Question

Mrs. Smith is a 63 year old obese, diabetic woman who is transferred from the hospital to the skilled nursing facility (SNF) where you work as a charge nurse. Mrs. Smith is being managed with IV vancomycin 1 gm IV piggyback (IVPB) every 12 hours for osteomyelitis resulting from an arterial foot ulcer. On review of her admission orders, you note that she has a newly inserted intermittent saline lock in her right forearm and is prescribed to receive the antibx for 4 more weeks.

1.The schedule for the administration of the IV drug is 2 am and 2 pm. Would you schedule her antibiotic at these times? Why or why not?

2.Two days later as you are planning to end your shift, the resident reports that her IV site seems red and swollen. What action will you take at this time? What will you document on the resident’s electronic health record?

3.What do you think about putting in a new IV on this patient? What access device would you suggest and why? With whom will you need to collaborate with to make this decision? What does the evidence say about VAD’s for this resident and their needs?

4.Using the SBAR technique, what will you report to the oncoming nurse about the resident’s IV complications? Based on the medication ordered, what particular monitoring interventions need to be done for this patient?

Answer 1

1. It's better to avoid the administration of other antibiotics along with IV vancomycin. Some drugs have the negative interaction with vancomycin. For the safer side, it is better to reschedule the timing of the second antibiotic.  

2. We need to remove the IV line immediately. Redness and swelling indicate signs of phlebitis. It is important to record the incident in the electronic system for future reference.

3. We need to insert another IV for the continuation of antibiotic therapy. Moreover, we need to consult with his doctor and also need to get a consent from the client to insert a new line. Explain the need for a new line to the patient.

4.S-Time: Patient informed that he is having redness and swelling at his IV site.

B-Patent IV line was present for the administration of Inj. Vancomycin and one another antibiotic for 2 days.

A-Noted that the IV site is swollen and red. Vital signs checked. Pain score assessed. Assessed the need for continuation of IV drug therapy.

R-Case informed to doctor and discussed the need of new iv line insertion. Explained the situation to the client. Taken consent from him. Informed to in charge and inserted the new line. Incident recorded to the electronic system. Medication time need to be updated if there is any change in administration time or dosage. Also, need to record to monitor for signs of inflammation and infiltration.