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Chapter 10: Infection Control and Prevention

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Chapter 10: Infection Control and Prevention

6 problems · 0 figures

Case Study 10.1.1 §10.1 source ↗

Refer back to Chapter 8 Admission, Transfer, and Discharge and Chapter 9 Safety and Security for Unfolding Case Study Parts 1–4 to review the patient data. A 65-year-old patient who presented to the emergency department with chest pain and shortness of breath was diagnosed with a myocardial infarction and treated successfully with placement of two coronary artery stents. The patient has been staying on the cardiology unit for post-procedure observation for the last three days. In the last two hours, the patient has developed a cough and reports shortness of breath.

Past Medical History Medical history: Hypertension, type 2 diabetes, coronary artery disease
Family history: Mother deceased, father alive with severe dementia; two healthy sons in their early 40s
Social history: Previous divorce, married to current husband, George, for twenty years
Allergies: Latex
Current medications:

• Aspirin 81 mg PO once daily

• Metformin 500 mg PO twice daily

• Lisinopril 10 mg PO once daily

• Atorvastatin 30 mg PO once daily
Flow Chart Post Procedure Day 3
2000: Assessment
Blood pressure: 136/81 mm Hg
Heart rate: 110 beats/minute
Respiratory rate: 26 breaths/min
Temperature: 100.6°F (38.1°C)
Oxygen saturation: 88 percent on room air
Nursing Notes 2100: Assessment
Patient reported increased shortness of breath. Crackles noted in base of right lung. Patient experiencing dyspnea and anxiety. Productive cough with yellow sputum noted.
Recognize cues: What cues should the nurse recognize as most concerning?

Answer

The patient is exhibiting several concerning respiratory cues, including low oxygen saturation, crackles in the right lung, dyspnea, increased shortness of breath, and cough with yellow sputum.

Case Study 10.1.2 §10.1 source ↗

Refer back to Chapter 8 Admission, Transfer, and Discharge and Chapter 9 Safety and Security for Unfolding Case Study Parts 1–4 to review the patient data. A 65-year-old patient who presented to the emergency department with chest pain and shortness of breath was diagnosed with a myocardial infarction and treated successfully with placement of two coronary artery stents. The patient has been staying on the cardiology unit for post-procedure observation for the last three days. In the last two hours, the patient has developed a cough and reports shortness of breath.

Past Medical History Medical history: Hypertension, type 2 diabetes, coronary artery disease
Family history: Mother deceased, father alive with severe dementia; two healthy sons in their early 40s
Social history: Previous divorce, married to current husband, George, for twenty years
Allergies: Latex
Current medications:

• Aspirin 81 mg PO once daily

• Metformin 500 mg PO twice daily

• Lisinopril 10 mg PO once daily

• Atorvastatin 30 mg PO once daily
Flow Chart Post Procedure Day 3
2000: Assessment
Blood pressure: 136/81 mm Hg
Heart rate: 110 beats/minute
Respiratory rate: 26 breaths/min
Temperature: 100.6°F (38.1°C)
Oxygen saturation: 88 percent on room air
Nursing Notes 2100: Assessment
Patient reported increased shortness of breath. Crackles noted in base of right lung. Patient experiencing dyspnea and anxiety. Productive cough with yellow sputum noted.
Analyze cues: Based on the recognized cues, what do you think is going on with the patient?

Answer

Based on the cues, it can be inferred that the patient has developed pneumonia. Because the patient has been in the hospital for the last several days, this can be classified as a hospital-acquired infection.

Case Study 10.2.3 §10.2 source ↗

Refer back to Unfolding Case Study #2: Part 5 for a review on the patient data.

Flow Chart Post Procedure Day 3
2200: Assessment
Blood pressure: 132/79 mm Hg
Heart rate: 105 beats/minute
Respiratory rate: 22 breaths/min
Temperature: 100.6°F (38.1°C)
Oxygen saturation: 92 percent on 3 L nasal cannula
Diagnostic Test Results Chest x-ray: bilateral lung infiltrates present
Provider’s Orders 2230: New Orders
Collect sputum culture.
Administer vancomycin IV 15 mg/kg q8 hours.
Titrate supplemental oxygen to maintain saturation > 92 percent.
Initiate droplet precautions.
Prioritize hypotheses: How do you suspect the patient developed pneumonia while in the hospital?

Answer

The patient likely developed pneumonia through contact with infected droplets. This is most likely related to poor hand hygiene, one of the major causes of healthcare-associated infections. The patient may also have underlying health conditions that put them at an increased risk for developing infection.

Case Study 10.2.4 §10.2 source ↗

Refer back to Unfolding Case Study #2: Part 5 for a review on the patient data.

Flow Chart Post Procedure Day 3
2200: Assessment
Blood pressure: 132/79 mm Hg
Heart rate: 105 beats/minute
Respiratory rate: 22 breaths/min
Temperature: 100.6°F (38.1°C)
Oxygen saturation: 92 percent on 3 L nasal cannula
Diagnostic Test Results Chest x-ray: bilateral lung infiltrates present
Provider’s Orders 2230: New Orders
Collect sputum culture.
Administer vancomycin IV 15 mg/kg q8 hours.
Titrate supplemental oxygen to maintain saturation > 92 percent.
Initiate droplet precautions.
Generate solutions: What is the rationale for each of the provider’s orders?

Answer

The provider has ordered a sputum culture to determine the causative agent of the pneumonia. The patient was started on vancomycin at first because it is a broad-spectrum antibiotic. However, once the sputum culture comes back, the antibiotic may be changed to one that is more specific for the type of pathogen causing the infection. Supplemental oxygen was ordered because the patient is experiencing shortness of breath and dyspnea secondary to the infection. Droplet precautions have been initiated to prevent the spread of infection to staff and other patients on the unit.

Case Study 10.4.5 §10.4 source ↗

Refer back to Unfolding Case Study #2: Part 5 for a review on the patient data.

Diagnostic Test Results Sputum culture positive for methicillin-resistant Staphylococcus aureus (MRSA)
Provider’s Orders 2230: New Orders
Infectious disease consult.
Titrate supplemental oxygen to maintain saturation > 92 percent.
Continue droplet precautions.
Take action: The nurse is preparing to enter the patient’s room. What personal protective equipment (PPE) is appropriate?

Answer

The patient has been placed on droplet precautions, which requires the nurse to wear a mask when entering the room. If the patient requires transport outside of the room, the nurse should ensure the patient is wearing a surgical mask.

Case Study 10.4.6 §10.4 source ↗

Refer back to Unfolding Case Study #2: Part 5 for a review on the patient data.

Diagnostic Test Results Sputum culture positive for methicillin-resistant Staphylococcus aureus (MRSA)
Provider’s Orders 2230: New Orders
Infectious disease consult.
Titrate supplemental oxygen to maintain saturation > 92 percent.
Continue droplet precautions.
Evaluate outcomes: What findings would indicate that the patient’s condition is improving?

Answer

Findings that would indicate an improvement in the patient’s condition include improved oxygen saturation with less supplemental oxygen needed, improved crackles in the lungs, no fever, normal respiratory rate, and improvement in shortness of breath. If the patient is not improving, it may require a change in antibiotics because the patient has MRSA, which is resistant to several kinds of antibiotics.

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Problems and answers are adapted from Fundamentals of Nursing by Christy Bowen, Lindsay Draper and Heather Moore, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/fundamentals-nursing/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.