COVID-19 Assignment

1015 Non-COVID Virtual Clinical Assignment Summer 2020

Laboure College

Summer 2020

Non-COVID-19 Virtual Clinical Assignment Infection

Course: NUR ____1015_____ Concept/Exemplar: ___Infection/ Clostridium difficile or C difficile_ Hours: __4.5___

Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.

Scenario: Please use your Pearson Text as reference

Date		Identify the 4 Top client findings requiring immediate follow-up
	J.J., a 79-year-old woman with a history of COPD and renal insufficiency, was hospitalized for pneumonia for over a month. While hospitalized, she received intravenous clindamycin and steroids. She was discharged a week ago on oral antibiotics and steroids. This morning, she developed severe, watery diarrhea that has a strong odor and abdominal pain. This evening, her daughter took her to the emergency department because J.J. had become extremely weak and drowsy, with some confusion. Her vital signs are: BP 100/68, P 118, R 24, T 100.5° F (38.1° C). Her daughter stated, “All of a sudden she had terrible diarrhea, about 8 or 9 times, and she said her belly hurt. She hasn’t eaten a thing all day, and I could not get her to drink anything.” An IV of 0.9% normal saline at 125 mL/hr. was started. Complete bed rest on the nursing care plan.	(NG NCLEX What matters most? Noticing) Tanner’s Clinical Judgement model

Chart View

Physician’s Orders: Normal saline IV at 125 mL/hr. Obtain stool specimen for culture, O&P and C. Diff PCR assay CBC, basic metabolic panel Admit to medical-surgical department Clear liquids as tolerated BRP with assistance only

1. Describe the correct way to obtain a stool specimen for these tests.

2. What problem is J.J. most at risk for because of the diarrhea? (NG NCLEX What matters most? Noticing)

3. Which signs and symptoms occur with fluid volume deficit? Select all that apply.

a. Weakness

b. Confusion

c. Decreased pulse

d. Increased urine output e. Dry mucous membranes

CASE STUDY PROGRESS

The Clostridium difficile PCR results are positive. The hospitalist visits J.J. and tells her daughter that J.J. has an antibiotic-associated C. difficile infection (CDI).

4. Explain CDI and the significance of the positive C. diff PCR result.

5. What likely led J.J. to develop CDI? (NG NCLEX What is most likely occurring? Interpreting)

6. How is CDI spread to others?

7. Describe the precautions needed for the suspected diagnosis of CDI to prevent the spread of disease.

8. As J.J.’s daughter leaves the room to go home, the nurse notices that she removed the gown and gloves without washing her hands afterward. Which action by the nurse is most appropriate?

a. Nothing, because the daughter is going home.

b. Ask the daughter to wash her hands when she gets home.

c. Remind the daughter to wash her hands immediately with soap and water.

d. Remind the daughter to wash her hands with the alcohol-based hand cleanser.

CASE STUDY PROGRESS

The hospitalist orders vancomycin, 250 mg PO 4 times a day. When the nurse comes in to give J.J. the first dose, her daughter asks, “If this was caused by an antibiotic, why is she getting another antibiotic now?”(Deliverable)

9. What is the nurse’s best response to the daughter’s question?

a. “You’re right! I’ll check with the hospitalist about this.”

b. “The antibiotic will cause the bowel’s normal bacteria to grow.”

c. “We need to make sure she does not develop pneumonia again.”

d. “This antibiotic works directly in the bowel to kill the organism that is causing the diarrhea.”

10. Which adverse effects are possible with oral vancomycin? Select all that apply.

a. Nausea

b. Tachycardia

c. Nephrotoxicity

d. Mouth irritation

e. Red rash on the face, neck, upper torso

11. True or False? Oral vancomycin is poorly absorbed by the GI tract.

12. J.J.’s daughter asks, “Can you give her some medicine to stop the diarrhea?” What is your response?

13. Which nursing action can be delegated to the unlicensed assistive personnel (UAP)? (What is your rationale?)

a. Perform regular assessments of the patient’s skin when bathing.

b. Review the patient’s record for allergies.

c. Discuss with patient common side effects of antibiotics.

d. Apply protective cream with perirectal care.

CASE STUDY PROGRESS

Over the next few days, J.J. continues to have frequent diarrhea stools. She is able to take some clear liquids, and she is less confused. She is able to make it to the bathroom for most of her bowel movements, but does have occasional incontinence.

14. List the top 4 problems that are high priorities in J.J.’s continued care. (NG NCLEX What interventions are needed immediately? Responding)

15. What interventions best meets the expected outcome of maintaining perineal skin integrity?

16. Complete a concept map on the care. (Deliverable)

CASE STUDY OUTCOME

J.J.’s diarrhea finally stopped after 5 days of treatment, and she started physical therapy (PT) to regain her strength. She was discharged to a skilled care facility to continue PT for strengthening and endurance.

Harding (2020) CS 125

“Think like a Nurse” questions

· What concepts are best defined by this assignment? Why?

· What did you learn from this assignment?

· What do you know now that you did not know prior to this assignment?

Submit Assignment: Upload deliverables to eLearning under the Coursework tab, labeled Non-COVID Clinical Assignment. · Assignment/scenario · ALT medication template · Concept map · Reflective journal

Rubric Criteria		Pass		Not Pass
Case assignment		Student demonstrates an understanding of the concept through complete and thoughtful answers to scenario questions and to the content within the deliverables..		Student does not demonstrate completion of scenario questions and deliverables.
Professionalism		Student completes and uploads virtual case assignments and deliverables in a timely manner.		Student does not complete and or uploads the virtual case assignment.
Comments Signatures and Dates:		Student		Faculty

Developed 6-2020 1