Chapter 11 – Assignment
Description
- Read the Case Study 11-2: Go to the Hospital and Come Back with Four More Medications in Chapter 11 of the textbook.
- Once you have read the Case Study thoroughly, answer the following questions:
- What does the administration of antibiotics have to do with a Clostridium difficile (C. diff infection) infection?
- List all the inappropriate medications prescribed for K.L. and describe the reason why they are inappropriate.
- What kind of treatment regimen is utilized for a patient with a C. diff infection?
- Do any of these treatments regimens raise suspicion as being inappropriate for K.L.?
- List the therapy and if contraindicated, give a reason why it is inappropriate.
- Your paper should be:
- One (1) page or more.
- Use factual information from the textbook and/or appropriate articles and websites.
- Cite your sources type references according to the APA Style Guide.
- What does the administration of antibiotics have to do with a Clostridium difficile (C. diff infection) infection?
- List all the inappropriate medications prescribed for K.L. and describe the reason why they are inappropriate.
- What kind of treatment regimen is utilized for a patient with a C. diff infection?
- Do any of these treatments regimens raise suspicion as being inappropriate for K.L.?
- List the therapy and if contraindicated, give a reason why it is inappropriate.
- One (1) page or more.
- Use factual information from the textbook and/or appropriate articles and websites.
- Cite your sources type references according to the APA Style Guide.
Case Study 11-2: Go to the Hospital and Come Back with Four More Medications
K. L. is an 84-year-old man who was sent to the hospital for treatment of possible urinary tract infection (UTI) and dizziness with fever. He has lived in assisted living at SHV assisted living facility for the past 4 years. K. L.s hospital course was complicated by aggressive antibiotic treatment resulting in a Clostridium difficile infection and diarrhea. Geriatric Nurse Practitioner B. G. checked on K. L. the first day after he returned from the hospital. B. G. compared her chart records to the new posthospital discharge records and found several discrepancies and inappropriate medication changes:
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- Ht = 6 ft 1 in, Wt = 178 lb, BP = 125/65, RR = 18, HR = 72
- PMH: DM2, HTN, OsteoArthritis, CAD, Afib, chronic UTI (colonization)
- Labs: CMP within normal limits (WNL) except for creatinine 1.8, BUN = 32, glucose 72; K = 3.0
- CBC WNL; Lipid panel TC = 70, LDL = 127, HDL = 65
| From ALF to ED | Hospital DC summary | Current in ALF chart | Assessment and de-prescribing by GNP |
|---|---|---|---|
| Metoprolol XL 25 mg daily | Metoprolol XL 25 mg daily | Metoprolol XL 25 mg daily | |
| Digoxin 0.125 mg every other day | Amiodarone 200 mg twice daily | Amiodarone 200 mg twice daily | Cardio consult placed him on amiodarone, purposefully avoided in the past, will switch back to digoxin every other day (Bahr, Lackner, & Pacala, 2008) DC amidarone. |
| Warfarin 3 mg daily | Warfarin 3 mg daily | Warfarin 3 mg daily | |
| Lisinopril 20 mg daily | Lisinopril 20 mg daily | Lisinopril 20 mg daily | |
| Amlodipine 5 mg daily | Amlodipine 10 mg daily | Amlodipine 10 mg daily | Amlodipine dose increased by hospitalist targeting BP = 120/80; too low for K.L. due to orthostasis and age. Decrease to 5 mg. |
| Metformin 500 mg BID | Metformin 500 mg BID | Metformin 500 mg BID | |
| Glyburide 5 mg daily | Glyburide 5 mg daily | Hypoglycemic and on glyburide. Glipizide a better choice in renal impairment (dose adjustment). Glyburide should be avoided in CrCl, 50ml/min. His est. CrCl = 33.3m/min. (American Geriatric Society Beers Criteria.) DC (discontinue, his BG likely went up due to acute infection) | |
| Simvastatin 40 mg daily | Simvastatin 40 mg daily | His lipid panel indicates that he does not need statin therapy, and amlodipine when given with simvastatin per FDA warning requires simvastatin dose of not more than 20 mg daily. DC | |
| Nitrofurantoin 100 mg daily | Nitrofurantoin 100 mg daily | Contraindicated in patients with CrCl < 60ml/min. (nitrofurantoin package insert) DCpatient known to have UT bacterial colonization. | |
| Cranberry supplement | Vancomycin oral 250 mg every 8 hours for 10 days | Vancomycin oral 250 mg every 8 hours for 10 days | Not clear when vancomycin started, need to clarify how many days remain, then re-culture. |
| Pantoprozole 20 mg daily prn | Pantoprozole 20 mg daily | This was a prn AST order (routine in hospital) carried forward to discharge which was mistranscribed to be routine. DC | |
| Diclofenac 75 mg twice daily prn | Diclofenac 75 mg twice daily | NSAIDS are contraindicated in patients on warfarin, and high risk for CV events in elders. (American Geriatrics Society Beers Criteria). DC. | |
| Routine APAP | Same | Same | Same |
References:
Nursing Standards
Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Clinical Guidelines
Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf
Living Guideline
Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E
Evidence-based practice
BMJ Best Practice
Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/
Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com
Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf
JBI: Evidence summary
Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global
JBI: Best practice information sheet
Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.
Cochrane Database of Systematic Reviews
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2
Drug Information
Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au
Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm
Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml
Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html
Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/
Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html
Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis
Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia
Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367
NCBI Bookshelf
Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/
Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au
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