- Information
- AI Chat
Med Surg 2 Feedback Log & Score — Harry Hadley Pharmacology
Medical-Surgical Nursing II (NSG 223)
Herzing University
Recommended for you
Preview text
Date of Completion
Jun 04, 2022 08:31 AM
Harry Hadley
Age: 78 years
Diagnosis: Cellulitis
Score
1
0
0
96%
÷÷ ÷
÷ ÷÷
÷ ÷ ÷
Feedback Log
0:00 You arrived at the patient's side.
0:00 You reviewed the patient information.
0:00 You introduced yourself.
0:01 You reviewed the orders.
0:01 You reviewed the patient log.
0:01 You reviewed the diagnostics.
0:01 You reviewed the clinical observations.
0:01 You reviewed the MAR.
0:01 You reviewed the 12-lead ECG.
0:01 You reviewed the intake and output.
0:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/ mm Hg. Respiration: 16. Conscious state: Appropriate. SpO2: 97%. Temp: 102 F (38 C)
0:22 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient.
You should have washed your hands as soon as you entered the room to maintain patient safety.
0:31 You asked if the patient was allergic to anything. He replied: 'No, I am not allergic to anything.'
0:41 You asked the patient if he had any pain. He replied: 'Yes, I have some pain.'
0:46 You asked the patient if he could describe his pain. He replied: 'My lower right leg is throbbing!'
0:52 You asked: How would you rate your pain? He replied: 'Not too bad; it's about a 2. '
1:03 You asked the patient when the pain started. He replied: 'Well, it started when I got bit obviously.'
1:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 102 F (38 C)
1:10 You asked the patient if anything made the pain better. He replied: 'No.'
1:14 You asked the patient if anything made the pain worse. He replied: 'No. It just keeps getting worse.'
1:20 You asked the patient if he needed anything for the pain. He replied: 'No. I'm okay.'
1:28 You asked the patient: What brings you here? He replied: 'I was sent here by my GP because I was bit by a cat 3 days ago. '
1:36 You asked the patient how he felt. He replied: 'How do you think I'm feeling? Can't you just give me some more pills and get me out of here? '
1:44 You asked the patient when the symptoms started. He replied: 'Initially the bite wasn't too bad, but the pain just got worse and worse.'
ø ÷ ø ø ø ø ø
3:32 You asked the patient: Do you use any recreational drugs? He replied: 'No.'
3:37 You asked the patient if he was a smoker. He replied: 'No, I don't smoke.'
3:44 You asked the patient: Do you have any pruritus? He replied: 'No.'
3:47 You asked the patient: Do you have any thoughts of harming yourself? He replied: 'No, I haven't had any of that.'
3:52 You asked the patient: Have you lost interest in your daily activities? He replied: 'No, I don't think so.'
3:57 You asked the patient: Do you have trouble sleeping? He replied: 'No, my sleeping is fine.'
4:03 You asked the patient: Have you lost your appetite lately? He replied: 'My appetite is fine, thanks.'
4:08 You asked the patient: Are you feeling sad? He replied: 'No, I feel ok.'
4:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 129/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38 C)
4:12 You asked the patient if he was awake. He replied: 'I'm awake.'
4:16 You asked the patient what year it is. He replied: 'It is 2022.'
4:25 You asked the patient if he knew where he was. He replied: 'I'm at the hospital.'
4:31 You asked the patient what date it was. He replied: 'It is the 4th'
4:35 You asked the patient: Can you tell me why you are here? He replied: 'I'm here because the medication I have been given isn't working.'
4:55 You assessed the patient's mouth. This was reasonable.
5:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 126/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38 C)
5:13 You examined the patient's skin. There is normal elasticity of the skin. He appears flushed, and his skin is warm and dry. There is a cat bite on the lower right leg with surrounding redness.
5:28 You examined the patient's head. There is no obvious airway obstruction.
5:35 You examined the patient's chest. He is breathing at 15 breaths per minute. The chest is moving equally.
5:44 You examined the patient's arms. There is nothing to find on examination of the arms.
ø
ø
5:52 You examined the patient's abdomen and pelvis. There is nothing to find on examination of the abdomen and pelvis.
6:01 You examined the patient's legs. There is a cat bite on the lower right leg with surrounding redness. There is nothing else to find on examination of the legs.
6:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38 C)
6:12 You examined the back and spine. There is nothing to find on examination of the back and spine.
6:37 You listened to the lungs of the patient. The breath sounds are clear and equal bilaterally.
6:56 You listened to the heart of the patient. This is reasonable. There were regular heart sounds without murmurs.
7:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 131/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38 C)
7:17 You listened to the abdomen of the patient. Normal bowel sounds were heard.
7:22 You looked for normal breathing. He is breathing at 15 breaths per minute. The chest is moving equally.
7:46 You attached the pulse oximeter. It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the patient continuously.
8:00 You checked the radial pulse. The pulse is strong, 90 per minute, and regular. It is correct to assess the patient's vital signs.
8:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 130/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 101 F (38 C)
8:33 You measured the blood pressure at 126/80 mm Hg. It is appropriate to monitor the patient by measuring the blood pressure.
8:49 You measured the temperature in the ear. The temperature was 100 F (38 C).
9:07 You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This will allow you to reassess the patient continuously.
9:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 129/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (38 C)
9:22 You checked the eye movements. Extraocular movements within normal limits.
9:39 You checked the patient's pupils, and they were 5 mm and reactive.
9:57 You assessed the patient's neurological status.
10:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 129/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 100 F (37 C)
ø ø ø ø ø ø ø ø
This was not necessary here.
18:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 128/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
19:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 125/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
19:10 You identified the patient. If you are in doubt, it is always a good idea to repeat the identification.
19:19 You asked if the patient was allergic to anything. He replied: 'No, I am not allergic to anything.'
19:26 You compared the medication label with MAR. This was reasonable.
19:51 You started infusing vancomycin (1700 mg in 250 mL bag) at 125 mL/hr. This was indicated by order.
20:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 126/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
20:22 You measured the temperature in the ear. The temperature was 99 F (37 C).
20:39 You educated the patient about the drug vancomycin.
21:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 125/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
21:13 You educated the patient about need for antibiotic therapy.
21:35 You educated the patient about activities, safety, and fall risk.
21:56 You educated the patient about adverse effects of antibiotic therapy.
22:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 128/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
22:22 You educated the patient about adverse effects of medication.
22:46 You educated the patient about correct storage of medication.
23:06 You educated the patient about drugs interactions.
23:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 128/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
23:27 You educated the patient about excessive use of medication.
23:46 You educated the patient about frequent vital sign assessments.
24:09 You educated the patient about medication adjustment based on labs.
24:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 123/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
ø ø ø ø ø ø
24:35 You measured the temperature in the ear. The temperature was 99 F (37 C).
24:47 You looked for normal breathing. He is breathing at 15 breaths per minute. The chest is moving equally.
25:09 You examined the patient's skin. There is normal elasticity of the skin. His color is normal, and he is not sweating. There is a cat bite on the lower right leg with surrounding redness.
25:10 Patient status - ECG: Sinus rhythm. Heart rate: 88. Pulse: Present. Blood pressure: 127/ mm Hg. Respiration: 15. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
25:27 You assessed the patient's IV. The site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. If you are in doubt, it is always a good idea to reassess any IVs the patient has.
25:57 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
ø
ø
Med Surg 2 Feedback Log & Score — Harry Hadley Pharmacology
Course: Medical-Surgical Nursing II (NSG 223)
University: Herzing University
This is a preview
Access to all documents
Get Unlimited Downloads
Improve your grades
