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?
Thank you all for your responses. I am very new to nursing school and still figuring all of this out. I did not know that you had to get orders for a culture and I really appreciate all of you pointing out the reasons that the patient is exhibiting serious signs.
Like I said in my original post, I really want to learn what happens in actual nursing and why. You all have taught me something that I am not likely to forget.
If the doc is in mention it to him/her. If they have gone home, write it on the doctors board, chart it and report to the next nurse. If it is a Friday/Saturday and no MD will be in over the weekend, contact the on call during reasonable hours. Start Q4 temps, monitor for confusion. However this would depend on the pt too, it always does. If they are critically ill already, more immediate action would be taken.
For NCLEX purpose, between the two options you mentioned, I would chose: culture the wound. According to Kaplan, in the NCLEX land ("ideal world") you have the MD's order to culture the wound. Also, wound culture is another piece of assessment.
In real world, as others said, I would call the MD and use SBAR.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Thank you all for your responses. I am very new to nursing school and still figuring all of this out. I did not know that you had to get orders for a culture and I really appreciate all of you pointing out the reasons that the patient is exhibiting serious signs.
*** Weather or not you need order for a culture depends on where you work. In the hospital were I work an RN can order cultures and other lab tests. Of course in realiety we are following a protocol of standing orders and not actually "writing" the order. My point being in not every hospital does there need to be communication with a physician for a culture to be ordered.
The answer is to first assess the wound and the patient. Then you would report your assessment finding to the provider responsible for that patient. Obviously both the assessment and notification of provider need to be documented.
Specializes in Infusion Nursing, Home Health Infusion.
This will help you to apply this to other situations. The patient had a change in his condition and any change in condition needs to be reported to the appropriate MD on the case. There has been many a nurse sued for failure to report a change in the a patients condition and a terrible outcome followed.
I'd probably get the culture right then. Too many patients seem to take it upon themselves to "clean" things. I'd hate to return to culture only to find a cleaner wound...
Then, in the real world, I'd call the doc. Let them know I gathered a culture specimen. If they don't want it (which although I'm not a provider, I think it'd be silly not to...) I'd toss it.
Oh, and I'd probably put them in contact isolation until I saw results.
This will help you to apply this to other situations. The patient had a change in his condition and any change in condition needs to be reported to the appropriate MD on the case. There has been many a nurse sued for failure to report a change in the a patients condition and a terrible outcome followed.
i can't count the number of times i've sent cultures without an order. if anyone hates it they can always cancel it, but ferhevvinsake, we know when something is newly yucky and when it's not. i would never hesitate and i've never worked anywhere that it would be a problem.
freezin
11 Posts
Thank you all for your responses. I am very new to nursing school and still figuring all of this out. I did not know that you had to get orders for a culture and I really appreciate all of you pointing out the reasons that the patient is exhibiting serious signs.
Like I said in my original post, I really want to learn what happens in actual nursing and why. You all have taught me something that I am not likely to forget.
Thank you for taking the time to answer my post.