preshee92

Hello, I was just wondering, if a patient has an infected skin abrasion on his left shin and he has been prescribed both Metronidazole and Cefuroxime (IV), what are the reasons for giving both antibiotics in conjunction with each other? Why not Cefuroxime alone to treat the skin infection. What are the reasons for metronidazole also being administered? Thanks Final Year Student Nurse

Thanks for replying, Although in the essay itself, I will be mentioning other problems that I have noticed and how it will be managed, however in regards to choosing only 2 Nursing problems, which one would you think would be best to stick to? Impaired gas exchange is a must!, its just the second problem I am puzzled about. I am following the ABCDE approach - would airway clearance still be a priority knowing that he is producing moderate amount of sputum? Should I still be concerned about his airways, or is it best to focus on the impaired gas exchange and the excess fluid volume?

Hi, I have a case study which I have to do where I have to create a care plan with 2 nursing problems/diagnoses and then complete an essay. Here is the scenario: Mr Kumar is admitted to the ward with breathlessness, general weakness and a productivecough. He is 65years old, and smoked between 20-25 cigarettes a day since his late teens,but gave this up 6months ago. He has had a 10year history of what he described as being‘chesty', with wheeziness and chest tightness. He had to retire from his job as a postman inhis mid 50s because of respiratory problems: chronic cough, frequent chest infections andincreasing breathlessness on exertion due to chronic bronchitis and he was eventuallydiagnosed with COPD which led to his retirement. He had suffered a myocardial infarctiontwo years previously and has occasional attacks of angina. Prior to this admission he hashad a two week history of worsening cough and wheeze which had not responded to a 7-day course of oral antibiotic therapy amoxicillin 500mg qds and oral steroid prednisolone 30mg od. He has become weaker and his ankles had started to swell. On admission Mr Kumar is mildly confused and tremulous. He is overweight with a pink appearance. He was started on oxygen 6L/min via a re-breathable mask by the paramedics.He has a weak, productive-sounding cough but is not able to bring up sputum. He is wheezy,tachypnoeic at 28 breaths/min and marked ankle oedema. His temperature is 37.6°C and he has an irregular pulse, with an apical rate of 125beats/min. His oxygen has been changed to24% by face mask, however, his saturations on pulse oximetry decreased to 75%. Therespiratory physiotherapist was on the ward and was able to carry out immediate chestphysiotherapy which helped Mr Kumar to cough up moderate amounts of green sputum. He was also prescribed 0.5mg ipratropium via an air-driven nebuliser. Arterial blood gases on admission breathing room air were: pO2 4.5kPa, pCO2 10kPa, pH7.25. An ECG was also done which confirmed atrial fibrillation and a chest x-ray shows overinflation but no evidence of pneumonia. His oxygen therapy has been changed to 28%. He isprescribed nebulisers salbutamol 5mg and ipratropium 0.5mg to be driven with compressed air. Now these are the problems I have come up with: Impaired gas exchange related to impaired oxygen supply as evidenced by shortness of breath, hypoxia, tachypnoea and tachycardia Excess fluid volume related to Atrial Fibrillation as evidenced by ankle odema I also came up with another problem which was : Ineffective airway clearance related to increased mucous production as evidenced by wheezing and weak productive-sounding cough However I am unsure whether the ineffective airway clearance becomes a priority over the excess fluid volume as I am sure it is his AF which is causing the oedema in his ankle and if not managed, can lead to stroke or heart failure. But at the same time, it is also important to maintain airway, but if he has been able to cough up moderate amounts of sputum, doesn't that mean his airway is being maintained and although we have to still focus on his airways, it is not much of a priority as the excess fluid retention. Am I on the right track? Does my chosen nursing diagnosis seem realistic, or is there anything else I may have to add on or remove? Thanks in advance

Do we worry about aspiration with a vomiting patient? We can replace fluid and electrolyte losses through giving her fluid intravenously as well as giving anti-emetics? I wouldn't know the alterations I see in the patients VS... Looking at her VS I was thinking it could be sign of sepsis, so it could be a good reason to start the sepsis six pathway.

The patient could be having alcohol withdrawal ?? Could that be a problem ?

Could she be dehydrated due to vomitting. Well if she is vomitting then there's a fluid volume deficient. So would it be dehydration ?

The patient is reporting of having tremors, she's also restless...

So if i was to pick just on main problem, would-be potential sepsis as that seems to be a very dangerous infection

Hello, i need some help. I have this case study i need assistance with. Here is the scenario: "Mrs. Perry has been admitted to the ward via the emergency department (ED) with a historyof severe abdominal pain due to pancreatitis. Mrs Perry informed staff in the ED that she drinks a couple of cases of beer each week”, stating her last drink was the early hours ofthe morning prior to her attending the ED. While doing rounds in the evening you notice thatMrs. Perry has tremors, is very anxious and restless. She has vomited approximately 250mLof bile type fluid. Her skin is cold and clammy to touch and she looks very pale. HR 121/minBP 90/42mmHg, RR 28/min, SpO2 92% on air, Temp.39.8C" As the nurse caring for Mrs Perry assess and plan her care Now looking at her observations, it looks like she has sepsis, I need to find one main problem, although she has pancreatitis, sepsis is a main problem so would the nursing diagnosis be: Deficient fluid volume related to vomiting secondary to sepsis as evidenced by decreased BP, High temperature and respiration rate.

You've made perfect sense, and I will definitely have a read on the relevant sites and guidelines. Thank you so much.

Yes, when I tell her I don't understand, she says "well you need to understand". No explanations on what to do. She's refusing to assist me. I've emailed the module leader so I'm waiting for a reply

Oh so the priority is not pain as I thought that it's what the patient is complaining of is what we act on which is her chest pain which radiates to her shoulder. So instead it's ineffective gas exchange or altered tissue perfusion related to myocardial infarction ?

Hi, I need some help on an assignment. Basically, I have to do a critical analysis of a nursing intervention in relation to a scenrio as well as a care plan. The sceario is: Mrs Davis is 62years old, and was at family gathering when she started complaining of nausea and heartburn which she put down to the food she had eaten and had taken some antacid tablets for the symptoms. After about two hours the symptoms had not resolved and she explained that she was experiencing a dull pain that seemed to spread to her shoulders and some mild shortness of breath. Her family called for an ambulance as they were concerned. She was given aspirin by the ambulance crew and sublingual GTN as they suspect she has Acute Coronary Syndrome (ACS)from the ECG strip. She is still complaining of chest pain on admission to the ED and very restless stating I feel like I have something heavy sitting on my chest.” Having formulated your care plan. Write a critical analysis of the nursing interventions identified in your care plan. To undertake a critical analysis of the nursing interventions you will first need to do a literature review of the nursing problem identified to explore what the evidence from research has to say about the specific nursing problem and how it is managed. For this piece of work you will need to source a minimum of three articles from peer reviewed journals or clinical guidelines for the identified nursing problem The problem I have identified is "Acute pain related to myocardial ischemia as evidenced by shortness of breath and radiation of pain to the shoulders." Will I have to find articles and guidelines on acute pain management and link the intervetions that I have come up with the the inerventions in the articles? I do not know what do, and my tutor does not seem to want to help me. Please help me.

Hi, I need some help on an assignment. Basically, I have to do a critical analysis of a nursing intervention in relation to a scenrio as well as a care plan. The sceario is: Mrs Davis is 62years old, and was at family gathering when she started complaining of nausea and heartburn which she put down to the food she had eaten and had taken some antacid tablets for the symptoms. After about two hours the symptoms had not resolved and she explained that she was experiencing a dull pain that seemed to spread to her shoulders and some mild shortness of breath. Her family called for an ambulance as they were concerned. She was given aspirin by the ambulance crew and sublingual GTN as they suspect she has Acute Coronary Syndrome (ACS)from the ECG strip. She is still complaining of chest pain on admission to the ED and very restless stating I feel like I have something heavy sitting on my chest.” Having formulated your care plan you critical analysis of the nursing interventions identified in your care plan. To undertake a critical analysis of the nursing interventions you will first need to do a literature review of the nursing problem identified to explore what the evidence from research has to say about the specific nursing problem and how it is managed. For this piece of work you will need to source a minimum of three articles from peer reviewed journals or clinical guidelines for the identified nursing problem The problem I have identified is "Acute pain related to myocardial ischemia as evidenced by shortness of breath and radiation of pain to the shoulders." Will I have to find articles and guidelines on acute pain management and link the intervetions that I have come up with the the inerventions in the articles? I do not know what do, and my tutor does not seem to want to help me. Please help me.

So my patient is complaining of pain. So in regards to the PES tool would it be Impaired mobility related to pain secondary to Cellulitis characterised by inflammation and redness. ?