a belly full of MRSA pus and no abx?

[birdgardner]

I'm a senior nursing student in my last semester - one of my patients these last two weeks is post-emergency colectomy, ileostomy, pus draining from the wound and another site, MRSA+. She was transferred to our hospital after the colectomy and an "event" at another hospital where they found CA during the surgery, but no details on that in chart. No abx. Is this usual, for an abdominal infection?

Last week she was strengthening; this week I was shocked at how much worse she was, and worse again the next day. Our hospital didn't even do x-rays or a bone scan until yesterday, four weeks after they got her. I'm thinking this may be because of the family trying to hide the "event" and the CA from her, but we talked about the event last week, and this week she knew about the CA - by report, the family still acts like she doesn't know.

This is not an elderly pt, not a DNR. I don't know how treatable the CA (and the doctors wouldn't either without the delayed radiology work-up) and that you couldn't treat it anyway until the infection is under control, but why not try to treat that, for comfort if nothing else? I never see her doctors or her family because of my hours, and her nurses don't know the whole picture when I ask.

If she is dying of CA, she needs to die close to home, not alone. And if she isn't dying, she needs treatment, because the infection is killing her. And all I could do for her was keep her company, and handle her gently, and wash her hair with shampoo, because someone washed it with soap last week. I don't expect to see her next week. I'm going to hate it when I have 6-8 pts and I have to push meds for a pt like that, pat her hand and run on to the next.

[november17, ASN, RN]

This is a question that would be better posed to the physician when you see them rounding. Don't be afraid to ask. It'd be a good question.

Or try reading the progress notes that the physicians write or a consult dictation, the answer to your question may be in there.

[birdgardner]

The four days I have seen her, I have not seen the physicians rounding, and I can't find the answer in the chart.

[november17, ASN, RN]

The four days I have seen her, I have not seen the physicians rounding.

Then call and ask. "Gee Dr. Smith, I was just wondering if maybe this patient should be on antibiotics or have an infectious disease consult?" It's the kind of initiative you have to take sometimes.

[Vito Andolini]

do not call the doctor if you are a student, unless you get permission to do so from your instructor.

what does your instructor say after she reviews the chart? or the nurse manager? i think the nurses from day to day probably don't want to take the time to get involved. does she have lots of different nurses?

do you ever see an infectious disease md whom you could ask for his opinion about how such a case should be handled?

are there any medical students or medical residents you could query?

do not discuss this with the family, either. it's a disaster (for you) waiting to happen.

if this patient is on no abx, is she febrile? are the fevers reported to the doctor? maybe if you point out these facts, you can enter sideways into this mine field. if you were a nurse already, you'd be remiss not to talk to the doctor. as a student, though, your options are more limited, i believe.