Walden University - NURS 6560 Week4 iHuman_100% Correct.

Week4 iHuman Primary Diagnosis: Acute Bacterial endocarditis (Infective endocarditis) Status/Condition: Critical Code Status: FULL Allergies: NKDA Admit to Unit: ICU Activity Level: BR Diet: NPO ...

Week4 iHuman 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 IVL 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 CT Surgery consult-surgical intervention v medical management of endocarditis (mitral valve) Substance abuse-IVDU, ETOH use, smoking Social work consult-outpatient rehab facilities and available resources, placement options if patient needs continued IV therapy HX of IVDU Patient Education and Health Promotion (address age appropriate patient education if applicable): Smoking cessation AA Drug rehabilitation signs and symptoms of endocarditis and heart failure when to seek immediate medical attention instructed to seek immediate medical evaluation for persistent fever (because IE can mimic a variety of febrile illnesses and blood cultures should be obtained for farther diagnosis) Importance of daily oral and dental hygiene and follow up care with the dentist Antibiotic prophylaxis prior to dental procedures Discharge planning and required follow-up care: Discharge patient home on PO medications (antibiotics) F/U with PCP within 24-48 hours Take medications as ordered do not stop or skip the medications even if you feel better without consulting the PCP. Notify your doctor immediately or report to the nearest emergency room if you have any of the following: Feeling tired for more than 2-3 days decreased exercise tolerance chest pain or shortness of breath Fever over 100.4°F and sweating severe abdominal or flank pain blood in your urine loss of appetite, weight loss, paleness, headache, or weakness, palpitations, fainting, trouble speaking, Weakness in any extremity or face, spots on your fingernails, fingertips, whites of the eyes, or other parts of your skin, or any other symptoms of a stroke such as trouble speaking or inability to move one side of your body. References (minimum of 3, timely, that prove this plan follows current standard of care). Armstong, G. (2017). Infective endocarditis. MerckManual. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/endocarditis/infective-endocarditis/?network=o&matchtype=e&keyword=endocarditis%20treatment&creative={creative}&device=c&devicemodel={devicemodel}&placement={placement}&position={adposition}&campaignid=141515371&adgroupid=3559035022&loc_physical_ms=66840&loc_interest_ms=&utm_source=bing&utm_medium=cpc&utm_campaign=EDL_MERCKUSA_Infectious%20Diseases-P-S_SE_SEM_N_MIX_NTL_US_EN_M&utm_term=endocarditis%20treatment&utm_content=Erysipelothricosis%20(Exact)#v939580, Crawford, M.H. (2017). Current diagnosis & treatment: Cardiology (5th ed.). New York: McGraw Hill Education. Keteepe-Arachi, T., Malhotra, A., & Papadakis, M. (2018). Infective endocarditis. UpToDate. Retrieved from https://online.epocrates.com/diseases/13911/Infective-endocarditis/Key-Highlights. Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2018). Harrison's principles of internal medicine 20E. McGraw Hill Professional. Sabatine, M. (2017). Pocket medicine, 6e. Philadelphia: Wulters Klower. Sexton, D. (2018). Antimicrobial therapy of infective endocarditis. UpToDate. Retrieved from https://www.uptodate.com/contents/antimicrobial-therapy-of-native-valve-endocarditis?topicRef=2149&source=related_link. Sexton, D. & Chu, V. (2018). Infective endocarditis in injecting drug users. UpToDate. Retrieved from https://www.uptodate.com/contents/infective-endocarditis-in-injection-drug-users?search=endocarditis%20treatment&source=search_result&selectedTitle=15~150&usage_type=default&display_rank=15#H8. UpToDate. (2018). Patient Education: endocarditis. Retrieved from https://www.uptodate.com/contents/endocarditis-the-basics?topicRef=2149&source=see_link.