What happens in the real world if:

TheCommuter, BSN, RN · Jun 25, 2012

The nurse cannot obtain a wound culture without a doctor's order, at least in the places where I have been employed.

You would call the doctor, use the SBAR format to report your assessment findings, and perhaps make a recommendation at the end of the phone call to culture the wound.

bagladyrn, RN · Jun 25, 2012

Tell us what you think you would do in this situation and then we can discuss why or why not this would be the course of action we would take. Good critical thinking exercise here for you.

Don't worry that you won't give the "right" answer - not a test!

canesdukegirl, BSN, RN · Jun 25, 2012

A culture is an ordered lab test, so you would call the provider to alert them of your findings, document what the provider ordered, and then implement orders given.

MN-Nurse, ASN, RN · Jun 25, 2012

I hope this is the right forum for my question. I am a nursing student and have a question about a test scenario. The test is already over and I am mostly curious what would happen in the real world if you were the nurse for this patient.
Here is the question:
A man has a wound that is red and is starting to have visible pus. His temp is 100.5 and his WBC count is 10,500. What should the nurse do?
I can't remember the exact choices but one was to take a culture of the wound and another was to call the provider and use SBAR. What would you do?

Real world:

Evening shift never looks at the wound or labs. Noc nurse gets bored and notices the labs. Doesn't do anything except report the pus to the day nurse, who figures the hospitalist rounding in AM will notice labs, pus, and temp and order an Infectious Disease consult and PRN blood cultures if fever spikes. ID orders IV antibiotics and wound culture. No one changes dressing until patient yells, "Is anyone gonna change my $%^# bandage?!?!"

Test world: Call the MD.

freezin · Jun 25, 2012

Thank you. It seemed extreme to me to call the provider when the lab values were pretty close to normal.

beckster_01, BSN, RN · Jun 25, 2012

^^That would never happen where I work.... if it did then the entire floor would be taken over by toe amps and BKA's (like it's not already). It is not extreme to call the provider because the wound is producing purulent drainage, as well as redness. These are both hallmark signs of infection and should be considered along with the lab values.

MN-Nurse, ASN, RN · Jun 25, 2012

Thank you. It seemed extreme to me to call the provider when the lab values were pretty close to normal.

No. Paging the oncall if you are the first to see the labs and pus is the correct response. Passing it on to the next shift hoping someone does something about it is wrong, even though it is often done.

Double-Helix, BSN, RN · Jun 25, 2012

The lab values may be close to normal (100.5 is rather elevated, though), but the pus is not normal. It's a sign of infection and needs to be reported. In the real world, if this was my patient, I'd notify the doctor about the pus, then ask for an order for a wound culture.

jadelpn, LPN, EMT-B · Jun 25, 2012

It probably should be cultured, providing that the patient is not on antibiotics for something else. Always call MD first, don't do a culture without an order. Lab values in this case will most likely not be the first thing that will go wonky if the wound is infected. While you talk to the MD about the culture, also ask about a dressing--as we need orders specific to what type of dressing and how often to change the dressing. Make sure the doctor sees the wound (and make sure you map it and mark the line of redness). Last thing you want is a nastier wound that probs should have been debrided or drained a few days ago....

minnymi · Jun 25, 2012

Thank you. It seemed extreme to me to call the provider when the lab values were pretty close to normal.

but his temp is rising (i assume it was previously normal) and the blood count is on the high end of normal. that and the redness are signs of infection. you wouldn't want to wait until his temp is too high and his count is actually "abnormal" before you take action. you would want to prevent it from getting worse.

KelRN215, BSN, RN · Jun 26, 2012

Thank you. It seemed extreme to me to call the provider when the lab values were pretty close to normal.

10.5 may even be a normal WBC value depending on the lab (every lab sets their own normal range so that 95% of the patients they test fall into "normal"- one of the labs I go to has a WBC range of 4-11) but that is not your only piece of data and by no means is it your primary concern. The patient is exhibiting overt signs of infection- purulent drainage, redness and fever. The MD needs to be called.