Explain why Mr. Hunter has the ‘superinfection’ known as C.difficile and describe the nursing care required to contain this infection.

Order Description
This case study involves solving skills that apply to drug administration and management in complex health care settings. The goal of this task is to analyse complex events in an authentic clinical scenario in order to formulate a plan of action that requires application of legal, ethical and pharmacological principles. In your role as a registered nurse you will be required to communicate the rationale for the decisions that you make in a clear and succinct way, especially in documentation. In the case study, you will give a reasoned argument for your proposed intervention that maintains the integrity of the profession and demonstrates a sophisticated level of understanding of the culture of safety.

1.5 line spacing and Times New Roman 12.
(The reference list is not included in the word count). Please use academic sources of information such as academic texts books and peer reviewed journal articles. Other trustworthy sites include Government operated websites (must contain ‘.gov.au’) and NPS MedicinesWise.

• Please use Harvard style references.
• Please avoid using any direct quotes.
• Please use a minimum of 12 references.

Other suggested references:

Berman, A Snyder, S J Levett-Jones,T Dwyer, T Hales, M Harvey, N Luxford, Y Moxham, L Park, T Parker, B Reid-Searl, K & Stanley, D 2012, Kozier and Erb’s Fundamentals of Nursing, Volume Two, Third Australian Edition, Pearson.

Brown, D & Edwards, H 2015, Lewis’s medical-surgical nursing: Assessment and Management of Clinical Problems, 4th edition, Elsevier.

Brown, K Valenta, K Fisman, D Simer, A & Daneman, N 2015, Hospital Ward Antibiotic Prescribing and the risks of Clostridium Difficile Infection. JAMA Intern.Med 175(4), 626-633 doi:10.100/jamainternmed.2014.8273.

Bryant, B & Knights, K 2015, Pharmacology for health professionals, 4th edition, Mosby, Elsevier.

Bullock, S & Manias, E 2014, Fundamentals of Pharmacology, 7th edition, Pearson.

Collignon, P 2015, Antibiotic resistance: are we all doomed? Internal Medicine Journal 45, 1109-1115 doi: 10.1111/imj.12902.

Tiziani, A 2013, Havard’s Nursing Guide to Drugs, 9th edition, Elsevier, Mosby.


• Please state what question you are answering. Alternatively you may put your answer underneath the question in this word doc (will also be uploaded).

• You must show an extensive understanding of key knowledge at an extended theoretical level, characterised by originality, application of learning in new domains and mastery of drug therapy concepts and principles in relation to the case scenario.

• Please combine highly relevant information sources in order to prioritise goals in care in a highly proficient manner.

• You must demonstrate highly skilful use of professional language and terminology to convey scientific and professional concepts clearly and concisely.

• Show comprehensive and sophisticated justification of clinical decision making in
relationto the case scenario.

• Demonstrate there is outstanding support for the information presented, using authoritative research / theoretical sources that are examined for their relevance and validity to the topic.

Answer all questions



Consider the patient Situation
Mr. Edward Hunter, an 89 year old widower, is now day 7 following his admission with end stage pulmonary fibrosis, hypoxaemia (oxygen saturations 82% in the ambulance) and chest infection.
He has been under the care of the community nursing team who have provided nursing support and home oxygen therapy. Mr. Hunter’s condition continues to deteriorate. He is on 15 litres oxygen via the nonrebreather mask to maintain oxygen saturations > 94%.
His severe dyspnoea renders him immobile and barely able to eat. At night he becomes quite
restless and distressed by his breathlessness. Whilst in hospital he has been under the care of
the palliative care team who prescribed Morphine elixir 2.02.5 mg PO PRN nocte to alleviate the distress associated with his dyspnoea.

Collect information
Mr. Hunter developed a fever of 38.0ºC two days ago and has chills and bloody, jelly like
sputum. Culture and sensitivity on Mr. Hunter’s sputum specimen reveals Streptococcus pneumoniae and Klebsiella pneumoniae and he is diagnosed with hospital acquired pneumonia. Mr. Hunter was previously prescribed Amoxycillin (Amoxicil, Alphamox) 500mg capsules PO TDS and Clarithromycin (Clarac, Klacid) 500mg PO BD for his chest infection and he has diarrhoea associated with the macrolide antibiotic therapy. Laboratory tests from a stool sample confirm that he has Clostridium difficile (C.difficile) infection.
The Klebsiella pneumoniae infection poses a serious risk to Mr. Hunter of further deterioration in lung function and of developing an empyema. Klebsiella infection is seen in elderly hospitalised patients who are already ill and immunocompromised and with
underlying chronic lung disease. Since Klebsiella demonstrates antimicrobial resistance the bacterium is intrinsically resistant to Penicillins and can acquire resistance to Cephalosporins
Mr. Hunter is commenced on an aminoglycoside and is prescribed gentamycin IV infusion

Identify problem/issue:
Question 1
Explain why Mr. Hunter has the ‘superinfection’ known as C.difficile and describe the nursing care required to contain this infection.

Question 2
Explain how aminoglycosides work to combat infection and why plasma drug concentrations of the aminoglycoside Gentamicin are monitored.

Question 3
Relate what you know about how Gentamicin achieves its antimicrobial effect (ie. is antimicrobial efficacy dose dependent or concentration dependent) to explain the consequences of a ‘missed’ dose or giving a ‘late’ dose in an antibiotic treatment regime.

Question 4
What is the nurse’ role in ‘antimicrobial stewardship?’ Examine the research literature in a library databases and choose at least 2 journal articles that discuss antimicrobial stewardship (AMS) in order to identify the nurses’ role in improving antimicrobial use in hospitals. Analyse the papers and summarise the main points.

Process information
Mr Hunter has had an indwelling urethral catheter in situ for 1 week. The catheter was removed 24 hours ago because urine was bypassing the catheter. He is now experiencing urinary frequency (<2hr) and pain on voiding. Mr Hunter asks if the catheter can be reinserted because of the fatigue and distress the ‘frequency of urination’ is causing.

Question 5.
What is your assessment of Mr Hunter’s current problem?

Question 6.
What pathology knowledge would help you to carry out your assessment? What data would validate your decision?

Question 7
What would be the potential outcome(s) if Mr. Hunter’s condition remains untreated? Establish and prioritise goals:

Question 8
Can you identify 2 short term nursing goals to alleviate Mr. Hunter’s urinary frequency and pain on voiding?

Take action:
Question 9
Can you plan your nursing care to describe the nursing actions (pharmacological and/or nonpharmacological) you would implement to manage Mr. Hunter’s ‘frequency of urination’ and associated fatigue? Give a rationale/justification for your decisions.

Nursing Goal – (stated above in Q8)
Nursing action –

Question 10a.
What are the three most important things that you have learned from this scenario?

Question 10b.
What actions will you take into clinical practice as a result of your learning in this scenario?