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Antimicrobial Case Study Assignment (Pharmacology)
This assignment will give you the opportunity to apply your knowledge related to antimicrobials. You will be asked to complete preparation work prior to reviewing a written case study. As you work through the related knowledge application questions, additional information about this caplete this activity, please download this worksheet and complete the fillable spaces, working through the document in the order that the questions appear.
Patient Information

Jasmine, a 12-year-old, is brought into the Pediatric Outpatient Clinic for assessment. Jasmine’s mother is concerned because over the past few days, Jasmine has developed a fever, productive cough and SOBOE. Jasmine’s appetite has been poor, and she is lethargic.

Upon assessment in the clinic, it is found that Jasmine is tachypnic, and her SpO2 is 90% on RA. Her heart rate is 125 and her blood pressure 105/ 65. She is pale and diaphoretic. Jasmine’s weight is 88lbs.

The physician orders a chest x-ray, which shows that Jasmine has developed right lower lobe pneumonia. Blood work indicates that Jasmine has a WBC of 14, and she is dehydrated. The physician decides that Jasmine should be admitted to the Pediatric Unit at the hospital for rehydration and IV antibiotic therapy. The physician writes the following orders:

• Ampicillin 10 mg/kg IV Q6H

Upon admission to the hospital, the nurse on the unit takes the following past medical history from Jasmine’s mom:
• Jasmine is generally a well child, with no history of significant illness or injury
• Jasmine has no known allergies. Jasmine’s mother state’s that she does not have allergies herself, but that Jasmine’s father is allergic to bee stings and penicillin

Case Study Preparatory Work- Mini Drug Cards (1.5 marks)

Ampicillin
Classification:

Indication:

Assessment required:

Contraindication:

Azithromycin (Zithromax)
Classification:

Indication:

Assessment required:

Contraindication:

Learning Resources

Please review the following resources to assist you in completing the assignment:

Sealock, K., Seneviratne, C. (2020). Lilley’s pharmacology for Canadian health care practice (4th edition). Elsevier. Chapter 43.

SickKids (November 6, 2009). Clostridium difficile (C difficile). About Kids Health. Clostridium difficile (C difficile) (aboutkidshealth.ca)

You are encouraged to procure any additional resources that you find useful for completing the worksheet.

1. Following review of this patient’s clinical presentation and past medical history, what are your primary concerns for this patient? Name at least three (3) concerns and give rationale for each concern.

2. Based on the information provided in the case study, what is the amount of medication that you will administer to the patient? Based on recommended dosing guidelines, is this a safe dose?

3. After giving the dose of antibiotics, what are the priority follow-up assessments and when should the nurse perform each of them?

4. When conducting your follow-up assessments following medication administration, you notice that the patient has developed the following symptoms:
• Wheezing
• Difficulty swallowing
• Nausea and vomiting

a. What do you suspect is happening with your patient?

b. What priority nursing interventions would you perform?

c. Using the SBAR format, what information would you provide when calling to update the physician?

5. In reviewing the patient’s history, what pertinent information may have contributed to her adverse reaction? Discuss your rationale.

6. Name at least 3 locations where the patient’s allergy needs to be documented to alert health care providers from administering this medication again in the future?

7. The patient is now well enough to be discharged home, and has been given a prescription for azithromycin (Zithromax) tablets to be taken orally for 5 days. What information will you include in the patient teaching?

8. 7 days after discharge, Jasmine’s mother calls into the Pediatric Outpatient clinic. She is concerned that Jasmine has been having loose stools 5-6 times a day for the past 2 days. What is a possible reason that Jasmine is experiencing loose stools? What recommendations would you provide Jasmine’s mother?

Reflection and Application of Learning

1. How might this situation have been handled differently? Which key nursing assessments were missed that might have led to a different outcome?

2. Did the mini drug card preparation assist you in critically thinking through antibiotic administration for this patient? Why or why not? If not, how can it be done better

3. What are two pieces of learning that you will take away from this case study?

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