NURS2007 Nursing Assignment: Medication Intervention Report

This report is a critical reflection on a nursing simulation involving a patient, Bobbi Telfer, experiencing a leg wound and requiring medication. The assignment focuses on the patient's medical history, including gestational diabetes and a history of chicken pox. The simulation scenario involves the administration of IV antibiotics and the subsequent observation of vital signs, including heart rate, respiratory rate, blood pressure, temperature, and SpO2 levels. The report details both objective and subjective signs, highlighting the development of an adverse drug reaction to Benzipenicillin Sodium, including skin redness, itching, and elevated vital signs. It discusses the importance of recognizing allergic reactions, ceasing medication administration, and providing appropriate patient care, including antihistamine administration and further assessment. The report emphasizes the roles of healthcare professionals, including nurses and physicians, in managing the situation and making informed decisions based on evidence-based practices and multidisciplinary collaboration. It also emphasizes the need for complete patient medical history and patient involvement in clinical decision making. The report concludes with recommendations for improved patient care, including complete medical history, patient involvement, and multidisciplinary team decision-making.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
This paper intends to prepare a lab report on the simulation activity scenario that
proceeded with the effective planning of the medication intervention. The medical intervention
was designed to help the patient Bobbi Telfer with her leg wound.
As presented by the case study, the client is 40 years old and works as a senior scientist in
a laboratory. She loves gardening and volunteers to teach gardening skills to kindergarten
children once in a week. The client stays alone and is reported to have been separated from her
partner a year ago and lost her child because of SIDS. The medical history reveals the client to
have developed gestational Diabetes at 20 years and suffer from chicken pox at the age of 3.
At present, Bobbi is suffering from a leg wound that has shown no signs of recovery
since the last three weeks. The client complains of intense pain around the wound area
accompanied with feelings of fatigue and exhaustion. The client is to be administered IV
antibiotic and is being visited by the primary nurse, documenting nurse and the treatment nurse.
It should be mentioned here that the facts presented in the case study reveals the episode
of an adverse drug reaction. Adverse Drug Reactions are associated with a large number of
patient morbidity and mortality owing to the manifestations of severe allergic reactions.
Discussion:
The medication would be designed on the basis of the subjective and objective signs and
symptoms that were studied during the clinical simulation scenario. The objective and the
subjective signs would be discussed under the following subheadings;

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Objective Signs:
The last vital assessment recorded prior to the administration of IV antibiotic revealed the
heart rate to be 85 beats per minute and the respiratory rate to be 24 breaths per minute. The
blood pressure recorded was 91/61 and the temperature recorded was 37.4 degree centigrade.
The SpO2 that was recorded was 97% and the
IVT was 0.9%. The NaCl was documented to be at the rate of 4/24 per hour and administration
of Oxygen at 2litre/min was carried out via nasal specs. This clearly revealed that the blood
pressure was normal but the respiratory rate was slightly elevated. The recorded pulse and
temperature were also within the normal range. The SpO2 level was also within the normal range
and hence it reflected that there were no presence of abnormalities or impact of allergic
reactions.
After the administration of IV antibiotics Benzipenicillin Sodium at the station, a
significant change in the next set of vital sign assessment was noted. The heart rate was recorded
to be 108 beats per minute, the respiratory rate was recorded to be 26 breaths per minute. In
addition to this the blood pressure recorded was 100/65 and the temperature recorded was 37.4
degree Celcius. The documented SpO2 was 98%. The vital assessment revealed elevated
elevated blood pressure, pulse rate, temperature and respiratory rate which signifies the fact that
there might be a possibility of an allergic reaction.
The vital sign assessment was again carried out after stopping the antibiotic dose. The
heart rate was recorded to be 92 beats per minute and the respiratory rate recorded was 20
breaths per minute. The recorded blood pressure was 109/71 and the temperature was recorded to
be 37.4 degree Celcius. The SpO2 was 98%.

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Subjective Signs:
The subjective signs that were recorded included the redness of the skin. The client
reported to feel an itching sensation and the manifestation of rashes were seen to spread. The
client’s respiratory rate was going up which meant that either there was a drug overdose, a
response to an allergic reaction or pulmonary infection. She was made to sit comfortably on the
bed in an elevated posture. The client was seen to panic and that could be the primary reason for
her respiratory rate to significantly rise up. The recorded blood pressure rate after the vital
assessment was considerably high which indicated that the allergic reaction caused inflammation
which restricted the blood flow and increased the blood pressure level. The patient was seen to
feel an intense irritation and itching sensation around the area where the antibiotic was
administered. Studies reveal that the administration of the drug Benzi Pencillin Sodium is
characterized by the manifestation of allergic histamine reaction that causes side-effects such as
elevated blood pressure, interference with drug activity and manifestation of allergy (Aldeek et
al. 2016). Benzi Pencillium is used as an antibiotic to treat a number of bacterial disorders that
involve the infection caused by a Gram-positive bacteria (Aldeek eta l. 2016). However, studies
reveal that the drug has the potential to treat a handful of infections caused by both gram positive
as well as gram negative bacterial strains (Bessaet al. 2015). Usually Benzi Penicillin Sodium is
used as a convenient wide-spectrum antibiotic that can help in curing a broad range of bacterial
infections. It is extremely important to administer the correct dose of the drug and at the same
time also ensure that drug is being given in a continued process (Franklin and Snow 2013).
It is extremely important to administer the correct dose of the drug and at the same time
also ensure that drug is being given in a continued process as the drug administration regulations
of the country and it is important for the nursing practitioner to comply with the regulations

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(Franklin and Snow 2013). It should also be noted prior to the administration of the drug that the
patient does not have an allergy history or cardiac and renal complications as in these cases the
drug has reported be ineffective. As is evident from the vital sign assessment, it can be said that
the patient is encountering a histamine reaction which is basically an allergic reaction
characterized by the manifestation of symptoms of allergy (Ilkit, Durdu and Karakaş 2012).
At this instance, it is extremely important to administer effective care to the client so as to
prevent the situation from worsening. The first thing would encompass of immediately ceasing
the administration of IV antibiotic, as this could be one of the major reason for the adverse drug
reactions seen in the patient’s health.. Further, the drug dose should be checked thoroughly along
with the time duration of the dose and the IV administration sites (Barry, M.J. and Edgman-
Levitan 2012). Further the patient must be handle with care and must be educated about the
underlying reason that has led to the cause of allergic symptoms (McNeil et al. 2015). As per the
World Health Organisation, few steps should be followed such as: collecting patient information
for further medications, collecting patient outcomes and a drug susceptibility test (Blood culture)
should be conducted so that the antibiotic reactions and adverse effects could be understood
(Barry, M.J. and Edgman-Levitan 2012). The patient must be enlightened about the fact that her
body is not compatible with the administered drug and as a result of which she has encountered a
histamine reaction (Wang et al. 2013). Histamines releases several chemical in the body and
hence, they creates conditions due to which contraction of smooth muscles of liver, uterus,
kidney and lungs and stomach. It also lowers blood pressure, and due to this gastric acids starts
secreting in stomach creating adverse conditions (Franklin and Snow 2013). Further, the patient
should be made to lie down comfortably and another set of vital assessment should be done so as
to detect the changes in her vitals in the unstable state such as changes in her blood pressure, her

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pulse rate, her respiratory rate, her heart condition and adverse conditions (Ilkit, Durdu and
Karakaş 2012). This assessment would help in comparing the assessment along with the prior
recorded assessment and accordingly devise medication.. The abnormality in the vital assessment
and the physiological reaction to the allergic reaction of the patient must be recorded and
documented for reference.
Further, it is important to understand the pathway that leads to allergic reaction in the
patient and caused several severe reactions in her body that increases the severity of her health
condition (Romano et al. 2018). The drug Penicillin sodium G is the primary reason for the
severe health condition. however, it is one of the most effective drugs to help the patients with
localized bacterial infections and hence, the health professionals used this drug for the health and
well being of the patient (Trubiano and Phillips 2013, Bourke et al. 2015). However, due to lack
of proper health history professionals were unable to understand that the patient has heart
condition as well and hence, the drug can possibly cause severe health condition in her (Albin
and Agarwal 2014). The drug may cause inflammation by three ways such as by causing hyper
sensitivity, causing metabolic reactive and by causing protein or peptide conjugates (Bourke et
al. 2015). As the protein is presented to the antigen presenting cell, it activates the T cells and
then eventually the antigen specific T cells are created which is further engulfed by the
macrophages and then causes inflammation, this was the process which occurred during
histamine reactions and affects the circulation process. Therefore, this was the primary reason
due to which the localized infection such as hives, and rashes were seen in case of the patient and
causes the hypersensitive reactions (Stone et al. 2014, Bourke et al. 2015).
Therefore, in this aspect the role of healthcare professionals becomes more critical as the
patient is suffering from infection, infection reactions and adverse drug reactions together

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together. Therefore, the healthcare professionals need to decide the escalation of the treatment
(Stone et al. 2014). In this aspect starting from pharmacist, documentation nurse, primary and
treatment nurse, and healthcare physicians everyone has their specific role and responsibility to
make the patient condition better. In this case, the nursing and physician professionals should
discuss with multidisciplinary team so that the escalation of the treatment could be decided
(Wang et al. 2013). The first priority should be lowering the drug reaction and for that the patient
should be provided with anti-histamine drug so that in several time her health condition could be
improved and then her infection and other health conditions such as diabetes. Further due to the
allergic reaction it could also be determined that she is also suffering from health condition and
hence, medication intervention should include this as well (Bourke et al. 2015).
Recommendations and conclusions
The assignment discussed the case study of Bobby Telfer who was admitted to the
healthcare facility for her health condition improvement and leg wound injury (Montañez et al.
2015). In this situation the healthcare professionals conducted her health assessment and
provided her with medication however, in a situation, the health condition of the patient
worsened due to the allergic reaction of the drug (Tannert et al. 2017). Therefore, it is
recommended that the patient should be able to provide her complete medical history to the
professionals so that while determining assessment they can understand the drugs which can be
used for the treatment of her wounds. Therefore, in the lack of that the drug penicillin sodium G
was provided to the patient that led to such infection (Montañez et al. 2015). It should also be
noted here that the patient should be involved equally in the clinical decision making process and
in collaboration with the unanimous decision made by the professionals present at the clinical
setting, an appropriate intervention must be developed. Then the healthcare professionals using

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their multidisciplinary team were able to decide the escalation of the care and provide an
evidence based care to the patient. Hence, in this case they were able to provide an active and
appropriate care to the patient and improve her health condition. Therefore, in conclusion in
could be said that the patients should provide complete health details to the healthcare facility
and their ailments as it can affect their health negatively (Tannert et al. 2017). Besides that, the
professionals were able to provide appropriate care and comply with the Australian guidelines of
the patient care and autonomy for nursing and midwifery.

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References:
Albin, S. and Agarwal, S., 2014, November. Prevalence and characteristics of reported penicillin
allergy in an urban outpatient adult population. In Allergy and asthma proceedings(Vol. 35, No.
6, p. 489). OceanSide Publications.
Aldeek, F., Canzani, D., Standland, M., Crosswhite, M.R., Hammack, W., Gerard, G. and Cook,
J.M., 2016. Identification of penicillin G metabolites under various environmental conditions
using UHPLC-MS/MS. Journal of agricultural and food chemistry, 64(31), pp.6100-6107.
Barry, M.J. and Edgman-Levitan, S., 2012. Shared decision making—the pinnacle of patient-
centered care. New England Journal of Medicine, 366(9), pp.780-781.
Bessa, L.J., Fazii, P., Di Giulio, M. and Cellini, L., 2015. Bacterial isolates from infected wounds
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Franklin, T.J. and Snow, G.A., 2013. Biochemistry of antimicrobial action. Springer.pp.111-115
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clinical manifestations, epidemiology, etiology, and management. Critical reviews in
microbiology, 38(3), pp.191-202.

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McNeil, B.D., Pundir, P., Meeker, S., Han, L., Undem, B.J., Kulka, M. and Dong, X., 2015.
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