Today is the 25th February 2014 and the time is 1300hrs. You are admitting Mrs Paula Ramsden to the medical ward at Deakin Private Hospital. Mrs Ramsden is aged 68 years and has a past history of hypertension (diagnosed 15 years ago) and atrial fibrillation (diagnosed 12 months ago). She sustained an injury to her lower left leg almost a month ago. The wound has become infected and she now requires intravenous antibiotics in hospital after 3 weeks of oral antibiotics (erythromycin) at home. Mrs Ramsden is allergic to ‘penicillin’ (severe urticaria when she was a child). She says that in the last few weeks she began taking ‘Tipton’s weed’ (a herbal medicine) that the lady in the health food store said is good for her mood as she has been feeling “down of late”. She insists that the doctor prescribes her usual ‘Tipton’s weed’ as well as the “pain killer” she occasionally takes when she gets a sore back. The admitting doctor has written up the patient’s ‘usual’ medicines, antibiotics for the wound infection, hydrocortisone to reduce inflammation associated with the crush injury, an antidepressant and some pain relief. The orders are as they appear on the medication chart. When you get her settled, Mrs Ramsden’s son says she has been “feeling increasingly breathless in recent weeks”. You find her observations to be: Temperature: 39.10C (tympanic) Heart rate: 65 bpm irregular Respirations: 26 bpm Blood pressure: 165/95 mmHg O2 saturation: 96% on RA Height: 162 cm Weight: 65 kg You speak to the junior resident medical officer regarding Mrs Ramsden’s blood pressure, who orders the patient to commence Ramipril. Pathology Her pathology results are all within normal limits except for the following: Urea: 9.2 mmol/L (Acceptable values 2-8.5mmol/L) Creatinine: 0.18 mmol/L (acceptable values 0.06-0.11mmol/L) White cell Count: 15 x 109/L (acceptable values 4-10 x 109/L) Wound cultures are positive for gram negative bacilli Questions 1. Assess Mrs Ramsden’s medication chart. Discuss three (3) significant risks involved with Mrs Ramsden’s home and/or inpatient use of medicines. (Expect approximately 400 words) [21 marks] 2. Describe the strategies a nurse may take to prevent/manage the risks you have identified in Question 1. Your answer should focus on Mrs Ramsden’s needs rather than a discussion of these medicines in general terms. (Expect approximately 600 words) [30 marks] 3. The doctor has ordered three doses of hydrocortisone in the STAT medicine order section. Explain why the patient has been ordered multiple doses over the next 24 hours. Your answer should include relevant pharmacokinetic concepts. (Expect approximately 250 words) [9 marks] 4. Mrs Ramsden is prescribed antibiotics. Describe five (5) relevant nursing strategies that the nurse may utilise to reduce the risk of antibiotic resistance developing in Mrs Ramsden and/or the ward area. (Expect approximately 250 words) [10 marks]
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