vSim: Harry Hadley (H.H)
NURS 501: Pathophysiological and Pharmacological Bases for Nursing Practice
, 2
H.H. is a 78-year-old Caucasian male admitted for lower right leg pain due to previous
cat bite and is complaining of increasing pain that has not improved. H.H was prescribed oral
amoxicillin taken over the course of 3 days to treat cellulitis caused by the cat bite. After
reviewing the diagnostic tests (Frandsen & Pennington, 2021, p.292), H.H was confirmed to
have methicillin-resistant Staphylococcus aureus (MRSA) that passed from the cat bite. The
provider caring for H.H. had orders for acetaminophen and vancomycin to be administered.
During the work up of H.H, a medication reconciliation should be conducted to give better
insight in what H.H. has already taken or is currently taking. In doing so, the nurse knows that
amoxicillin was previously prescribed, and understands that MRSA will not be affected by the
amoxicillin. It also gives the provider insight on what alternatives can be used to mitigate
increasing the resistance within H.H (Frandsen & Pennington, 2021, p.294). While the
medication reconciliation may not be perfectly accurate and complete, it does provide the
healthcare team a baseline.
When encountering H.H., there are numerous things that needed to be completed, but
prioritization needs to be done to ensure that more urgent matters are attended to first. During
H.H.’s workup, H.H was asked about any changes to his appetite. While this does need to be
addressed, it could have been asked further down the line. H.H should have been informed of
frequent vital sign assessments prior as well as during the conversation, as vital signs could have
been monitored concurrently. The order of these could have been switched as it would not only
be more productive for the patient, but also more informative to the nurse.
Prioritization of care is essential in a nurse’s role and in H. H’s case, due to the cat bite,
he has impaired skin integrity which can cause him to be at an increased risk of a secondary
infection. The skin works as a barrier to keep bacteria out, but when there are breaks in our skin,
bacteria can enter the body to create harm (Frandsen & Pennington, 2021, p.290). In addition,