BMS: Integumentary Medications Case study
Name: A 57-year-old female client had a large mole removed from her left upper arm by a dermatologist in the office 2 days ago. She has a history of atrial fibrillation, chronic heart failure, diabetes mellitus type 2, and multiple lower back surgeries for persistent back pain. This morning the client asked her daughter to drive her to the emergency department (ED) for severe radiating 8/10 pain in her entire left arm. When the nurse removes the bandage from the area, the nurse notes that the skin and tissue around the wound are reddened, very swollen, and warm. The wound drainage is foul smelling and greenish yellow. The client’s current temperature is 100.6°F (38.2°C), and she is admitted to the hospital with left upper arm cellulitis. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the nurse’s assessment findings, the client is at risk for complications as a result of her cellulitis and wound, especially _________________1___________________ and _______________1________________. Assessment findings for which the nurse would monitor include _______________2___________________, __________________2___________________, ________________2_________________, and __________________2__________________.| Options for 1 | Options for 2 |
| Neurovascular compromise Myocardial infarction Diabetic ketoacidosis Sepsis Hyperkalemia Anemia | Increased temperature Chest pain Dyspnea Left arm tingling and numbness Leukocytosis Diminished left radial pulse |
| Nursing Action | Indicated | Contraindicated | Nonessential |
| Place the client on Contact Precautions | |||
| Apply cold compresses on her left upper arm. | |||
| Elevate the client’s left arm on a pillow. | |||
| Take a wound culture every shift to determine if the infection is improving. | |||
| Initiate IV access for the client to receive fluids and antibiotic therapy | |||
| Administer subcutaneous sodium heparin every 12 hours. |
A 57-year-old female client admitted to the hospital with a left upper arm open wound infection
(methicillin-resistant Staphylococcus aureus [MRSA] and several gram-negative bacteria) and cellulitis has been on IV daptomycin and tobramycin for less than 2 days. This morning she reports having frequent foul-smelling diarrhea and severe abdominal discomfort. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the nurse’s assessment, the client most likely has ___________1____________
as a result of antibiotic therapy. The most common drugs used to treat this problem are ____________2______________ and ______________2_____________. The nurse would remind the nursing staff to ______________3_________________ and ____________3_____________ to prevent transmission to other clients on the hospital unit.
| Options for 1 | Options for 2 | Options for 3 |
| Pseudomembranous colitis Crohn disease Clostridium difficile infection Viral gastroenteritis Diverticulitis Secondary bowel cancer | Clindamycin Cefoxitin Vancomycin Trimethoprim Metronidazole Tetracycline | Wear a mask when in the client’s room Use strict hand hygiene measures. Record the number of stools the client has each day Use strict Contact Precautions Teach the client to increase dietary fiber Restrict oral fluids for the client to decrease stools |
| Assessment findings | Effective | Ineffective | Unrelated |
| Client’s oral temperature this morning is 98°F (36.7°C) | |||
| Client reports mild pain in upper left arm at 2/10 on a scale of 0 to 10. | |||
| Client reports that she has had less diarrhea today than the past 2 day | |||
| Client’s early morning finger stick blood glucose (FSBG) was 97 mg/dL (5.4 mmol/L). | |||
| Client’s left upper arm slightly reddened when compared with right upper arm | |||
| Client reports that her back is achier since she came to the hospital. |