Question

In: Nursing

A 43 y/o Anglo male comes into the Emergency Department. He says he is a retired...

A 43 y/o Anglo male comes into the Emergency Department. He says he is a retired Special Forces veteran (since 2007) who has been teaching Chemistry 2009. He complains of malaise, fever, anorexia for three weeks. He states he has had that rash for several days. He denies having diabetes, kidney problems, stiff neck or headaches. He had a flu shot about three weeks ago. You weigh patient and find his weight to be 190 lb (86.3 kg).

Patient responds that his weight last month was 205 lb (93.2 kg). He says food does not taste and smell the same. On physical exam, you note patient has temperature of 38oC, presents with petechiae on his left shoulder, nodules on his left and right fingers which are sensitive to touch, and macules on his palms and soles. His eyes are clear, with optic cup unremarkable. Auscultation of lungs is unremarkable, but heart indicates some murmurs—a grade 3/6 diastolic murmur.

The patient admits that he recently started using his kitchen and bathroom water to prepare intravenous drugs, and he was making methamphetamine. A flu PCR was negative. Antibody tests and PCR for Covid-19 were both negative. Several blood cultures were performed, and five of the seven were positive for Gram-negative bacilli, and were oxidase positive; oxidized fructose and mannitol. The patient was later placed on an antibiotic regimen.

Bacteria were tested by Kirby–Bauer antimicrobial susceptibility testing; organisms were resistant to aminoglycosides, colistin (Polymixin E) and polymixin B. The organism is aerobic, grows on MacConkey agar, motile with polar or amphitrichous flagella, reduces nitrate but not nitrite, and is urease negative.

1.What is your differential diagnosis?

2. What questions should you ask the patient about his medical history?

3. Given patient’s signs: a. what might the patient have, and what is your rationale? b. What general treatments and tests should be performed next? c. What organisms should be suspected--name at least three?

4. What was the final diagnosis of the patient?

5. Identify this organism—what other non-medical property does it have?

This is all the information I was given.

Solutions

Expert Solution

ANSWER :

1.What is your differential diagnosis?

· Risk for infection

2. What questions should you ask the patient about his medical history?

Ask the patient about the medical history of recent exposure to newer environment,tours,habitual history,past medical history,socio economic history,source of water for drinking.

3.. Given patient’s signs: a. what might the patient have, and what is your rationale? b. What general treatments and tests should be performed next? c. What organisms should be suspected--name at least three?

Patient signs includes

  • Patient has temperature of 38oC,
  • Presents with petechiae on his left shoulder
  • Nodules on his left and right fingers which are sensitive to touch
  • Macules on his palms and soles
  • His eyes are clear, with optic cup unremarkable
  • Auscultation of lungs is unremarkable, but heart indicates some murmurs—a grade 3/6 diastolic murmur.

4. What was the final diagnosis of the patient?

General treatments and tests should be performed next

  • · Tests that are frequently performed to help us with the diagnosis of a bacterial infection include a complete blood count and cultures of fluid that we are concerned about. This may include a blood culture, urine culture, or spinal culture (which requires a spinal tap).
  • · Blood culture and urine culture
  • · Antibiotic treatment
  • · Sensitivity tests

Suspected organisms:

  • · Klebsiella pneumonia
  • · E-coli
  • · Serratia marcescens

The nursing interventions

The nursing interventions to help reduce the risk for infection includes implementing strategies to prevent infection, if infection cannot be prevented, the goal is set to prevent the spread of infection between individuals, and to treat the underlying infection.

5. Identify this organism—what other non-medical property does it have?

Aminoglycosides are frequently, although not uniformly, effective against multidrug-resistant Pseudomonas aeruginosa and Escherichia coli.


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