This paper intends to prepare a lab report on the simulation activity scenario that proceeded with the effective planning of the medication intervention. The medical intervention was designed to help the patient Bobbi Telfer with her leg wound.
As presented by the case study, the client is 40 years old and works as a senior scientist in a laboratory. She loves gardening and volunteers to teach gardening skills to kindergarten children once in a week. The client stays alone and is reported to have been separated from her partner a year ago and lost her child because of SIDS. The medical history reveals the client to have developed gestational Diabetes at 20 years and suffer from chicken pox at the age of 3.
At present, Bobbi is suffering from a leg wound that has shown no signs of recovery since the last three weeks. The client complains of intense pain around the wound area accompanied with feelings of fatigue and exhaustion. The client is to be administered IV antibiotic and is being visited by the primary nurse, documenting nurse and the treatment nurse.
It should be mentioned here that the facts presented in the case study reveals the episode of an adverse drug reaction. Adverse Drug Reactions are associated with a large number of patient morbidity and mortality owing to the manifestations of severe allergic reactions.
The medication would be designed on the basis of the subjective and objective signs and symptoms that were studied during the clinical simulation scenario. The objective and the subjective signs would be discussed under the following subheadings;
The last vital assessment recorded prior to the administration of IV antibiotic revealed the heart rate to be 85 beats per minute and the respiratory rate to be 24 breaths per minute. The blood pressure recorded was 91/61 and the temperature recorded was 37.4 degree centigrade. The SpO2 that was recorded was 97% and the
IVT was 0.9%. The NaCl was documented to be at the rate of 4/24 per hour and administration of Oxygen at 2litre/min was carried out via nasal specs. This clearly revealed that the blood pressure was normal but the respiratory rate was slightly elevated. The recorded pulse and temperature were also within the normal range. The SpO2 level was also within the normal range and hence it reflected that there were no presence of abnormalities or impact of allergic reactions.
After the administration of IV antibiotics Benzipenicillin Sodium at the station, a significant change in the next set of vital sign assessment was noted. The heart rate was recorded to be 108 beats per minute, the respiratory rate was recorded to be 26 breaths per minute. In addition to this the blood pressure recorded was 100/65 and the temperature recorded was 37.4 degree Celcius. The documented SpO2 was 98%. The vital assessment revealed elevated elevated blood pressure, pulse rate, temperature and respiratory rate which signifies the fact that there might be a possibility of an allergic reaction.
The vital sign assessment was again carried out after stopping the antibiotic dose. The heart rate was recorded to be 92 beats per minute and the respiratory rate recorded was 20 breaths per minute. The recorded blood pressure was 109/71 and the temperature was recorded to be 37.4 degree Celcius. The SpO2 was 98%.
The subjective signs that were recorded included the redness of the skin. The client reported to feel an itching sensation and the manifestation of rashes were seen to spread. The client’s respiratory rate was going up which meant that either there was a drug overdose, a response to an allergic reaction or pulmonary infection. She was made to sit comfortably on the bed in an elevated posture. The client was seen to panic and that could be the primary reason for her respiratory rate to significantly rise up. The recorded blood pressure rate after the vital assessment was considerably high which indicated that the allergic reaction caused inflammation which restricted the blood flow and increased the blood pressure level. The patient was seen to feel an intense irritation and itching sensation around the area where the antibiotic was administered. Studies reveal that the administration of the drug Benzi Pencillin Sodium is characterized by the manifestation of allergic histamine reaction that causes side-effects such as elevated blood pressure, interference with drug activity and manifestation of allergy (Aldeek et al. 2016). Benzi Pencillium is used as an antibiotic to treat a number of bacterial disorders that involve the infection caused by a Gram-positive bacteria (Aldeek eta l. 2016). However, studies reveal that the drug has the potential to treat a handful of infections caused by both gram positive as well as gram negative bacterial strains (Bessaet al. 2015). Usually Benzi Penicillin Sodium is used as a convenient wide-spectrum antibiotic that can help in curing a broad range of bacterial infections. It is extremely important to administer the correct dose of the drug and at the same time also ensure that drug is being given in a continued process (Franklin and Snow 2013).
It is extremely important to administer the correct dose of the drug and at the same time also ensure that drug is being given in a continued process as the drug administration regulations of the country and it is important for the nursing practitioner to comply with the regulations (Franklin and Snow 2013). It should also be noted prior to the administration of the drug that the patient does not have an allergy history or cardiac and renal complications as in these cases the drug has reported be ineffective. As is evident from the vital sign assessment, it can be said that the patient is encountering a histamine reaction which is basically an allergic reaction characterized by the manifestation of symptoms of allergy (Ilkit, Durdu and Karaka? 2012).
At this instance, it is extremely important to administer effective care to the client so as to prevent the situation from worsening. The first thing would encompass of immediately ceasing the administration of IV antibiotic, as this could be one of the major reason for the adverse drug reactions seen in the patient’s health.. Further, the drug dose should be checked thoroughly along with the time duration of the dose and the IV administration sites (Barry, M.J. and Edgman-Levitan 2012). Further the patient must be handle with care and must be educated about the underlying reason that has led to the cause of allergic symptoms (McNeil et al. 2015). As per the World Health Organisation, few steps should be followed such as: collecting patient information for further medications, collecting patient outcomes and a drug susceptibility test (Blood culture) should be conducted so that the antibiotic reactions and adverse effects could be understood (Barry, M.J. and Edgman-Levitan 2012). The patient must be enlightened about the fact that her body is not compatible with the administered drug and as a result of which she has encountered a histamine reaction (Wang et al. 2013). Histamines releases several chemical in the body and hence, they creates conditions due to which contraction of smooth muscles of liver, uterus, kidney and lungs and stomach. It also lowers blood pressure, and due to this gastric acids starts secreting in stomach creating adverse conditions (Franklin and Snow 2013). Further, the patient should be made to lie down comfortably and another set of vital assessment should be done so as to detect the changes in her vitals in the unstable state such as changes in her blood pressure, her pulse rate, her respiratory rate, her heart condition and adverse conditions (Ilkit, Durdu and Karaka? 2012). This assessment would help in comparing the assessment along with the prior recorded assessment and accordingly devise medication.. The abnormality in the vital assessment and the physiological reaction to the allergic reaction of the patient must be recorded and documented for reference.
Further, it is important to understand the pathway that leads to allergic reaction in the patient and caused several severe reactions in her body that increases the severity of her health condition (Romano et al. 2018). The drug Penicillin sodium G is the primary reason for the severe health condition. however, it is one of the most effective drugs to help the patients with localized bacterial infections and hence, the health professionals used this drug for the health and well being of the patient (Trubiano and Phillips 2013, Bourke et al. 2015). However, due to lack of proper health history professionals were unable to understand that the patient has heart condition as well and hence, the drug can possibly cause severe health condition in her (Albin and Agarwal 2014). The drug may cause inflammation by three ways such as by causing hyper sensitivity, causing metabolic reactive and by causing protein or peptide conjugates (Bourke et al. 2015). As the protein is presented to the antigen presenting cell, it activates the T cells and then eventually the antigen specific T cells are created which is further engulfed by the macrophages and then causes inflammation, this was the process which occurred during histamine reactions and affects the circulation process. Therefore, this was the primary reason due to which the localized infection such as hives, and rashes were seen in case of the patient and causes the hypersensitive reactions (Stone et al. 2014, Bourke et al. 2015).
Therefore, in this aspect the role of healthcare professionals becomes more critical as the patient is suffering from infection, infection reactions and adverse drug reactions together together. Therefore, the healthcare professionals need to decide the escalation of the treatment (Stone et al. 2014). In this aspect starting from pharmacist, documentation nurse, primary and treatment nurse, and healthcare physicians everyone has their specific role and responsibility to make the patient condition better. In this case, the nursing and physician professionals should discuss with multidisciplinary team so that the escalation of the treatment could be decided (Wang et al. 2013). The first priority should be lowering the drug reaction and for that the patient should be provided with anti-histamine drug so that in several time her health condition could be improved and then her infection and other health conditions such as diabetes. Further due to the allergic reaction it could also be determined that she is also suffering from health condition and hence, medication intervention should include this as well (Bourke et al. 2015).
Conclusions
The assignment discussed the case study of Bobby Telfer who was admitted to the healthcare facility for her health condition improvement and leg wound injury (Montañez et al. 2015). In this situation the healthcare professionals conducted her health assessment and provided her with medication however, in a situation, the health condition of the patient worsened due to the allergic reaction of the drug (Tannert et al. 2017). Therefore, it is recommended that the patient should be able to provide her complete medical history to the professionals so that while determining assessment they can understand the drugs which can be used for the treatment of her wounds. Therefore, in the lack of that the drug penicillin sodium G was provided to the patient that led to such infection (Montañez et al. 2015). It should also be noted here that the patient should be involved equally in the clinical decision making process and in collaboration with the unanimous decision made by the professionals present at the clinical setting, an appropriate intervention must be developed. Then the healthcare professionals using their multidisciplinary team were able to decide the escalation of the care and provide an evidence based care to the patient. Hence, in this case they were able to provide an active and appropriate care to the patient and improve her health condition. Therefore, in conclusion in could be said that the patients should provide complete health details to the healthcare facility and their ailments as it can affect their health negatively (Tannert et al. 2017). Besides that, the professionals were able to provide appropriate care and comply with the Australian guidelines of the patient care and autonomy for nursing and midwifery.
References:
Albin, S. and Agarwal, S., 2014, November. Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population. In Allergy and asthma proceedings(Vol. 35, No. 6, p. 489). OceanSide Publications.
Aldeek, F., Canzani, D., Standland, M., Crosswhite, M.R., Hammack, W., Gerard, G. and Cook, J.M., 2016. Identification of penicillin G metabolites under various environmental conditions using UHPLC-MS/MS. Journal of agricultural and food chemistry, 64(31), pp.6100-6107.
Barry, M.J. and Edgman-Levitan, S., 2012. Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), pp.780-781.
Bessa, L.J., Fazii, P., Di Giulio, M. and Cellini, L., 2015. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. International wound journal, 12(1), pp.47-52.
Bourke, J., Pavlos, R., James, I. and Phillips, E., 2015. Improving the effectiveness of penicillin allergy de-labeling. The Journal of Allergy and Clinical Immunology: In Practice, 3(3), pp.365-374.
Franklin, T.J. and Snow, G.A., 2013. Biochemistry of antimicrobial action. Springer.pp.111-115
Ilkit, M., Durdu, M. and Karaka?, M., 2012. Cutaneous id reactions: a comprehensive review of clinical manifestations, epidemiology, etiology, and management. Critical reviews in microbiology, 38(3), pp.191-202.
McNeil, B.D., Pundir, P., Meeker, S., Han, L., Undem, B.J., Kulka, M. and Dong, X., 2015. Identification of a mast-cell-specific receptor crucial for pseudo-allergic drug reactions. Nature, 519(7542), p.237.
Montañez, M.I., Najera, F., Mayorga, C., Ruiz-Sanchez, A.J., Vida, Y., Collado, D., Blanca, M., Torres, M.J. and Perez-Inestrosa, E., 2015. Recognition of multiepitope dendrimeric antigens by human immunoglobulin E. Nanomedicine: Nanotechnology, Biology and Medicine, 11(3), pp.579-588.
Romano, A., Valluzzi, R.L., Caruso, C., Maggioletti, M., Quaratino, D. and Gaeta, F., 2018. Cross-Reactivity and Tolerability of Cephalosporins in Patients with IgE-Mediated Hypersensitivity to Penicillins. The Journal of Allergy and Clinical Immunology: In Practice.
Stone, S.F., Phillips, E.J., Wiese, M.D., Heddle, R.J. and Brown, S.G., 2014. Immediate?type hypersensitivity drug reactions. British journal of clinical pharmacology, 78(1), pp.1-13.
Tannert, L.K., Mortz, C.G., Skov, P.S. and Bindslev-Jensen, C., 2017. Positive skin test or specific IgE to penicillin does not reliably predict penicillin allergy. The Journal of Allergy and Clinical Immunology: In Practice, 5(3), pp.676-683.
Trubiano, J. and Phillips, E., 2013. Antimicrobial stewardship’s new weapon? A review of antibiotic allergy and pathways to ‘de-labeling’. Current opinion in infectious diseases, 26(6).
Wang, P., Tang, Y., Dong, Z., Chen, Z. and Lim, T.T., 2013. Ag–AgBr/TiO 2/RGO nanocomposite for visible-light photocatalytic degradation of penicillin G. Journal of Materials Chemistry A, 1(15), pp.4718-4727
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