Question

Case Study - Questions at the bottom

Dorothy Payne (D. P.) is a 76-year-old female who was admitted to the hospital 2 days earlier with complaints of right lower quadrant abdominal pain. Her medical history includes type 2 diabetes mellitus. She was evaluated in the emergency department and sent to the operating room for an appendectomy 8 hours after coming to the hospital.

D. P.'s vital signs are temperature 38.4° C (101.2° F), P 96 and regular, R 22 and unlabored, BP 130/72, and pulse oximetry of 96% on room air. She rates pain in her right lower abdomen as 3 of 10, but with movement, the pain level increases to 8 of 10. She reports sharp, stabbing pain in the abdominal area around her incision site. Pain medication and position change relieve the pain. The skin around the incision is warm and red, and the area is tender to the touch. Laboratory results are WBC 20,000 (cells/mm³), Hgb 16 g/dL, Hct 47%, BUN 25 mg/dL, creatinine 0.8 mg/dL, K 4.0 mEq/L, blood glucose 150 mg/dL, and Na 142 mEq/L.

Treatment orders are as follows:

• Vital signs q 4 h and as needed (PRN)

• Regular diet with supplements twice daily

• Intake and output (I&O)

• Activity: Up with assist of one

• Right abdominal dressing: Dry sterile dressing, cleanse incision with sterile saline solution, change q 8 h

• Turn, cough, and deep breathe q 4 h while awake

• Incentive spirometry q 2 h while awake

• Antiembolism stockings while out of bed

• Sequential compression devices (SCDs) while in bed

• Complete blood count (CBC) every morning

• Fall precautions

• Physical therapy (PT) for ambulation daily

Medication orders are as follows:

• Continuous intravenous 5% dextrose in 0.45% normal saline (D₅/0.45 NS) at 50 mL/h

• Enoxaparin 40 mg subcutaneously daily

• Metformin 500 mg PO twice daily

• Hydrocodone 5 mg and acetaminophen 500 mg PO q 4 h PRN for pain

• Cefuroxime 750 mg IV q 8 h

Please answer the following questions related to the Case Study.

Questions:

1. Identify at least four diversity considerations related to D. P. and infection control.

2. List the techniques necessary to assess D. P.'s possible infection.

3. Write a goal for the nursing diagnosis of Risk for Infection; Supporting Data: break in skin integrity, chronic disease: diabetes mellitus.

4. Identify at least three nursing interventions with rationales for the goal for D. P.: Patient's incision will remain infection-free during hospitalization.

Answer 1

Appendectomy:

The surgical procedure for the removal of Vermiform Appendix, usually in case of Appendicitis.

1. Diversity considerations related to D.P and infection control:

Health care professionals should have an idea about the diversity considerations related to D.P and infection control as she undergone a surgical procedure. The major consideration should be;

* Her age: Ms D.P is 72 year old. When comparing with younger and adult people, elderly may have weaken immune system and less general health status. It may increase their susceptibility for easy infection at the surgical site.

* Medical conditions, especially Diabetes Mellitus( DM) , Type 2. Delayed wound healing is a characteristic feature of DM. This disease condition may cause poor  healing at the surgical site. Proper control of Blood sugar level is essential for infection control and proper healing.  

* presence of Surgical incision: Surgical incision is a major risk site for infection.

* Increased WBC count , is an indication for the presence of an infection .

2. Techniques to assess the infection:

* Observation: Observe for the signs of infection, such as

- Fever and chills

- Pus or drainage

- Bad smell from wound

- Pain or sore to toch

- Redness and hot to touch the area.

* Basic metabolic panel: to detect the underlying condition that can increase the wound infection and delayed wound healing.  

- Blood glucose test

- Complete blood count

- Increased WBC count is an indication of infection.  

* Wound culture: to detect any bacterial infections ( Staphylococcus Aureus )

3. Goal for Nursing Diagnosis: Risk for infection

Nursing Diagnosis: Risk for infection related to break in skin integrity and the presence of Diabetes Mellitus.  

Goal: Patient remains free of infection as evidenced by the absence of signs and symptoms of infection and normal vital signs . /

Patient's incision will remain infection - free during hospitalization

4. Nursing Interventions for the goal : Patient's incision will remain infection- free during hospitalization.

Interventions with rationale

* Monitor the signs of infection at the surgical site and general symptoms of infection; check for any drainage or pus from wound, erythema and edema at the site, fever etc.

to identify the presence of infection and to get a baseline information (rationale)

* Maintain strict aseptic techniques for the surgical site care and while dressing change:

Aseptic techniques reduces the chances of wound  infections  

* Perform hand hygiene before and after touching the patient:

Washing hands in running water with antiseptic soap can significantly reduces the microorganisms on hands or use an alcohol hand rub for the same effect.

* Encourage the patient to take protein and vitamin C rich food:

protein helps in tissue building and vitamin C increases healing of wounds.

* Educate the client regarding the importance of control of Hyperglycemia.

Increased glucose level in the blood may interfere with wound healing.

* Administer antibiotics and Antidiabetics as per physician's order.

Antibiotics to prevent infections and Antidiabetics to reduce the blood glucose level to normal.