Case studies: these case studies may appear to be challenging, but it is important to plan your work and undertake each case study in a systematic way.By adopting a systematic approach with each case,...

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Case studies: these case studies may appear to be challenging, but it is important to plan your work and undertake each case study in a systematic way.By adopting a systematic approach with each case, you will be able to develop appropriate therapeutic recommendations for each patient.



In your timetable there is a scheduled session to go through the case studies so that you are equipped to complete the assessment.



Note: you need to completeall four cases studies. You also have a summary question (maximum 150 words) at the end of the case studies that you need to complete. The summary question is an opportunity for you to describe how you have completed this assignment.



Remember that this assignment is worth 30% of your final grade. All questions are worth the same number of marks, different numbers of words may be required for different answers. You have a total of 1500 words for this assignment.






Tips to tackle these case studies




  1. Carefully read and think about the information included in the case study.


    • Take notes, highlight relevant facts, underline key problems.

    • Look up the meaning of words you don’t know and start a
      glossary
      for yourself.



A glossary is alistoftermsin asubjectwithaccompanyingdefinitions.





MedlinePlus is produced by the U.S. National Library of Medicine and provides authoritative information in clear non-medical language.




    • I have suggested by using italics some of the words you should be looking up. I have started a glossary for you on the next page.






  1. Focus your analysis


    • The questions that are asked are there to guide you. Answer the questions.






  1. Uncover possible solutions


    • Review course materials and outside research as suggested. Remember to reference the outside resources that you use.

    • Use APA referencing. References are included in your total word count

    • To reference correctly seehttp://rmit.libguides.com/nursing-referencing






  1. Select the best solution(s)


    • Consider strong supporting evidence, pros, and cons: is this solution realistic?




5.Answer the questions in the allotted spaces –The boxes will expand as you type.The final document, (cases, questions and your answers) should be uploaded on Canvas. The document should be uploaded as YOUR ID_FAMILY NAME.







EXAMPLE GLOSSARY(You will see that I have put the words in alphabetical order.)




Anterior

:
nearer the front, especially in the front of the body




Lymph node:
A small bean-shaped structure that is part of the body’s immune system. Lymph nodes filter substances that travel through the lymphatic fluid, and they contain lymphocytes (white blood cells) that help the body fight infection and disease. There are hundreds of lymph nodes found throughout the body. They are connected to one another by lymph vessels. Clusters of lymph nodes are found in the neck, underarm, chest, abdomen, and groin.




Oedematous:

An accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities.






CASE STUDY 1


Peter, a 76-year-old man, presented to outpatients—after having been referred by his general practitioner—with 6 weeks of intermittent lower abdominal pain, vomiting, anorexia, and
febrile
episodes.


He had been treated for a urinary tract infection by his general practitioner, with no improvement.


The computed tomography (CT scan) suggested
intestinal perforation
secondary to an ingested bone.The patient was taken to the operating theatre and a loop of intestine
resected
. Once the
incision
was closed, the patient was returned to the ward where he was treated with a number of different I.V. antibiotics.



Remember the tips to tackle case studies above.


















1



Consulting the Antibiotic Therapeutic Guidelines, select a course of suitable intravenous antibiotics for Peter and justify (explain) why this selection is the best option for Peter.


Include dosing information


Your Response



2



Justify (explain) why it is necessary to treat Peter with a course of multiple antibiotics.You will get some clues from the Antibiotic Therapeutic Guidelines, but you will need to research further


Your Response



3



Antimicrobial use may be prophylactic, empirical, or directed against a known organism.Explain whether Peter is receiving prophylactic, empirical, or directed therapy in this case.



You will need to consult the Therapeutic Guidelines and your course resources.


Your Response




CASE 2


Ralph is a 68-year-old male who was admitted to the hospital from his long-term care nursing home after 1 week of dyspnoea and cough. He was seen by a G.P. at the nursing home and was diagnosed with a COPD exacerbation. He was prescribed oral amoxycillin, but his condition did not improve after 3 days of treatment.


Upon admission to hospital, it was thought that Ralph had community acquired pneumonia (CAP).Ralph was prescribed a regimen of two different antibiotics - intravenousceftriaxone1 gonce a day, andoral doxycycline 100mg every 12 hours (twice each day).





















1



Consulting the Australian Medicines Handbook and the electronic Therapeutic Guidelines (eTG), justify (explain) why Ralph is being administered two different antibiotics at the one time after his admission to hospital.


Your Response



2



Explain why ceftriaxone is administered intravenously.


Your Response



3



Antibiotics have differing spectrums of activity. Describe the differences between the antimicrobial spectrums of amoxycillin and ceftriaxone + doxycycline?


Your Response





CASE 3


Penny, is a 50-year-old woman who has a has a history of rheumatoid arthritis and complicated diverticulitis. She had previously undergone a temporary colostomy and has subsequently undergone successful reversal of the colostomy.


After recovery and subsequent return to normal dietary activity, Penny continues to have some discomfort in the lower abdomen and develops a watery diarrhea. The diarrhoea persists despite several return visits to the specialist’s office. She is admitted to hospital so that she can have a series of tests to identify the cause of the diarrhoea. Penny is eventually found to test positive for aClostridium difficileinfection.























1



A medication history was taken when Penny was admitted to hospital to undergo her temporary colostomy. Discuss why it is important to take a medication history for new admissions.


Your Response



2



Consulting the Australian Medicined Handbook and the electronic Therapeutic Guidelines (eTG), select a course of suitable antibiotics for Penny and justify (explain) why this selection is the best option for her. Include the recommended dosing information.


Your Response



3



Penny is to be discharged from hospital. She will need to take her oral antibiotics for several days after discharge. You are the nurse who must counsel Penny about her discharge medication.


Outline the advice you will give Penny.


Your Response



4



Antimicrobial use may be prophylactic, empirical, or directed against a known organism.Explain whether Penny is receiving prophylactic, empirical, or directed therapy in this case.


Your Response



CASE 4


Alison is a healthy 28-year-old woman. She wakes early after a very disrupted night, in which she has needed to get up frequently to urinate, however each time she passed only a small amount of urine which feels as if it is “burning”.


Alison goes into a pharmacy onto her way to work. After she has described her symptoms to the pharmacist, she is advised to see a doctor. The doctor suspects that Alison has a urinary tract infection and gives her a prescription for antibiotics.Alison is heterosexual and has been sexually active since she was 18 years of age.She has been in a monogamous sexual relationship for the last 6 monthsand takes the oral contraceptive pill each day. She has not missed any pills this month. She is a social drinker and does not smoke.





























1



Consulting the Australian Medicined Handbook and the electronic Therapeutic Guidelines (eTG), select a course of suitable antibiotics for Alison and justify (explain) why this selection is the best option for her. Include dosing information in your answer.


Your Response



2



Taking some antibiotics may result in decreased protection from pregnancy by oral contraceptives.


·Explain how antibiotics may decrease protection from pregnancy by oral contraceptives.


·Decide whether this may be a concern for Alison, given your antibiotic recommendation, and explain your answer.


Your Response



3



Antimicrobial use may be prophylactic, empirical, or directed against a known organism.Explain whether Alison is receiving prophylactic, empirical, or directed therapy in this case.


Your Response



4



One week after the commencement of antibiotic therapy, Alison wakes early with uncomfortable symptoms again. She feels very itchy in the vagina and vulva, has a burning sensation while urinating and has developed a thick white, odour-free vaginal discharge. Identify the condition Alison may have developed and describe the most likely explanation for how this condition occurred.


Your Response



5



Consulting the Australian Medicines Handbook, select a course of suitable treatment for Alison and justify (explain) why this selection is the best option for her. Include the recommended dosing information.


Your Response










SUMMARY QUESTION









You are providing advice to a student who is taking this course in 2021. What advice do you provide to them about completing this assignment?


Your Response(maximum 150 words)






Answered Same DayApr 29, 2021

Answer To: Case studies: these case studies may appear to be challenging, but it is important to plan your work...

Tanaya answered on May 11 2021
132 Votes
Running Head: CASE STUDIES        1
CASE STUDIES        3
CASE STUDIES
Table of Contents
Case 1    3
Question 1    3
Question 2    3
Question 3    4
Case 2    4
Question 1    4
Question 2    5
Question 3    5
Case 3    6
Question 1    6
Question 2    6
Question 3    7
Question 4    7
Case 4    8
Question 1    8
Question 2    8
Question 3    8
Question 4    8
Question 5    9
Summary    9
References    10
Case 1
Question 1
In the case of Peter
, it is important to inject intravenous antibiotics. This will include Cefazolin of dosage 2 to 3 gm. This drug is recommended to be provided with a re-dose interval of 4. Cefazolin is known to be a cephalosporin antibiotic, which will help in the prevention of bacterial infection. Usually, the operated site is prone for bacterial infections, especially at the site of the incision (Therapeutic Guidelines, 2020).
This will help in protecting Peter from infecting from gram-positive bacteria as well as few gram-negative bacteria. In addition, Peter also needs to be administered with Ampicillin sulbactam with a dose of 3 gm. The combination drug will contain ampicillin of 2 gm and Sulbactam of 1 gm. Ampicillin sulbactam will treat the already existing bacterial infection. Further, Ampicillin sulbactam will be administered with the Cefazolin so that it can stabilize the drug Ampicillin sulbactam (Brand & Grieve, 2019).
Question 2
It has been observed that post-operative infection is a common condition of the wound in case the patient is not being injected with correct antibiotics after operation through IV. This type of infection is termed as SSI (Surgical site infection). Additionally, this kind of infection, in most cases, creates complication in a patient’s recovery. According to the CDC report, it is stated that SSI develops after the 30 days of operation. This is the time, when the bacteria colonize within the alimentary canal, including the genital tract. This kind of infection is caused by Staphylococcus aureus at the wound site, including other endogenous bacteria. As a result, the wound is prevented from healing.
Question 3
According to the CDC, the surgical site of any patient can be infected with as many as 50,000 bacteria. In the case of Peter, it is crucial that he has been injected with peri-operative antibiotics for controlling the prophylactic function. The peri-operative antibiotics are a type of drugs that are injected one hour before the operation procedure. At the end of the operative procedure, after a gap of 24 hours, the peri-operative antibiotics are changed with the administration of post-surgical antibiotics.
In this case, Peter will be injected with Sulbactam in addition to Cefazolin as post-operative antibiotics. As soon as the post-intervention antibiotics are injected into Peter, it will result in creating a resistance against the bacterial infection. The Prophylaxis guideline for Antibiotics states that in order to maintain surgical prophylaxis, it is crucial that the post-operative drug is injected in Peter with the correct duration, frequency and dose.
Case 2
Question 1
The symptoms, which Ralph showed after being admitted to the hospital, were dyspnea and cough. As stated by the Australian Medicine Handbook, for CAP, it is vital that an empiric treatment is carried out. Empiric treatment involved in the administration of certain combination drugs that include fluoroquinolones, macrolides and doxycycline. Once the condition of the patient improves, the oral administration of the drugs can be continued. Ralph's condition highlights the need for a combination of Ceftriaxone and doxycycline for his therapy (Flanders, Dudas, Kerr, McCulloch & Gonzales, 2006). Ceftriaxone, a macrolide when included in the combination therapy with doxycycline it results in protecting the patient from pneumonia without affecting the clinical condition of the patient. Based on the patient's response to the combination therapy, the next set of treatments and antibiotics will be decided.
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