Following a colostomy for colon cancer, Sam Smith, a 72-year-old male patient of

Question

Following a colostomy for colon cancer, Sam Smith, a 72-year-old male patient of Community Hospital with a history of adult-onset diabetes and renal insufficiency, felt more ill after going home. A blood test revealed MRSA, and he was readmitted to Community Hospital for treatment with IV vancomycin.

1.Write one short phrase that relates vancomycin to each of the subconcepts in the unit outline.

2.List what Mrs. Smith’s nurse is monitoring and why.

3. The physician’s order for vancomycin has no peaks or troughs; state what should the nurse ask the physician to order and why.

4.State how the nurse should use Beers Criteria.

Explanation / Answer

A. Methicillin-resistant Staphylococcus aureus (MRSA): MRSA screening test solely for the presence of MRSA and no other microbes. It is primarily used to identify the presence of MRSA in a colonized person so they can be treated to eliminate MRSA and prevent its spread to others. MRSA bloodstream infection (BSI) represents one of the most common healthcare associated infections seen by clinical pharmacists and result in significant morbidity and mortality. Like common S. aureus (SA), MRSA may cause deep (invasive) or life-threatening infections in some people. Because it is resistant to commonly used antibiotics, it can be harder to treat or become worse if the right treatment is delayed. MRSA is a specific "staph" bacteria that is often resistant to (is not killed by) several types of antibiotic treatments.

B. Vancomycin: It is used to treat serious bacterial infections. It is an antibiotic that works by stopping the growth of bacteria. This medication is usually given by injection into a vein. However, the form in vials may also be given by mouth to treat a certain intestinal condition (inflammation of the inner lining of the colon) that may rarely happen after treatment with antibiotics. This condition causes diarrhea and stomach /abdominal discomfort or pain. When vancomycin is taken by mouth, it stays in the intestine to stop the growth of bacteria that cause these symptoms. This antibiotic treats only bacterial infections.

C. Dosage Forms & Strengths: Capsule (125mg, 250mg), injectable solution (5mg/mL) and powder for injection (500mg 750mg).

D. Nurse is monitoring: the doctor asked nurse to monitor Mr Sam Smith because if any over dose of vancomycin can leads to serious side effects and leads to death. So while initial monitoring of patient can shows overdose signs due to this nurse monitored Mr Sam Smith.

E. Major Side Effects and nurse monitoring signs:

Bladder pain, bloating or swelling of the face, arms, hands, lower legs, or feet, bloody or cloudy urine, painful urination, dry mouth, fever, frequent urge to urinate, increased thirst, irregular heartbeat, loss of appetite, mood changes, muscle pain or cramps, shortness of breath, nausea or vomiting and numbness or tingling in the hands, feet, or lips.

F. Over dose: An over dose refers to when a person takes too much of a medication, whether accidental or intentional. Although it is possible to suffer from a vancomycin overdose, the signs of one are actually unknown. This signs of an overdose vary with different medications, and a person taking vancomycin might not know it if he is experiencing an overdose. The side effects of the medication might help in distinguishing between what is normal and what is abnormal when under vancomycin treatment. The most common side effect of vancomycin is an upset stomach. Less common side effects include back pain, musle pain and nausea, while side effects that are less common but more serious include bloody or watery diarrhea, ringing in the ears, and skin rash. A person who experiences any persistent or serious side effect doctor should start immediate treatment. So according to the given situation the physician’s order for vancomycin has no peak or troughs and nurse monitoring.

G. Beers Criteria: The Beers criteria was used in potentially inappropriate medication for Older Adults, commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults. The American Geriatric Society has updated the Beers Criteria list based on evidence-based recommendations. So by observing the patient position beer criteria were implemented.

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