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
A 57-year-old female client is admitted to the hospital with a left upper arm open wound infection (methicillin-resistant Staphylococcus aureus [MRSA]) and cellulitis. Use an X to indicate whether the nursing actions listed below are Indicated (appropriate or necessary), Contraindicated (could be harmful), or Non-Essential (make no difference or are not necessary) for the client’s care at this time.
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.
57-year-old female client is admitted to the hospital with a left upper arm open wound infection (methicillin-resistant staphylococcus aureus [MRSA] and several gram-negative bacteria) and cellulitis. The primary health care provider prescribes IV daptomycin and tobramycin to treat the infection. What health teaching will the nurse include for the client prior to administration of these drugs? Select all that apply. _____ A. “We will be monitoring you for any nausea or diarrhea that may occur when taking these drugs.” _____ B. “Please let a nurse know if you have any ringing in your ears or have problems hearing while you are taking these drugs.” _____ C. “We will be carefully monitoring your kidney function while you are on this drug therapy.” _____ D. “Although very rare, let us know if your muscles feel weak or you feel them tightening.”
_____ E. “We will be drawing blood frequently to measure drug levels to make sure they are effective.”
_____ F. “We will be changing the IV site often to prevent your veins from getting irritated.”
_____ G. “We will discontinue your maintenance IV after we make sure you don’t have nausea and your fever comes down.”
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
The nurse is reassessing a 57-year-old female client who was admitted to the hospital with a left up-per arm open wound infection (methicillin-resistant Staphylococcus aureus [MRSA] and several gram-negative bacteria) and cellulitis 5 days ago. Tomorrow she is scheduled for discharge to home with her daughter to continue oral antibiotic therapy for another 10 days. For each assessment finding, use an X to indicate whether the interventions were Effective (helped to meet expected outcomes), Ineffective (did not help to meet expected outcomes), or Unrelated (not related to the expected outcomes).
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.
A 57-year-old female client was admitted to the hospital with a left upper arm open wound infection (methicillin-resistant Staphylococcus aureus [MRSA] and several gram-negative bacteria) and cellulitis 5 days ago. Her wound is packed and requires a dressing change twice a day. Tomorrow she is scheduled for discharge to home with her daughter to continue antibiotic therapy for another week. What health teaching will the nurse include as part of the discharge instructions for the client and her daughter? Select all that apply. _____ A. “Use strict sterile technique when packing the wound and changing the dressing twice a day.” _____ B. “Stop taking the antibiotics when your arm feels better and is not reddened.” _____ C. “Notify your primary health care provider if your wound drainage is foul smelling or changes color.” _____ D. “Notify your primary health care provider if your diarrhea gets worse.”
_____ E. “Avoid strenuous activity and take frequent reset periods.”
_____ F. “Do not return to work until after your follow-up appointment.”
_____ G. “Notify your primary health care provider if your arm feels numb or becomes more painful.
