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Susan Smith 41 y/o Female Primary Diagnosis: Presumptive MRSA &…
Susan Smith
41 y/o
Female
Primary Diagnosis:
Presumptive MRSA & Infective Endocarditis
Pt. is guarded
Possible complications
Cardiac Arrest
Manifests as...
chest pain
unconsciousness
no pulse
no or rapid decrease in pulse
altered mental status
begin CPR if protocol fits
administer ordered medications
Call provider
supply oxygen/ breaths
Spread of infection/ unable to treat infection with antibiotics
(SEPSIS)
Manifests as...
fever
fatigue
hypotension
pain
SOB
hypotension treatment
antibiotic treatment
fluids for hydration
Treatment
Telemetry ON
Apply O2 to maintain sats >88%
2 gram sodium, Cardiac, Consistent Carbs Diet
Insert Foley Catheter
Diabetes Management per protocol
IV NS 125 mL/hr to maintain SBP > 110
MRSA
contact precautions
Risk of acute HF
Risk for cariogenic emboli
Full Code
Medications
Vancomycin 1 g in 250 mL IV @ 9 am (first dose)
Acetaminophen 650 mg q 6 hrs (1000/1600/2200/ 0400)
PRN Medications
Dilaudid 1-2 mg IVP PRN q 2 hrs for severe pain (level 6-10)
Oxycodone 10 mg PO PRN 4 hrs for mild to moderate pain (level 1-5)
Labs
CBC w/ diff
CMP; monitor K and MG
PT/INR/PTT
Cardiac Enzymes x 3 sets (0300/0900/1500); indicates cardiac ischemia
UA w/cx
Urine Tox Screen; evaluate kidney function
Blood CXs x2 sets: for MRSA
Diagnostic Tests
CXR; evaluates heart and lungs
TEE; evaluates heart structure and function
History of IV drug abuse
Pathophysiology
MRSA infection is caused by a staph bacteria that becomes resistant to many antibiotics. This makes it very difficult to treat.
Endocarditis forms when the bacteria enters the bloodstream and vegetates on the heart valves, causes damage and inflammation.