You arrived at the patient's side. 0:00 You reviewed the patient information. 0:00 You reviewed the orders.
0:00 You introduced yourself.
0:08 You washed your hands. To maintain patient safety, it is impo
...
You arrived at the patient's side. 0:00 You reviewed the patient information. 0:00 You reviewed the orders.
0:00 You introduced yourself.
0:08 You washed your hands. To maintain patient safety, it is important to wash your hands as soon as you enter the room.
0:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 126/81 mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 97%. Temp: 102 F (38.9 C)
0:24 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient.
0:34 You asked if the patient was <Allergy>allergic<> to anything. He replied: 'No, I am not allergic to anything.'
0:52 You looked for normal breathing. He is breathing at 15 breaths per minute. The chest is moving equally.
1:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 128/81 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 102 F (38.8 C)
1:13 You checked the radial pulse. The pulse is strong, 90 per minute, and regular. It is correct to assess the patient's vital signs.
1:35 You measured the <Temperature>temperature<> in the ear. The temperature was 102 F (38.7 C).
1:54 You attached the <Pulseoximeter>pulse oximeter.<> It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the patient continuously.
2:09 You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This will allow you to reassess the patient continuously.
mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 102 F (38.7 C)
2:21 You assessed the patient's wound. There is a cat bite on the lower right leg with surrounding redness.
2:50 You examined the patient's legs. There is a cat bite on the lower right leg with surrounding redness. There is normal elasticity of the skin. He is sweating, and his skin is warm. There is nothing else to find on examination of the legs.
3:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/82 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.6 C)
3:13 You consulted the pharmacist. This was reasonable.
4:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 131/83 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.5 C)
5:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/81 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.4 C)
6:06 You compared the medication label with MAR. This was reasonable.
6:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/82 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.3 C)
6:20 You started infusing vancomycin (1700 mg in 250 mL bag) at 125 mL/hr. It is important to use the basic rights of medication administration to ensure proper drug therapy. This was indicated by order.
6:32 You asked the patient if he had any pain. He replied: 'Yes, I have some pain.'
6:40 You asked: How would you rate your pain? He replied: 'Not too bad; it's about a 2. '
7:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 129/82 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.2 C)
7:25 You educated the patient about adverse effects of antibiotic therapy.
7:51 You educated the patient about the drug vancomycin.
mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38.1 C)
8:21 You educated the patient about need for antibiotic therapy.
8:40 You reviewed the MAR.
8:41 You educated the patient about frequent vital sign assessments.
9:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 125/80 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (38 C)
9:14 You reviewed the diagnostics.
10:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 130/83 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (37.9 C)
11:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 128/81 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (37.8 C)
12:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 127/82 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (37.7 C)
12:33 You reviewed the clinical observations. 12:33 You reviewed the 12-lead ECG.
13:03 You looked for normal breathing. He is breathing at 15 breaths per minute. The chest is moving equally.
13:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 127/81 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (37.6 C)
13:23 You checked the radial pulse. The pulse is strong, 90 per minute, and regular.
13:47 You measured the <Temperature>temperature<> in the ear. The temperature was 100 F (37.5 C).
13:53 You reviewed the patient log.
14:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 130/82 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37.5 C)
14:15 You phoned the provider in order to discuss the patient.
15:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 127/81 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37.4 C)
15:39 You consulted the pharmacist. This was reasonable.
16:10 Patient status - ECG: Sinus rhythm. Heart rate: 89. Pulse: Present. Blood pressure: 131/83 mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37.3 C)
16:56 You asked: How would you rate your pain? He replied: 'Not too bad; it's about a 2. '
17:05 A patient handoff was performed.
This scenario presents a 78-year-old white male admitted to the medical-surgical unit with fever, severe pain, redness, and swelling of the lower right leg. The patient has taken oral antibiotics for 3 days to treat cellulitis caused by a feral cat bite carrying methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a type of Staph that is resistant to some of the antibiotics that are often used to treat Staph infections.[newline][newline]According to the Centers for Disease Control and Prevention (CDC):[newline] [newline]- There are 94,360 invasive MRSA infections annually in the US[newline]- 18,650 MRSA-associated deaths occur each year[newline]- 86% of all invasive MRSA infections are healthcare associated.[newline]MRSA is commonly resistant to erythromycin, clindamycin, aminoglycosides, fluoroquinolones, co-trimoxazole, and rifampin. However, some strains remain sensitive to minocycline, and recently, it has been shown that strains acquired outside of healthcare settings remain susceptible to agents, such as clindamycin and gentamicin.[newline][newline]Vancomycin continues to be the drug of choice for treating most MRSA infections caused by multidrug-resistant strains. Clindamycin, co-trimoxazole, fluoroquinolones, or minocycline may be useful when patients do not have life-threatening infections caused by strains susceptible to these anti-infectives.[newline][newline]Use of trough vancomycin concentrations is the most accurate and practical method to guide vancomycin dosing. Serum trough concentrations should be obtained at steady-state conditions, before the fourth or fifth dose.[newline]Thorough vancomycin monitoring is recommended for patients with serious infections or who are morbidly obese, have renal dysfunction (including those receiving dialysis), or
have fluctuating volumes of distribution.[newline] [newline]In older adult patients, it is important to consider hepatic and renal changes and their effects on drug metabolism and renal elimination. In this case, there is added concern because vancomycin has the adverse effects of ototoxicity (at high peaks) and nephrotoxicity (at high troughs). [newline][newline]Vancomycin treatment course for MRSA skin infections typically lasts 10 to 14 days. Monitoring the signs of infection, such as fever, redness, and swelling, are important to evaluate the effectiveness of drug therapy and the resolution of cellulitis.[newline] [newline]Many over-the-counter (OTC) medications can impair renal function.
OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen decrease kidney function, because they reduce the blood flow to the kidney. Aspirin also falls into this category. The use of low-dose aspirin once a day is not harmful to a person with renal impairment; however, large doses of aspirin taken several times a day such as are used to treat arthritis can be harmful. [newline] You are expected to evaluate the signs of infection, evaluate lab results, and identify abnormal lab results indicative of reduced renal function. You should also verify the appropriate antibiotic dose for the older adult patient with reduced renal function, administer IV antibiotics, and provide patient education on antibiotic treatment and reduced renal function.
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