NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
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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 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 the 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. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
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, 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
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 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 (NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals)
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 was started on ciprofloxin 3 days ago but her symptoms have continued to worsen. Her past medical history includes hypertenstion, hypothyroidism. She underwent a right knee replacement 2 weeks ago. Current medications include lisinopril, ciprofloxin, and rivaroxaban. Her current symptoms include fever, chills, productive cough with purulent green sputum, and worsening shortness of breath. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
- 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
How would you treat this patient?
Decision Point One
Discontinue the ciprofloxinStart levofloxin 750 mg IV every 24 hours
Discontinue the ciprofloxinInitiate piperacillin/tazobactam 4,5 g IV every 6 hours,
tobramycin 5 mg/kg IV every 24 hours,
and vancomycin. 15 mg/kg every 12 hours
Continue the Ciprofloxinand add Meropenem 1 gram IV every 8 hours
Decision Point One
Discontinue the ciprofloxinInitiate piperacillin/tazobactam 4,5 g IV every 6 hours,
tobramycin 5 mg/kg IV every 24 hours,
and vancomycin. 15 mg/kg every 12 hours
RESULTS OF DECISION POINT ONE
Correct!
This patient meets the criteria for hospital acquired pneumonia (HAP) due to her surgery 2 weeks ago and inpatient stay at the rehabilitation facility. She is at risk of drug resistant bacteria and MRSA. . A three drug combination for broad spectrum coverage is indicated until culture and sensitivity report on her sputum is available and antibiotic deescalation can occur.
The patients culture and sensitivity report for sputum and blood culture is now available. Utilizing this information, what adjustments to the patients antibiotics would you make?
WHAT ADJUSTMENTS WOULD YOU MAKE?
Discontinue the Tobramycin and VancomycinContinue the piperacillin/tazobactam
Discontinue the Tobramycin, Vancomycin, and piperacillin/tazobactamBegin Cefoxitin
Decision Point Two
Discontinue the Tobramycin and VancomycinContinue the piperacillin/tazobactam
RESULTS OF DECISION POINT TWO
- Correct!
- The sensitivity report indicates that the bacteria in the sputum and blood is sensitive to piperacillin/tazobactam. Continuing it and discontinuing the other antibiotics will still provide good coverage for this infection. A full 10 day course would be indicated.
- The patient condition is improving and she requests to have her IV removed and go home.
HOW WOULD YOU MANAGE HER CARE?
Place a PICC and complete an assessment to see if discharge home or to the rehabilitation facility is a safe option for her to continue the 10 day treatment course.Change her antibiotic to an oral cephalosporin and send her home.The patient should remain in the hospital for the full 10 days of IV antibiotic treatment.Decision Point Three
Place a PICC and complete an assessment to see if discharge home or to the rehabilitation facility is a safe option for her to continue the 10 day treatment course.Guidance to Student
Correct!
The patient needs to receive a 10 day course of IV antibiotics.
Inpatient hospitalization is not required as long as there is available resources at home or in another facility.
Submission and Grading Information. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “MD5Assgn+last name+first initial.(extension)” as the name.
- Click the Module 5 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Module 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD5Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
Grading Criteria
To access your rubric:
Module 5 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Module 5 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 9
To participate in this Assignment:
Module 5 Assignment
Knowledge Check: Infections, Antimicrobials, and Antifungals
Complete the 10-question Knowledge Check to gauge your understanding of this module’s content.
Photo Credit: Getty Images
Complete the Knowledge Check
Rubric Detail – NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
Select Grid View or List View to change the rubric’s layout.
| Excellent
Point range: 90–100 |
Good
Point range: 80–89 |
Fair
Point range: 70–79 |
Poor
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 and 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 2 of 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 2 of 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, includes 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. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
|
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 include 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 include 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 include 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. Be specific 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 indication for consult (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. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
|
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 address age-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 Required Follow-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 includes non-professional level resources to support their admission order set. APA format is incorrect.
|
0 (0%) – 4 (4%)
The order set is missing 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 meets the complete needs of the patient. |
5 (5%) – 5 (5%)
Written order set is complete, addresses all the needs of the patient, and are 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 are missing 3 to 4 essential elements are reflect an incorrect standard of care. NRNP 6566F Week 9: Infections, Antimicrobials, and Antifungals
|
0 (0%) – 2 (2%)
Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care.
|
| Total Points: 100 |
|---|