Microbiology Case Studies

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 Micro- The patient’s microbiology test result shows that the blood culture has no growth. Whereas, the respiratory culture was obtained from tracheal aspiration and has positive test results with many WBC’s less than 25 squamous epithelial cells, moderate Gram-negative Rods, many Pseudomonas aeruginosa and moderate Klebsiella pneumonia which was resistant to Ampicillin.
 CBG- Capillary blood gas results conclude that the patient has moderate hypoxemia and the acid-base status of this blood gas could be interpreted as compensated respiratory acidosis or compensated metabolic alkalosis. Obtained capillary blood gas values of the patient are as follows; PcCO2 51 mmHg; PcO2 53 mmHg; HCO3 32; and pH 7.41.
4) Chest X-Ray- Patient’s chest X-ray
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v. Ferrous Sulfate (FER-IN-SOL) 15 mg, Route: PO, every 12 hours (Q12H)
 It was prescribed to the patient to treat iron deficiency anemia as the patient has poor food intake as well as low hemoglobin and hematocrit. It is needed by the body to produce red blood cells. vi. Lansoprazole 6 mg, Route: PO, once daily (QD)
 It was prescribed to the patient to prevent gastroesophageal reflux, stomach pain and treat conditions that cause excess stomach acid. vii. Methadone 0.3 mg, Route: PO, every six hours (Q6H)
 It was prescribed to the patient to treat moderate to severe pain and reduces the withdrawal symptoms of Ativan as the patient was weaned from Ativan. viii. Sodium Chloride (Hypertonic Saline 3% inhalation solution) 4 ml, Route: nebulizer solution via in- line SVN (small volume nebulizer) inhalation, every six hours (Q6H)
 It was prescribed to the patient to thin airway secretions in the lung so it will be easier to remove via suctioning. ix. Tobramycin 80 mg, Route: nebulizer solution via in- line SVN (small volume nebulizer) inhalation, every twelve hours
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a) Therapies:
i. Chest Physiotherapy (CPT)- Performed manually for five minutes on right side of the lung, every six hours (Q6H)
 It was prescribed to the patient to loosen up mucus or any secretion in the right lung as there were coarse crackles heard during auscultation and observed sub-segmental atelectasis on the X-ray. ii. In-Line Suctioning- In-line suction catheter was used; pre-oxygenated to 79% FiO2 at a suction pressure of -80 mmHg.
 It was prescribed to the patient to remove secretion if there is any after performing the CPT, which can help prevent infections and Ventilator Associated Pneumonia (VAP). ii. Oral Care- Deep mouth suction with the suction catheter, brushed jaw with the suction pressure on and lubricated the lips with the cream.
 Oral care is important as it helps prevent the risk of more infection, help keep the lips moisturized and prevent mouth

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