Question

case study

doing chat rules es weren't too severe: a five-da as she told Bud his infect red, and seeping a small amou He Did It His Way of doing things his own way. He hda lo were made for the other guy. As a young ad alway the Bad had a long history incision and obrd violtinse lab on fire, a weekend in JDC for s ounrelenting "I told you so" fra Asa90-yearoldmarding hisdotor's rules, Bud carried 26010、 his wound wasn't putrid. time was football and brews at the pub liehdly fruity aroma. " Bud return His favorite pastime was tootball and brews at irame t meat and potatoes man whose idea of lifestvle of Doritos on the top dabetes carbohydrate grams and calories were out of the q shelf. Bud's lifestyle resulted in his diagnonisialdor frive ag 4 What is the formal na the bugtes, eight years ago. Most days he remembered to take diagho s Why did Dr. Drorak initia much of an inconvenience. But Dr. Dvorak's order the culture results? sng their uanlyeRivofth motto. In fact, he was the quadruple bypass surgery Dr. Dvorak performed yeste should he give up donuts, ribs, and his wife' convinced that doctors weren't happy unless thev gested as the causative a hot a call to Dr. Dvorak. The wound his antibiotic but confessed to c Dr. Drorak ordered Bud to recerived indicated infection w dl must be working). Why & The fruity odor from Bu trmilk biscuits? You only live once and you ought to e that ts with horror stories about heart attack and stroke But here Bud was in the CC of St. Vincent's Medical Cene Medical Center recovering fro rday. Bud couldn't b hin was grilled or steamed, and there was never enough. Desperate to ge hote iev it..ad he couldn't wait to get home and away from all rules. The only thing worse than the hospital rules was the h old life, Bud feigned sincere complia Dr. Dvorak told Bud to come diligently pe rformed his rehab exercises for the next five days Dr. Dvorak he was turning over a new leaf and focusing on the con diabetes. He convincingly agreed to all of the discharge orders the nurse 8. What was the most pr with him: continue rehab exercises, walk twice a da time, follow the carbohydrate-restricted diet, and work with the home healh y, take all medications on 9. The laboratory repor nurses on wound care. Why wasn't he impro 10. What feature(s) On his first day home, Bud reminded his wife, Jenny, how lucky she was he was still around. Voila! Jenny made Bud his favorite chicken fried steak, cuits with gravy, and sugar cream pie for dinner. When Nancy from home beal arrived the next morning, she scolded Bud. He hadn't taken a walk or followed his diet and as a result had a blood glucose level of 352 mg/dl. To make mattm Upon admission to IC and was re-cultured at th Dr. Dvorak's dismay, even spiked a fever of 38.7°C (1 infection, Dr. Dvorak ord worse, Nancy discovered that Bud had disregarded his discharge orders and a shower as soon as he got home. She tried to explain the risk of infection, ba Bud knew he had nothing to worry about since soap and water w germs. T. What medical ter Bud's demeanor was very different two days later when Nancy returned change his dresings. His chest incision had become quite tender Na ed the site and was concerned about the pronounced in lammaot her dn ing the site and applying a sterile dressing, she promised to reportfr When the culture fror ation. After clean monas the next day, Bu tissues in Bud's chest we was continued to target The morning after this s s temperature rema Dr. Dvorak immediately 1. It appears Bud has developed an infection in his chest 2. How could Buds elevated blood glucose levels complicate bod declined rapidly av 3. To counter this problem, what pol 2. Why did Bud w during and immediately after open heart surgery Nancy returned early the next morning with a prescription of Cipro for Bad and orders to culture his incision. Bud was a little examine his incision and obeain the specimen. Her facial expression registered concern as she told Bud his infection had spread. The entire incision was w hot, red, and seeping a small amount of pus. Nancy smiled at Bud and told him at s the nervous as he watched Nancy returned her smile...how bad could a fruity smell be? slightly fruity aroma."Bud to reach of Type 4 What is the formal name of Cipro? How does this drug work? s Why did Dr. Dvorak initiate therapy with this antibiotic prior to r ar pills the culture results? t count- e (those amous s Bud's y were Figure 1. Gram stain of Pseudomonas & The fruity odor from Bud's incision is significant. What microbe is sug- gested as the causative agent of this infection? a call to Dr. Dvorak. The wound was cosiderably worse. Bud had faithfully taken his antibiotic but confessed to continuing his indulgence in his wife's fine cooking. When Nancy returned 48 hours later and examined Bud, she immediately placed g from n't be edical Every Dr. Dvorak ordered Bud to return to the hospital. The lab results he had just received indicated infection with Psendomonas aeruginosa. Since Bud was not responding to the therapy, it was time to implement more aggressive measures Dr. Dvorak told Bud to come immediately, saying This is a bad bug to beat. n. He mised of his iewed ns on ealth 7. Characterize the morphology and Gram staining of Pseudomonas aeruginosa. &. What was the most probable source of Bud's P.aeruginosa infection? 9. The laboratory report indicated that Bud's infection was Cipro-sensitive. Why wasn't he improving? 10. What feature(s) of Pseudomonas aeruginosa make it a "bad bug to beat?" Upon admission to ICU, Bud received a combination antibiotic therapy and was re-cultured at three successively deeper sites within his incision. To Dr. Dvorak's dismay, even the deepest tissues were contaminated, and Bud had spiked a fever of 38.7 C (101.6 F). Concerned about the spread of Pseudomonas that bis- ealth tters aken but way infection, Dr. Dvorak ordered blood cultures and a biopsy of Bud's sternum. 11. What medical term describes a bone infection? An infection in the When the culture from the sternal biopsy was reported positive for Pseudo- monas the next day, Bud underwent surgery to remove the bone. All infected tissues in Bud's chest were successfully removed. Intensive IV antibiotic therapy was continued to target the systemic infection indicated by his blood cultures. The morning after this surgery, repeat blood cultures were free from infection yet Bud's temperature remained high and signs of vascular collapse appeared. As pul- monary capillaries were affected, the subsequent edema resulted in Acute Respi- ratory Distress Syndrome (ARDS). Although the systemic infection had resolved, bloodstream? to to Bud declined rapidly and expired 16 hours later He Dic 12. Why did Bud worsen and die despite a successful antibiotic therapy? He had al Bud had a long history of doing things his own way. believer that rules were made for the other guy. As a younse for violating the rules weren't too severe: a five-da y suspension fo shoplifting a pack of s school science lab on fire, a weekend in JDC for sho and of course, the unrelenting "I told you so" from his parent As a 50-year-old man, Bud was not about to change his was especialy tr a oothall and brews at the pub with bs his doctors rules. Bud carried 260 b frame. His favorite pastime was foothall and brews at the pub with He was a meat and potatoes man whose idea of exercise was the bag of Doritos on the top shelf. Bud's lifestyle resulted in his diagno A metabolic Il diabetes eight years ago. Most days he remembered to take his os of T maniy middle- viduals Although akes insulin these to the hormone od glucose levels since that wasn't much of an inconvenience. But Dr. Dvorak'erp ing carbohydrate grams and calories were out of the question! Bud felt f pills must be working). Why should he give up donuts, ribs, and his wiek buttermilk biscuits? "You only live once and you ought to enjoy it,w motto. In fact, he was convinced that doctors weren't happy unless atients to heartscaring their patients with horror stories about heart attack and stroke. y disease. But here Bud was in the CCU of St. Vincent's Medical Center surgery-A ch healthy the quadruple bypass surgery Dr. Dvorak performed yesterday. Bud couldnt ba lieve it...and he couldn't wait to get home and away from all of the new medical rules. The only thing worse than the hospital rules was the hospital food. Ever thing was grilled or steamed, and there was never enough. Desperate to get honse to his old life, Bud feigned sincere compliance with every medical instruction. He diligently performed his rehab exercises for the next five days and promised Dr. Dvorak he was turning over a new leaf and focusing on the control of his diabetes. He convincingly agreed to all of the discharge orders the nurse reviewed with him: continue rehab exercises, walk twice a day, take all medications on time, follow the carbohydrate-restricted diet, and work with the home health are o replace onary vessebs surgery nurses on wound care. On his first day home, Bud reminded his wife, Jenny, how lucky she was that he was still around. Voila! Jenny made Bud his favorite chicken fried steak, bis- cuits with gravy, and sugar cream pie for dinner. When Nancy from home health arrived the next morning, she scolded Bud. He hadn't taken a walk or followed his diet and as a result had a blood glucose level of 352 mg/dl. To make matters worse, Nancy discovered that Bud had disregarded his discharge orders and taken a shower as soon as he got home. She tried to explain the risk of infection, but Bud knew he had nothing to worry about since soap and water germs. washed away Bud's demeanor was very different two days later when Nancy returned to inspect change his dressings. His chest incision had become quite tender. Nancy ed the site and was concerned about the pronounced inflammation. After cleans- ing the site and applying a sterile dressing, she promised to report her findings to 1 It appears Bud has developed an infection in his chest incision. What are 2. How could Bud's elevated blood glucose levels complicate this infection? To counter this problem,what policy is pypically mplamented for patiens Dr. Dvorak immediately the likely sources of microbes? during and immediately after open heart surgery? Infections Nancy returned early the next morning with a prescription of Cipro for Bud and orders to culture his incision. Bud was a little nervous as he watched Nancy examine his incision and obtain the specimen. Her facial expression registered concern as she told Bud his infection had spread. The entire incision was now hot, red, and seeping a small amount of pus. Nancy smiled at Bud and told him at least his wound wasn't putrid. "In fact," she said, "you actually have a pleasant, slightly fruity aroma. Bud returned her smile...how bad could a fruity smell be? 4. What is the formal name of Cipro? How does this drug work? s. Why did Dr. Dvorak initiate therapy with this antibiotic prior to receiving the culture results 6 The fruity odor from Bud's incision is significant. What microbe is sug- gested as the causative agent of this infection? Figure 1. Gram stain of Pseudomonas When Nancy returned 48 hours later and examined Bad, she immediately placed a call to Dr. Dvorak. The wound was considerably worse. Bud had faithfully taken his antibiotic but confessed to continuing his indulgence in his wife's fine cooking. Dr. Dvorak ordered Bud to return to the hospital. The lab results he had just received indicated infection with Pseudomonas aeruginosa. Since Bud was not responding to the therapy, it was time to implement more aggressive measures. Dr. Dvorak told Bud to come immediately, saying "This is a bad bug to beat." 7. Characterize the morphology and Gram staining of Pseudoeonas aeruginosa. 8. What was the most probable source of Bud's P. aeruginosa infection? . The laboratory report indicated that Bud's infection was Cipro-sensitive. Why wasn't he improving? 10. What featureis) of Psendomonas senuginosa make it a "bad bug to beat?" Upon admission to ICU, Bud received a combination antibiotic therapy and was re-cultured at three successively deeper sites within his incision. To Dr. Dvorak's dismay, even the deepest tissues were contaminated, and Bud had spiked a fever of 38.7"С 101.6"F). Concerned about the spread of Pseudomronas infection, Dr. Dvorak ordered blood cultures and a biopsy of Bud's sternum. 11. What medical term describes a bone infection? An infection in the bloodstream? When the culture from the sternal biopsy was reported positive for Pseudo monas the next day, Bud underwent surgery to remove the bone. All infected tissues in Bud's chest were successfully removed. Intensive IV antibiotic therapy was continued to target the systemic infection indicated by his blood cultures. The morning after this surgery, repeat blood cultures were free from infection yet Bud's temperature remained high and signs of vascular collapse appeared. As pul- monary capillaries were affected, the subsequent edema resulted in Acute Respi atory Distress Syndrome (ARDS). Although the systemic infection had resolved Bud declined rapidly and expired 16 hours later He Did It His Way 12. Why did Bud worsen and die despite a successful antibiotic therapy?

Answer 1

1. Bud has developed the infection and the likely sources may be the meat he took, water as he took bath and the water contains several invisible micro organisms and the soap he was using. soap might be having adhered microbes.

2. The blood sugar levels definetly made the infection complicated because the sugar serves as a nutrient for the growth of the several micro organisms.

3. To counter this problem generally after open surgeries doctors prescribe the broad spectrum antibiotics

4. The formal name of cipro is ciprofloxacin. It is a fluoroqinolone antibiotic acting against a variety of organisms. It acts by inhibiting the cell division of microbes and thus helps as bacteriostatic agent.

5. ciprofloxacin is a broad spectrm antibiotic and acts against the wide range of the organisms, ths he started sing it prior to the culture results.

6. Streptococcus anginosus has a very distinct caramel/butterscotch (sweet) odor and Pseudomonas aeruginosa can famously generate a 'grape juice' smell in infected patients.

7. Pseudomonas aeruginosa is a gram-negative, rod-shaped, asporogenous, and monoflagellated bacterium that has an incredible nutritional versatility. It is a rod about 1-5 µm long and 0.5-1.0 µm wide.

.Gram staining of Pseudomonas aeruginosa, strain ATCC 27853.

Metabolism: Is often classified as aerobic, but can also exploit NO3- as final electron acceptor in the respiratory chain. Should, therefore, be classified as facultatively anaerobic

8. the probable source is hospital. it is hospital bourn infection.

9. Pseudomonas infections are generally treated with antibiotics. Unfortunately, in hospitalized patients, Pseudomonas infections, like those caused by many other hospital bacteria, are becoming more difficult to treat because of increasing antibiotic resistance. Selecting the right antibiotic usually requires that a specimen from a patient be sent to a laboratory to test to see which antibiotics might still be effective for treating the infection.

10. its antibiotic resistance made it a bad bug to beat.

11. Osteomyelitis is the medical term for a bone infection.

12. AS the infection reached the bone and the blood stream it is very difficult to treat that hospital acqired infection.

9.