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Exam (elaborations)

Exam (elaborations) Osteomye litis/Surgery RAPID Reasoning

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2020/2021 Written for academic year
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Osteomye litis/Surgery RAPID Reasoning
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Exam (elaborations) Osteomye litis/Surgery RAPID Reasoning History of Present Problem: Gene Potts is a 78-year-old Caucasian male with diabetes type 2, MRSA cultured in left foot ulcer and dementia who came to the emergency department because he had increased pain in left foot, chills, fever and feeling weaker the past two days. His wife noticed an increase in redness and swelling of his chronic left foot ulcer. Initial vital signs: T: 101.5 F/38.6 C P: 98 R: 22 BP: 148/90. O2 sat: 94% room air. His left great toe is black with an open stage III ulcer 1x1 cm on the top of his left foot. Surrounding tissue is bright red and extends from his left foot to his lower left leg. His initial WBC: 18.5, lactate: 1.8, and creatinine: 1.7. A CT of his left foot confirmed osteomyelitis in the left great toe. He is admitted to the med/surg floor and started on piperacillin/tazobactam IVPB and vancomycin IVPB. He is scheduled to have his left great toe amputated in surgery tomorrow. Personal/Social History: Gene has been married for 55 years and is cared for by his wife, Ruth, who is a retired nurse. They have no children. His dementia has progressed, and Gene no longer recognizes his wife. He has become more difficult for his wife to manage at home. Gene is DNR/DNI. Palliative care was consulted to clarify goals of care and communicated that Gene is at high risk for decline after surgery and may require skilled care after discharge. Ruth is stern and communicates that she knows her husband best and insistent that he will come home after surgery no matter what. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?

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Osteomye litis/Surgery




RAPID Reasoning

Gene Potts, 78 years old

Primary Concept
Infection
Interrelated Concepts (In order of
emphasis)
● Tissue Integrity
● Perfusion
● Gas Exchange
● Pain
● Clinical Judgment
● Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered
Category/Subcategory in Case
Study
Safe and Effective Care Environment
✔ Management of Care 17- ✔
23%
✔ Safety and Infection Control 9-
15%
Health Promotion and Maintenance 6- ✔
12%
Psychosocial Integrity 6- ✔
12%

, Physiological Integrity
✔ Basic Care and Comfort 6- ✔
12%
✔ Pharmacological and Parenteral Therapies 12- ✔
18%
✔ Reduction of Risk Potential 9- ✔
15%
✔ Physiological Adaptation 11- ✔
17%

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