Online Case Studies Learning Activity #2: Antimicrobials Case Study Assignment
Assignment Outline
This assignment will give you the opportunity to apply your knowledge related to antimicrobials. You will be asked to complete preparation work prior to reviewing a written case study. As you work through the related knowledge application questions, additional information about this case will be provided. To complete this activity, please download this worksheet and complete the fillable spaces, working through the document in the order that the questions appear. Please submit your completed document to Dropbox by midnight Friday March 24th, 2023. You will be evaluated based on your responses on the worksheet. This assignment is worth 5% of your overall theory mark.
Patient Information
Jasmine, a 12-year-old, is brought into the Pediatric Outpatient Clinic for assessment. Jasmine’s mother is concerned because over the past few days, Jasmine has developed a fever, productive cough and SOBOE. Jasmine’s appetite has been poor, and she is lethargic.
Upon assessment in the clinic, it is found that Jasmine is tachypnic, and her SpO2 is 90% on RA. Her heart rate is 125 and her blood pressure 105/ 65. She is pale and diaphoretic. Jasmine’s weight is 88lbs.
The physician orders a chest x-ray, which shows that Jasmine has developed right lower lobe pneumonia. Blood work indicates that Jasmine has a WBC of 14, and she is dehydrated. The physician decides that Jasmine should be admitted to the Pediatric Unit at the hospital for rehydration and IV antibiotic therapy. The physician writes the following orders:
- Ampicillin 10 mg/kg IV Q6H
Upon admission to the hospital, the nurse on the unit takes the following past medical history from Jasmine’s mom:
- Jasmine is generally a well child, with no history of significant illness or injury
- Jasmine has no known allergies. Jasmine’s mother state’s that she does not have allergies herself, but that Jasmine’s father is allergic to bee stings and penicillin
Case Study Preparatory Work- Mini Drug Cards (1.5 marks)
| Ampicillin | Classification: penicillins |
| Indication: Infection of respiratory tract, GI/GU tract, skin and structures, meningitis, soft tissue infections | |
| Assessment required: skin assessment, muscle aches and joints, seizures, monitor signs pseudomembranous colitis, allergic reactions, obtain specimen for culture and sensitivity | |
| Contraindication: Hypersensitivity to any penicillins, Infectious mononucleosis patients | |
| Azithromycin (Zithromax) | Classification: macrolide |
| Indication: Pertussis, penicillin allergy, uncomplicatedgenital infections, drug resistance enteric fever, cat scratch disease, mycoplasma pneumonia | |
| Assessment required: vital signs, skin assessment, obtain specimen for culture and sensitivity | |
| Contraindication: Hypersensitivity to azithromycin or any other macrolide and in hepatic disease |
Learning Resources
Please review the following resources to assist you in completing the assignment:
Sealock, K., Seneviratne, C. (2020). Lilley’s pharmacology for Canadian health care practice (4th edition). Elsevier. Chapter 43.
SickKids (November 6, 2009). Clostridium difficile (C difficile). About Kids Health. Clostridium difficile (C difficile) (aboutkidshealth.ca)
You are encouraged to procure any additional resources that you find useful for completing the worksheet.
Assignment Questions (21.5 marks total)
- Following review of this patient’s clinical presentation and past medical history, what are your primary concerns for this patient? Name at least three (3) concerns and give rationale for each concern.
(3 marks)
My top 3 concerns would be her low Spo2 levels on RA, her fast heart reate the developed right lower lobe pneumonia
- Based on the information provided in the case study, what is the amount of medication that you will administer to the patient? Based on recommended dosing guidelines, is this a safe dose? Include the guidelines that you are comparing your dosage to (1 marks)
The amount of medication I will be administering is 400mg of ampicillin IV every 6 h. The recommended doasage for a child that is at least 40kg and has pneumonia is 250 mg – 500 mg IM or IV q6h or q8h, therefore the medication I will administer is a safe dose.
- What are the anticipated therapeutic outcomes of prescribed antibiotics? When should you anticipate clinical changes in your patient once they have started their antibiotic?
(2 marks)
Antiobiotics are used to treat or prevent bacterial infection. They kill or prevent reproduction of bacteria ad they are nit effective towards viruses. I should anticipate clinical changes in 3-5 days, since antibiotics can take a few days, or even longer depending on the infection, before a person can start to feel it’s effects.
- After giving the dose of antibiotics, what are the priority follow-up assessments and when should the nurse perform each of them? (2 marks)
Monitor for allergy and adverse reactions or side effects, check vital signs
- When conducting your follow-up assessments following medication administration, you notice that the patient has developed the following symptoms:
- Wheezing
- Difficulty swallowing
- Nausea and vomiting
- What do you suspect is happening with your patient? (1 mark)
Patient may be reacting to antibiotic
- What priority nursing interventions would you perform? (2 marks)
Call physician and assess the cause of the symptoms to see if antibiotic needs to discontinued
- Using the SBAR format, what information would you provide when calling to update the physician? (4 marks)
S – After being given given ampciliin 400mg IV q6h the patient has now developed symptoms of wheezing, difficulty swallowing, nausea and vomiting.
B – The patient came into the clinic tachypnic with an SPO2 of 90% on RA, HR – 125 and BP of 105/65. Shw was palw and diaphoretic and after a chest X-ray was found to have develop pneumonia on her right lower lobe.
- A- Risk for allergy reaction as evidenced by wheezing, difficulty sweallowing, nausea and vomiting experienced after receiving antibiotic
R- Consult Physician suggest allergy test or different antibiotic option
- In reviewing the patient’s history, what pertinent information may have contributed to her adverse reaction? Discuss your rationale. (2 marks)
The patient reaction could have been a result of an allrgy reaction, although no known allergies where stated for the patient it is unknown the date of the last test and since the father of the patient does have allergies the patient herself could have taken after him.
- Name at least 3 locations where the patient’s allergy needs to be documented to alert health care providers from administering this medication again in the future?
(1.5 marks)
Mar sheet, patient chart and medical record
- The patient is now well enough to be discharged home, and has been given a prescription for azithromycin (Zithromax) tablets to be taken orally for 5 days. What information will you include in the patient teaching? (1 mark)
Additional information I would include in patients teaching is that azithromin does nit treat viral infections and that is should be used for full prescribed length.
- 7 days after discharge, Jasmine’s mother calls into the Pediatric Outpatient clinic. She is concerned that Jasmine has been having loose stools 5-6 times a day for the past 2 days. What is a possible reason that Jasmine is experiencing loose stools? What recommendations would you provide Jasmine’s mother? (2 marks)
Diarreha could be a symptom of uncomplicatedgenital infections. I would therefore recommend jasmine mother to bring her daughter in to be properly assessed by a physician.
Reflection and Application of Learning (4 marks total)
- How might this situation have been handled differently? Which key nursing assessments were missed that might have led to a different outcome? (2 marks)
Knowing that Jasmines father has allergies, a date for the last allergy test for jasmine could have been asked preventing the adverse reactions that she ended up experiencing.
- Did the mini drug card preparation assist you in critically thinking through antibiotic administration for this patient? Why or why not? If not, how could you better prepare yourself for medication administration? (1 mark)
Yes, it helped. Having the knowledge on the drugs prior to beginning the case study helped me determine what was normal vs abnormal helping me with making certain decisions
- What are two pieces of learning that you will take away from this case study? (1 mark)
The two things I will take away from this case study are the importance of knowing about a medication prior to giving it as well as how important follow up questions are when gathering health history.
References
Please include your APA formatted references here if you have incorporated additional references into your learning.
Ampicillin Dosage Guide + max dose, adjustments. Drugs.com. (n.d.). Retrieved February 23, 2023, from https://www.drugs.com/dosage/ampicillin.html#Usual_Pediatric_Dose_for_Pneumonia
Ampicillin. Ampicillin | Davis’s Drug Guide for Rehabilitation Professionals | F.A. Davis PT Collection | McGraw Hill Medical. (n.d.). Retrieved February 23, 2023, from https://fadavispt.mhmedical.com/content.aspx?bookid=1873§ionid=139001673#:~:text=Examination%20and%20Evaluation&text=Monitor%20signs%20of%20allergic%20reactions,rash%2C%20pruritus%2C%20urticaria).
Antibiotics. Tests & treatments | NHS inform. (n.d.). Retrieved February 23, 2023, from https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/antibiotics#:~:text=Antibiotics%20are%20used%20to%20treat,most%20coughs%20and%20sore%20throats.
Azithromycin (Zithromax, Zmax): Davis’s Drug Guide. Azithromycin (Zithromax, Zmax) | Davis’s Drug Guide. (n.d.). Retrieved February 23, 2023, from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51087/all/azithromycin#:~:text=Observe%20for%20signs%20and%20symptoms,%3B%20may%20be%20life%2Dthreatening.
Oncall, P. (2022, October 24). Diseasea-Z. Pediatric Oncall. Retrieved February 23, 2023, from https://www.pediatriconcall.com/drugs/ampicillin/266
Terez Malka, M. D. (2023, January 10). How long does it take amoxicillin to work? what you need to know. K Health. Retrieved February 23, 2023, from https://www.khealth.com/learn/antibiotics/how-long-does-it-take-for-amoxicillin-to-work/#:~:text=Antibiotics%20can%20take%20a%20few,(like%20with%20bacterial%20pneumonia).
U.S. National Library of Medicine. (n.d.). Ampicillin: Medlineplus Drug Information. MedlinePlus. Retrieved February 23, 2023, from https://medlineplus.gov/druginfo/meds/a685002.html#:~:text=Ampicillin%20is%20in%20a%20class,flu%2C%20or%20other%20viral%20infections.
Total /27 marks