NUR231: Bachelor Of Nursing Science-Case Study Assignment
Mr. Edward Hunter, an 89 year old widower, is now day 7 following his admission with end-stage pulmonary fibrosis, hypoxaemia (oxygen saturations 82% in the ambulance) and chest infection. He has been under the care of the community nursing team who have provided nursing support and home oxygen therapy. Mr. Hunter’s condition continues to deteriorate. He is on 15 litres oxygen via the non-rebreather mask to maintain oxygen saturations > 94%. His severe dyspnoea renders him immobile and barely able to eat. At night he becomes quite restless and distressed by his breathlessness. Whilst in hospital he has been under the care of the palliative care team who prescribed Morphine elixir 2.0-2.5 mg PO PRN nocte to alleviate the distress associated with his dyspnoea.
Mr. Hunter developed a fever of 38.0oC two days ago and has chills and bloody, jelly-like sputum. Culture and sensitivity on Mr. Hunter’s sputum specimen reveals Streptococcus pneumoniae and Klebsiella pneumoniae and he is diagnosed with hospital acquired pneumonia. Mr. Hunter was previously prescribed Amoxycillin (Amoxicil, Alphamox) 500mg capsules PO TDS and Clarithromycin (Clarac, Klacid) 500mg PO BD for his chest infection and he has diarrhoea associated with the macrolide antibiotic therapy. Laboratory tests from a stool sample confirm that he has Clostridium difficile (C.difficile) infection. The Klebsiella pneumoniae infection poses a serious risk to Mr. Hunter of further
deterioration in lung function and of developing an empyema. Klebsiella infection is seen in elderly hospitalised patients who are already ill and immunocompromised and with underlying chronic lung disease. Since Klebsiella demonstrates antimicrobial resistance – the bacterium is intrinsically resistant to Penicillins and can acquire resistance to Cephalosporins – Mr. Hunter is commenced on an aminoglycoside and is prescribed gentamicin IV infusion.
Question 1- Explain why Mr. Hunter has the ‘superinfection’ known as C.difficile and describe the nursing care required to contain this infection.
Question 2 – Explain how aminoglycosides work to combat infection and why plasma drug concentrations of the aminoglycoside Gentamicin are monitored.
Question 3 – Relate what you know about how Gentamicin achieves its antimicrobial effect (ie. is antimicrobial efficacy dose-dependent or concentration-dependent) to explain the consequences of a ‘missed’ dose or giving a ‘late’ dose in an antibiotic treatment regime.
Question 4 – What is the nurses’ role in ‘antimicrobial stewardship?’ Examine the research literature in the USC library databases and choose at least 2 journal articles that discuss antimicrobial stewardship (AMS) in order to identify the nurses’ role in improving antimicrobial use in hospitals. Analyse the papers and summarise the main points.