Medical Surgical Cystic fibrosis #5

Question

A nurse is performing a medical interview of a return client with cystic fibrosis who is being admitted for another possible infection. The mother remarks the child is also having difficulty hearing and wonders if he also has an ear infection. Which action by the nurse demonstrates keen critical thinking skills?

Answers

  1. Examine the client's record to ascertain past treatment plans.
    • Rationale:

      This answer is correct because clients with frequent IV aminoglycoside use are at risk for ototoxicity. This client is a return client, admitted for “another ” infection and mom observes the client is having trouble hearing. By examining the past records, the nurse can learn which IV antibiotic has been used and supply the provider with more information. IV aminoglycosides are frequently used in clients with cystic fibrosis and ototoxicity is a common adverse effect.

  2. Obtain an order for a complete blood count with differential.
    • Rationale:

      This answer is not correct because although obtaining a CBC will indicate if the client is having a viral or bacterial infection, it is most likely part of the normal workup of a client exhibiting signs of infection. The nurse has connected the client’s new symptom of hearing loss to past antibiotic use evidenced by her researching his past history.

  3. Obtain an order for IV antibiotics from the provider like last admission.
    • Rationale:

      This answer is not correct because there is no indication if the client requires antibiotics since no lab studies have been performed. However, if lab studies indicate a bacterial infection, benchmark institutions have set the standard for the first dose of IV antibiotics to occur within 4 hours of admission.

  4. Obtain an order for a sputum culture for testing of resistance and sensitivity.
    • Rationale:

      This answer is not correct because it does not take keen critical thinking skills to obtain an order for a sputum culture for a client with cystic fibrosis. If the labs show a bacteria infection, then a sputum culture may be clinically indicated.

Overview

Intravenous aminoglycosides are frequently used in clients with cystic fibrosis. Clients with frequent IV aminoglycoside use are at risk for ototoxicity. Signs of ototoxicity is sensorineural hearing loss and disequilibrium.

Explanation

Learning Outcomes

Intravenous aminoglycosides are frequently used in clients with cystic fibrosis. Clients with frequent IV aminoglycoside use are at risk for ototoxicity. Signs of ototoxicity is sensorineural hearing loss and disequilibrium. While performing a medical interview, it is important to listen to the client and the client’s caretaker carefully for pertinent information. By examining the past records, the nurse can learn which IV antibiotic has been used and supply the provider with more information. In this case, potentially important information regarding the client’s new symptom. IV aminoglycosides are frequently used in clients with cystic fibrosis and ototoxicity is a common adverse effect.

Test Taking Tip

Remember that aminoglycosides “-micins” is a broad spectrum antibiotic that is commonly used in clients with cystic fibrosis to treat pseudomonas. Pseudomonas is the most common bacteria found in CF clients. It has a narrow therapeutic range. It is important to increase fluids to help prevent nephrotoxicity. Ototoxicity is an adverse effect.

Video Rationale