Yesterday I took at test where we had to put how we would take care of this patient who was diabetic with a surgical wound with pus-type discharge on bandage and had a temperature of 104 degrees. The following information was given and we had to put the following list in sequence order as to what intervention we would do first, second, third and fourth. What I want to know is what sequence would you list the following interventions?
a. acetaminophen (Tylenol)
b. IV antibiotics
c. wound care
d. sponge to wipe body with cool water
I'm interested in finding out, especially from RNs, what sequence you think is the correct sequence and why?
If answering this for a nursing exam here is how I'd place these in order. Remember with nursing exams you always have an order for the options given and remember Maslow's Heirarchy.
Tylenol - fever needs to be treated asap. An increased temp and draining wound in a diabetic increases the risk of dehydration which increases the risk of DKA. As well as many other issues related to fluid imbalance and electrolyte imbalance.
Start Abx - we must assume that a dose is due
Wound care - pus draining wound - you would want this area free of drainage before applying a cool bath and you need to assess the wound for changes and a draining wound increases the risk of skin breakdown in diabetic.
Cool bath -but with 104 temp it would be more like not too cool bath
In the real world:
What is pt's LOC like? Full assessment for any other changes. Is there a foley? is it draining? (kidney fuction impared?) Medicate pt with Tylenol, culture wound, order labs if it is protocol in hospital, get accucheck for sugar levels - and give insulin if needed, run LR IV fluids to replace fluid loss through fever and draining wound, start IV abx if due, apply cool wash clothes to areas of warmth (arm pits, groin, forehead to help cool pt). Call MD with findings and for further orders.
Yes, there is a difference between the 'book' world, and the 'real' world. I was told to take the question for what it is and not read into it anymore than what is there. Very difficult to do when a nurse! We have so many questions regarding the patient (real world).
As with you I would of also put into the same order, taking the question as it is. Real world, a lot more assessment is done!
I'm Only a Lpn, but I would of iv abt, tylenol, wound care, cool wash. Abt will clear up infection while tylenol will dec. The temp. I could be wrong though...
If answering this for a nursing exam here is how I'd place these in order. Remember with nursing exams you always have an order for the options given and remember Maslow's Heirarchy.
Tylenol - fever needs to be treated asap. An increased temp and draining wound in a diabetic increases the risk of dehydration which increases the risk of DKA. As well as many other issues related to fluid imbalance and electrolyte imbalance.
Start Abx - we must assume that a dose is due
Wound care - pus draining wound - you would want this area free of drainage before applying a cool bath and you need to assess the wound for changes and a draining wound increases the risk of skin breakdown in diabetic.
Cool bath -but with 104 temp it would be more like not too cool bath
In the real world:
What is pt's LOC like? Full assessment for any other changes. Is there a foley? is it draining? (kidney fuction impared?) Medicate pt with Tylenol, culture wound, order labs if it is protocol in hospital, get accucheck for sugar levels - and give insulin if needed, run LR IV fluids to replace fluid loss through fever and draining wound, start IV abx if due, apply cool wash clothes to areas of warmth (arm pits, groin, forehead to help cool pt). Call MD with findings and for further orders.
Yeah you will see these on the NCLEX.
I agree with this user in their rationales. The fever has the highest priority level. a time sensitive drug like abt needs to be given on time to maintain blood levels..then I would do the bath because a fever of 104 is pretty high and would be higher priority then dealing with the wound. finally I would go clean that pus!!
LOL. Even if u cant figure all of these out..or if i am wrong, just being able to rationalize 1 or 2 choices greatly increases your chance of getting the question right. knowing the whole maslow thing helps so much. Psychosocial answers are almost always last in these priority questions. (Teach the diabetic, ect.)
i remember in school the instructors always telling me if it was on the exam then i had an order for it. I would almost say ABX, tylenol, wound care, sponge. ABX will help with the infection which can be a source of the fever, but you still need to get the fever down with the tylenol. wound care now that we have anx on board, and sponge last...
Thanks for the tip on assuming you have an order when answering test questions! That's what stumped me. When reading your tip, I then put the interventions in the same order you had them. :)
My reasoning: infection is the reason for the fever, so take care of infection med order first, fever med order second, and do the non-med interventions in the same order as the med interventions because the rationale applies.
One thing I hate is our instructors saying,"Don't read into the question!" Yet, according to some wise advice already provided here.....you have to "assume" the you have the order for ABX(uhhh, reading into the question!)!
Also, don't know about everyone else here....but, in clinicals what I saw was the nurse gets ALL the meds and gives them all at the same time.... so the tylenol and the abx are a tie! Unless, of course, you look at the seconds between hanging the IVP or giving the pt tylenol!
It is a silly question because you can do the ABX and the tylenol at the same time. But most of the questions on NCLEX are pretty silly. We were taught that you always assume you have an order for something. I wouldn't do the cool bath at all since it can cause shivering and actually raise the temp. We were taught not to do cool baths in Nursing School. I have had high fevers before and the thought of a cool bath makes me feel very uncomfortable.
As for ther abx... The reason that I would not answer this as the 1st thing you will do as abx generally do not stop an infection with a dose, it takes several doses generally. But in the "real world" you would give tylenol and hang IV abx at the same time (taking it for granted that a dose is due). Give a dose that isn't due is a med error. And again in the real world if the pt spiked a temp while already in iv abx... then it's warranted to discuss this with the MD, as there may need to be a change in abx or an addition of another abx. The spike in temp tells me that either the abx isn't working or there is another issue causing the fever. Which is why in the real world you'd be doing a while lot more assessment first, and without that just giving a dose of abx isn't doing the pt a whole lot of good.
The greatest danger to the patient at this time (what's going to kill him first) is the fever and the risks involved due to other conditions (diabetes). The fever needs to be treated now, and we need to continue the abx for it's duration to ultimately treat the infection.
As for a cool bath... I really don't like this answer and if I had to do it, as I stated in previous post, it would be after I provided wound care. You don't want to spread a draining wound to others areas of the body and start another infection.
Yesterday I took at test where we had to put how we would take care of this patient who was diabetic with a surgical wound with pus-type discharge on bandage and had a temperature of 104 degrees. The following information was given and we had to put the following list in sequence order as to what intervention we would do first, second, third and fourth. What I want to know is what sequence would you list the following interventions? 
Unless, of course, you look at the seconds between hanging the IVP or giving the pt tylenol!
Trulibra
30 Posts
Yes, there is a difference between the 'book' world, and the 'real' world. I was told to take the question for what it is and not read into it anymore than what is there. Very difficult to do when a nurse! We have so many questions regarding the patient (real world).
As with you I would of also put into the same order, taking the question as it is. Real world, a lot more assessment is done!