vegetation and other valves Consults: [Do not defer management to a specialist. As an ACNP you must manage the patient’s acute needs for at least a 24 hour period]. Include indication for consult, for example “Cardiology consult for evaluation of new-onset atrial fibrillation., or Nutrition consult for TPN recommendations.” Cardiologist-endocarditis, with mitral regurgitation, murmur Infectious disease-management of bacterial endocarditis [Show More]

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