Ambulatory Care Scenario


Read over the ambulatory care scenario below and then use your PDA to find information about this condition so you can provide appropriate nursing care.

Ambulatory Care Scenario:

Mrs. Carter is a 56 year old female who was discharged from the hospital eleven days ago following surgical removal of a benign abdominal cyst. She was again seen five days ago in your surgical clinic by Dr. Williams because she had been complaining of post-operative problems, specifically with her abdominal incision. She told Dr. Williams at this time that for the last twenty-four to thirty-six hours, she has noticed her incision is mildly though continuously tender to touch, & appears slightly reddened & swollen. She denied any drainage, but did note that she had been feeling ”run down” & “washed out,” more so than any time since her operation. Mrs. Carter stated that she had anticipated being recovered from her surgery by now, & fully returned to her prior activity level. She periodically feels “warm” & flushed, but has not checked her temperature.

At the clinic visit five days ago Mrs. Carter’s temperature was 39º C, BP 130/82, and P 98. She denied any nausea or vomiting, diarrhea or constipation since her post-operative visit. The only medication she takes is Acetaminophen 500 mg on an as-needed basis. She had taken her Acetaminophen four times in the last twenty-four hours, for incisional tenderness.

Dr. Williams ordered blood cultures and then placed Mrs. Carter on oral antibiotics, Cephalexin 750 mg PO every 6 hrs x 10 days, after obtaining these cultures.

Today Mrs. Carter calls the clinic and states that she is still not feeling well. She still feels hot to the touch and her incision has not gotten better. In fact, it is more swollen and tender than before. The redness has also increased in size. When you ask Mrs. Carter if she has been taking her Cephalexin, she states that she “has taken it twice a day as directed.”

  • What is Mrs. Carter’s temperature in Fahrenheit? Go to Archimedes and click on Speciality Index from the top arrow. Then select Celsius<==>Farenheit. Change the keypad from ABC to 123 and at the Degrees box type in 39. At the Celsius/Fahrenheit box select Celsius.
  • Look up information about each of the medications: Acetaminophen and Cephalexin.  
    • What is the trade name of each of these? Go to DrugGuide and then to either the Main Index or Generic Index. Type in the name of the medication. At the drop down arrow at the top select US Brand Names.
    • What is the normal dosage of each? Select Route/Dosage (Do). 
    • What types of organisms is Cephalexin use to treat?  Select Action (A).
    • Why is it important to take Cephalexin as directed? Go to Pharmacokinetics and look at the Half-Life for Cephalexin.  
    • What does the half-life mean? go to Tabers and at the Main Index, type in half. Select half-life and read item 3.  
    • Based on the recommended dose and the half-life information, how much will be left in Mrs. Carter's system after the first 4 hours?
  • Select the appropriate nursing diagnoses. 
    • Go to the RnDxInt software. Make sure you are on the Nursing Diagnosis. The type in infection. Select Infection, Risk for. 
      • Why would this be an appropriate nursing diagosis for Mrs. Carter?
      • What signs and symptoms does Mrs. Carter have that would indicate a possible infection? Select Actions Inverventions (A). Then read over Nursing Priority No. 1.
      • What other nursing interventions would be approporiate for Mrs. Carter? Read over Nursing priority No. 2 and No. 3.
    • Now go back to the Main Index and type in knowledge and select Knowledge, Deficient. 
      • Why would this be an appropriate nursing diagnosis for Mrs. Carter? Select Factors (F).
      • What is your objective data to support this nurisng diagnosis? Select Characteristics and look at Objective.
      • What would your nursing interventions be? Select Actions Interventions (A). Read over the 9 Nursing Priorities. Which ones would be appropriate for Mrs. Carter?