NRNP 6566F Week 9 Branching Exercise Common Diseases and Disorders

 Week 9

Posted on: Monday, April 26, 2021 9:05:25 AM EDT Dear students,

Welcome to week 9! First, I want to go over some of the frequently missed questions on your knowledge checks:

When the patient is post-op day 1..the likelihood of the patient having an infection immediately post-op is low. More than often the patient is experiencing atelectasis and needs aggressive pulmonary toilet (Incentive spirometry, ambulation, deep breathing/cough, chest PT, pep treatments (depending on where the anastomosis is). This will PREVENT the patient from getting pneumonia.

● You must assess the patient and the ventilator on a newly intubated patient that is fighting the vent. Don’t just assume the patient is agitated and sedate them. Make sure the tube is in the correct place, there isn’t a mucus plug, the patient doesn’t have a pneumothorax or that the ventilator isn’t malfunctioning (trust me, it happens).

● When you intubate a patient that is on a non-rebreather-Remember the non-rebreather is giving the patient 100% of FiO2. So it would be prudent to place the patient on an FiO2 of 100% and wean as tolerated by way of pulse ox or abgs.

● When you are weaning someone from the ventilator and thinking about extubating..make sure the underlying cause of intubation has resolved.

This week you will be learning about infections, antimicrobials and antifungals. Please utilize the learning resources to help you better understand these concepts.

You have 2 assignments due. Your last branching exercise is due Monday, May 3rd @ 0159. Please review the branching exercise in the module. Critically think about what is going on with the patient. Write orders for a 24 hour period and decide what her disposition will be. You can make up her DNR status…all other information will be in the branching exercise.

There is also a knowledge check due on Monday, May 3rd @ 0159. Please let me know if you have any questions, concerns, or comments. Have a great week!

Week 9: Infections, Antimicrobials, And Antifungals

 The story of an advanced practice nurse will include efforts to care for and treat a variety of serious health concerns. Among these are issues involving infection and resultant conditions, like sepsis.

Tools in the battle to fight these conditions include antimicrobials and antifungals. While their administration can vary by patient and condition, the goal is the same: the development of a treatment plan to ward off serious infection and corresponding conditions.

This week, you examine various types of infections and the antibiotic treatments that can be used to effectively treat them. You also explore common pathogens and the challenges they present.

Learning Objectives Students will:

■ Analyze how common pathogens impact prescription of empiric antibiotic medications

■ Formulate appropriate antibiotic prescriptions for various types of infections

■ Formulate appropriate antifungal prescriptions for various types of fungal infections

■ Analyze how comorbidities impact appropriate antibiotic treatment

■ Interpret diagnostic tests to assist in determination of infections

 ■ Evaluate the impact of renal function on the dosage, route, and clearance of antibiotic medications

■ Identify concepts related to antimicrobials and antifungals

Learning Resources

 Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

■ Chapter 73, “Fever” (pp. 916–928)

 ■ Chapter 81, “Other Infections” (pp. 1095–1107) NRNP 6566F Week 9 Branching Exercise Common Diseases and Disorders

Grace, C. J., & Robinson, B. (2017). Empiric antibiotic selection. Retrieved from http://www.antimicrobe.org/e62.asp

Leekha, S., Terrell, C. L., & Edson, R. S. (2011). General principles of antimicrobial therapy. Mayo Clinic Proceedings, 86(2), 156–167. doi:10.4065/mcp.2010.0639

Document: Admission Orders Template (Word document)

Required Media

 MedCram. (2016, August 15). Cephalosporins – Antibiotics explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=TgstImOf3k8 MedCram. (2016, March 15). Penicillins – Antibiotics explained clearly [Video file].

Retrieved from https://www.youtube.com/watch?v=JZt1MiygQHYWalden University (Producer). (2019c). Branching exercise: Common diseases and disorders [Interactive media file]. Minneapolis, MN: Author.

 Assignment: Branching Exercise: Common Diseases And Disorders

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Photo Credit: Getty Images/Maskot

To prepare:

■ Review the interactive media piece/branching exercise provided in the Learning Resources.

■ Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.

■ Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.

■ You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

■ Be sure to address each aspect of the order template

■ Write the orders as you would in the patient’s chart

■ Make sure the order is complete and applicable to the patient

■ Any rationale you feel the need to supply should be done at the end of the order set – not included with the order

■ Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.

■ A minimum of three current, evidenced based references are required.

 By Day 7 Of Week 9

Submit your completed Assignment by Day 7 of Week 9 in Module 5. Scenario #5 68 Year Old Female

BACKGROUND

 A 68 year old female is brought to the hospital from the acute rehabilitation facility with complaints of shortness of breath and productive cough for 1 week. She started on ciprofloxacin 3 days ago but her symptoms have continued to worsen. Her past medical history includes hypertension, hypothyroidism. She underwent a right knee replacement 2 weeks ago. Current medications include lisinopril, ciprofloxacin, and rivaroxaban. Her current symptoms include fever, chills, productive cough with purulent green sputum, and worsening shortness of breath.

■ Current vital signs T 102.6 HR 92. RR 22 BP 128/82

■ O2 saturation is 96% on 4L of O2

■ Chest x-ray shows consolidation in the right lower lobe

■ CBC and CMP are all within normal limits

Rubric Detail

 Excellent Point range: 90–100Good Point range:80–89Fair Point range:70–79Poor Point range:0–69
Using the Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. Be sure to address the following:· Identify the Correct Diagnosis.5 (5%) – 5 (5%) The order set includes an accurate and correct diagnosis.4 (4%) – 4 (4%) The order set includes a diagnosis that is an appropriate differential diagnosis.3 (3%) – 3 (3%) The order set includes a diagnosis that is incorrect and not supported by patient data.0 (0%) – 2 (2%) The order set includes an inaccurate / dangerous diagnosis.
· Identify the ‘Status/Condition’, ‘Code Status’, ‘Admit to Unit’for the patient in the presenting case.5 (5%) – 5 (5%) The order set includes an accurate description / plan for condition, code status, and admission location.4 (4%) – 4 (4%) The order set includes an accurate description for 2of the 3 variables.3 (3%) – 3 (3%) The order set includes an accurate description for 1 of the 3 variables.0 (0%) – 2 (2%) The order set includes inaccurate, missing, or dangerous descriptions for
    these variables.
· Describe the “Allergies’, ‘Activity Level’ and “Diet” for the patient in the presenting case.5 (5%) – 5 (5%) The order set includes an accurate description / plan for allergies, activity level, and diet.4 (4%) – 4 (4%) The order set includes an accurate description for 2of the 3 variables.3 (3%) – 3 (3%) The order set includes an accurate description for 1 of the 3 variables.0 (0%) – 2 (2%) The order set includes inaccurate, missing, or dangerous descriptions for these variables.
· Identify any ‘IV Fluids’ needed for the patient in the presenting case.9 (9%) – 10 (10%) The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.7 (7%) – 8 (8%) The order set is missing 1 element of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.5 (5%) – 6 (6%) The order set is missing 2 elements of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.0 (0%) – 4 (4%) The order set is incomplete, including wrong / dangerous fluids or flow rate, incorrect parameters for IV fluid type, flow rate, and administration parameters for the patient in
    the presenting case.
· Identify any ‘Respiratory’ needs for the patient in the presenting case. Be specific about oxygen (if ordered, include type and rate), pulmonary toilet needs, and ventilator settings.5 (5%) – 5 (5%) The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.4 (4%) – 4 (4%) The order set is missing 1 element of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.3 (3%) – 3 (3%) The order set is missing 2 elements of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.0 (0%) – 2 (2%) The order set is incomplete, includes wrong/ dangerous orders, or incomplete parameters for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
· Describe the ‘Medications’ including any IV drips for the patient in the presenting case.Be specific about medications related to the reason for admission and any chronic medications the patient may be taking (ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc.). Be sure to include name, dose, route of administration, and frequency of each medication.13 (13%) – 15 (15%) The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.10 (10%) – 12 (12%) The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. There are incomplete orders, missing medications, or missing elements in the orders.5 (5%) – 9 (9%) The order set is missing essential elements of a medication order, missing medications, or are inappropriate to treat the patient in the presenting case.0 (0%) – 4 (4%) The order set is incomplete, includes wrong/ dangerous orders, or inappropriate medications to treat the patient in the presenting case.
· Explain any ‘Nursing Orders’ for the patient in the presenting case. Be specific about vital signs, skin care, toileting, and ambulation.9 (9%) – 10 (10%) The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.7 (7%) – 8 (8%) The order set includes inaccurate or is missing 1 or 2 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.5 (5%) – 6 (6%) The order set includes inaccurate or is missing 3 or 4 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.0 (0%) – 4 (4%) The order set includes inaccurate, missing, or provides dangerous nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
· Explain the ‘Follow-Up Lab’ tests for the patient in the presenting case. Bespecific about diagnostic testing (e.g., CXR, US, 2D Echo,etc.).9 (9%) – 10 (10%) The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.7 (7%) – 8 (8%) The order set includes most (missing 1 or 2) laboratory and diagnostic testing to adequately monitor and assess the presenting patient.5 (5%) – 6 (6%) The order set includes some (missing 3 or 4) complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.0 (0%) – 4 (4%) The order set is missing essential laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
· Explain the ‘Consults’ for the patient in the presenting case. Be specific about how you, as an ACNP, would manage the patient’s acute needs for at least a 24-hour period. Include indications for consultation (e.g., “Cardiology consult for evaluation of new-onset atrial fibrillation,” “Nutrition consult for TPN recommendations”).5 (5%) – 5 (5%) The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.4 (4%) – 4 (4%) The order set is missing one of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.3 (3%) – 3 (3%) The order set is missing 2 or more of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.0 (0%) – 2 (2%) The order set is missing multiple consults, rations, or accurate descriptions for consults needed to manage the presenting patient.
· Explain the ‘Patient Education and Health Promotion’ for the patient in the presenting case. Be sure to addressage-appropriate patient education, if applicable.9 (9%) – 10 (10%) The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.7 (7%) – 8 (8%) The order set is missing 1 or 2 essential elements of patient education and health promotion for the patient in the presenting case.5 (5%) – 6 (6%) The order set is missing 3 or 4 essential elements of patient education and health promotion for the patient in the presenting case.0 (0%) – 4 (4%) The order set is missing multiple essential elements of patient education and health promotion for the patient in the presenting case.
· Explain the ‘Discharge Planning and RequiredFollow-Up Care’ for the patient in the presenting case.5 (5%) – 5 (5%) The order set provides clear, accurate, and complete discharge planning and necessary follow up care for the patient in the presenting case.4 (4%) – 4 (4%) The order set is missing 1 or 2 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.3 (3%) – 3 (3%) The order set is missing 3 or 4 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.0 (0%) – 2 (2%) The order set is missing multiple essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
· Identify a minimum of three ‘References.’ Be sure that they are timely and support the admission order in following current standards of care.9 (9%) – 10 (10%) The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.7 (7%) – 8 (8%) The order set does not include a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. APA format is incorrect.5 (5%) – 6 (6%) The order set does not include a minimum of three references or includesnon-profession al level resources to support their admission order set. APA format is incorrect.0 (0%) – 4 (4%) The order set is missing a minimum number of references or includes poor sources that do not reflect professional writing or current standard of care information.APA format is not followed.
Written orders include all elements, address all the needs of the patient, are complete, logical, and meet the complete needs of the patient.5 (5%) – 5 (5%) Written order set is complete, addresses all the needs of the patient, and is based on current literature.4 (4%) – 4 (4%) Written orders are mostly complete, only missing 2 essential elements in addressing the needs of the patient.3 (3%) – 3 (3%) Written orders missing 3 to 4 essential elements reflect an incorrect standard of care.0 (0%) – 2 (2%) Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care