Question

Patient Introduction

Location: Orthopedic unit 0800

SBAR report from a night nurse:

Situation: Jared Griffin is a 63-year-old African American male who had a right total knee arthroplasty (TKA) yesterday morning.

Background: Mr. Griffin has a history of MRSA, which was diagnosed 3 years ago when he had surgery for a hammertoe. A nasal swab was done in the office during his recent preoperative check that came back positive for MRSA. Decolonization protocol was initiated prior to the admission for the total knee procedure and he is currently under contact precautions per hospital policy. He has a history of osteoarthritis and mild hypertension.

Assessment: Mr. Griffin is afebrile with a temp of 37.2 °C (99.8 °F), and vital signs have been stable during the night. Pain level has been at a 2-3. He has dangled his feet off the side of the bed and will have physical therapy in his room at 1000. He has been able to bend his knee to a 75-degree angle and the goal is 90 degrees. The surgeon changed Mr. Griffin’s dressing, and discontinued the drain and IV fluids, at 0700 on his morning round. His labs just came up, but I haven't had a chance to look at them yet.

Recommendation: You'll need to go in and do your morning assessment. Continue with contact precautions and observe for signs and symptoms of infection.

Fundamentals of Nursing Care

Taylor, C., Lynn, P., Bartlett, J. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care, 9th Edition. Medical-Surgical Nursing Care Asepsis and Infection Control, Chapter 24, pp. 594-637Medical-Surgical Nursing Care Components of a Neurovascular Assessment, Chapter 26, p. 721, Box 26-7Medical-Surgical Nursing Care Postoperative Nursing Care, Chapter 30, pp. 958-966

Diseases and Conditions

Expert Clinical Content from Lippincott Advisor

Methicillin-resistant Staphylococcus aureus

Pharmacology

Expert Clinical Content from Lippincott Advisor Pharmacology

Clindamycin hydrochloride Pharmacology

Oxycodone hydrochloride-acetaminophen Pharmacology

Enoxaparin sodium

Diagnostics

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White blood cell count and differential Pharmacology

Red blood cell count Pharmacology

Hematocrit test Pharmacology

Hemoglobin level test Pharmacology

Red blood cell indices Pharmacology

Platelet count Pharmacology

Blood urea nitrogen level test

Procedures

Expert Clinical Content from Lippincott Procedures Pharmacology

Isolation garb, donning Pharmacology

Isolation garb, removal Pharmacology

Hand hygiene

1. Document your finding related to Mr. Griffin's preoperative and postoperative assessment findings regarding the presence of an infection.

2. Identify and document key nursing diagnoses for Mr. Griffin regarding current condition.

3. Referring to your feedback log, document all nursing care provided as well as Mr. Griffin's response to this care, including responses related to infection control and the use of personal protective equipment (PPE).

4. Document your handoff report in the SBAR format to communicate Mr. Griffin's future needs.

Answer 1

1)Mr. Griffin is a MRSA positive patient so there is more chances for surgical site infection. To prevent further infection need to do pre-opreactive and post-operative assessment.

Preoperative assessment:-

-pre-operatively microbiological swab collected and it was positive for MRSA.

-Decolonization protocol was initiated prior to the admission.

-He is currently under contact precaution.

Post operative assessment:

- Patient having mild fever and pain. His vitals are stable.

- He is under antibiotics and also having medication for fever and pain.

-Surgeon changed dressing and Disconnected drain and iv fluids.

-contact precaution is continuing.

2) Nursing Diagnosis

- Risk for infection.

- Acute pain.

-Impaired physical mobility.

3) Nursing care

- provide mobility of the leg. He has to bend lend for 90degree Angle now patient can able to bend 75 degree angle.

-pain management by providing comfortable position and medications.

-Monitor vitals.

-Ensure clean environment.

-Administer antibiotic to prevent infection.

-Encourage strict hand hygiene.

-Continue contact precaution use personal protective equipments to prevent transmission.

4)situation - Mr. Griffin 63yr old African American man had undergone TkA yesterday morning. He is positive for MRSA.

Background - He had undergone hammertoe surgery 3years before and also having history of mild hypertension and osteoarthritis. He is MRSA Ppositive for last 3years.

Assessment - He has afebrile for last night that is 37.2 degree Celsius. His vitals are stable. He can able to bend his leg up-to 75degree angle. Physio is going on. Surgeon changed dressing and disconnected drain and iv Line in the morning. Lab reports are informed.

Recommendation- you can go in and do assessment. Continue contact precaution. Observe signs and symptoms for infection. Encourage mobility. Continue medication as per doctor's order.