Safe and Effective Care Environment Q 8
The home health nurse is planning for the day’s visits. Which client should be seen first?
A. The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube
B. The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension
C. The 50-year-old with MRSA being treated with Vancomycin via a PICC line
D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter
Correct Answer: Answer: D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter
The client at highest risk for complications is the client with multiple sclerosis who is being treated with cortisone via the central line. Multiple sclerosis is a complex disease process. In addition to sensory and visual changes, weakness, coordination problems, or spasticity can present. Other complaints relating to overall health include bladder and bowel dysfunction, depression, cognitive impairment, fatigue, sexual dysfunction, sleep disturbances, and vertigo. The others are more stable.
Option A: This client is more stable and can be seen later. Although PEG is a relatively safe procedure, acute and chronic complications have been reported, including early mortality. Pih et al conducted a single-center study aimed at determining risk factors associated with complications and 30-day mortality after pull-type (n = 139) and introducer-type (n = 262) PEG.
Option B: The client is already discharged and has discharge medications given. Prognosis of pneumonia depends on many factors including age, comorbidities, and hospital setting (inpatient or outpatient). Generally, the prognosis is promising in otherwise healthy patients. Patients older than 60 years or younger than 4 years of age have relatively poorer prognosis than young adults.
Option C: MRSA is Methicillin-Resistant Staphylococcus Aureus. Vancomycin is the drug of choice and is given at scheduled times to maintain blood levels of the drug. Intravenous vancomycin is the drug of choice for most MRSA infections seen in hospitalized patients. It can be used both as empiric and definitive therapy as most MRSA infections are susceptible to vancomycin. There are sporadic cases of vancomycin-resistant MRSA. The dosage depends upon the type and severity of the infection.