SBER Case Study
SBER CASE STUDY
As a result of being on several immunosuppressive medications, she should be isolated and not be with someone who has an illness. So this assignment is in appropriate. The two major complications of organ transplantation are rejection and infection. As part of the transplantation process, preventive tactics must be tailored to take into account local immunosuppressant regimens as well as technological techniques and a thorough understanding of the local patterns of infection (Fisherman, 2018). J.L. receiving tacrolimus (Prograf) because she got a heart transplant, so she is on immunosuppressant’s, this influence the assessment and we'd like to check for infection and rejection. Keep an eye on their temperature, and if they develop septic, keep an eye on their blood pressure and heart rate.
When Compare and contrast the signs and symptoms of organ rejection and sepsis that needs to assess for in J.L, in both cases there is fatigue and malaise, temp elevation and tachycardia. In sepsis the signs and symptoms are tachycardia, warmth redness, elevated lactic acid, hypertension and possible drainage while in organ rejection the signs and symptoms are Edema in lower extremities, dyspnea, weight gain, fluid retention and mild chest pain. The possible causes of the burning and what type of urine specimen obtained shows that she may be suffering from an undiagnosed urinary tract infection (UTI) and have a negative UA test.
Interpretation of J.L.'s UA results shows UTI as a result of high levels of white blood cells (WBC) and bacterial contamination in the urine. Urine nitrates are another indication of a UTI. Bacteria generate nitrates as a by-product of their normal metabolism (Bryan & Loscalzo, 2017). When the physician believes a urinary tract infection is the reason for J.L.'s symptoms band orders IV levofloxacin (Levaquin) 500mg every 24 hours the primary nursing concerns for J.L. at this time is for our patient to not go septic it will cause issues for her heart. Considering J.L.'s urinary infection and her immunosuppressed status, the other interventions should you implement when caring for J.L is to check vitals, to take neutropenic measures, and to check labs, stringent I/O, daily weight, dyspnea?, do your lungs sound moist when you breathe? Avoid fresh fruits and vegetables, and wash them thoroughly before eating them if you're on a low-sodium/cardiac diet. The three expected outcomes for J.L. as a result of the interventions. WBC returns to normal, weigh within normal limits, no longer showing signs of sepsis or infection and no adverse reaction to the antibiotics.
Interpretation ofJ.L.'s urine C&S results clearly shows that she has a staph infection and that those are the drugs that may be used to treat it. According to Brown et al (2019) the immediate action is to notify the doctor about the results and double-check that the patient is not allergic to any of the drugs, and stop the Levaquin because it is ineffective against the illness and begin the next antibiotic. Description of the transmission-based precautions needed to institute for J.L is to begin MRSA contact precautions. You will put on a robe, gloves, and practice good hand hygiene. Ascertain that she has her own room, blood pressure machine, and stethoscope. Before leaving the room, ensure that all of the equipment has been sterilized. other information needs to aware before beginning the vancomycin is any drug allergies she may have, as well as her baseline kidney function levels. Ensure that the PICC line is patent-protected.
Interventions that needs to be implemented to safely administer vancomycin are; If J.L. complains of tinnitus, hold the infusion, after each injection, take a trough level 6 hours later (Berman et al., 2018), keep track of urine output, BUN, and creatinine levels, replace the PICC line every 48 hours, give each infusion for at least 1 hour and lastly during the infusion, keep an eye out for the start of hypertension.
During discharge, J.L. says that her husband's parents gave her son a pet cat. She jokingly says, “They gave him the play and me the work! Because of the risk of exposing her to a virus or sickness, in this case I will ask the husband to keep the litter box clean. The cat's toxoplasmosis might put her in much more danger. Reinforced teachings regarding things J.L. can do to protect herself from infection are to put on a mask, continue your antibiotic treatment at home, hand hygiene is essential, nutritional instruction, fresh veggies should be washed and she should keep herself hydrated. Be on the lookout for symptoms such as a high fever, any discharge, warmth or redness, an increased heart rate or blood pressure, indicators of an infection such as a UTI or URI, an ear infection or a throat infection, and know when to call a doctor. J.L statement “I will drink a minimum of eight glasses of fluid per day.” Showed she had understood the instructions.
References
Bearman, G., Abbas, S., Masroor, N., Sanogo, K., Vanhoozer, G., Cooper, K., ... & Edmond, M. B. (2018). Impact of discontinuing contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: an interrupted time series analysis. infection control & hospital epidemiology, 39(6), 676-682.
Brown, N., Darby, W., & Coronel, H. (2019). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing, 30, 1-6.
Bryan, N. S., & Loscalzo, J. (Eds.). (2017). Nitrite and nitrate in human health and disease (pp. 21-31). New York, NY: Humana Press.
Fishman, J. A. (2017). Infection in organ transplantation. American Journal of Transplantation, 17(4), 856-879.
