C. difficile/Sepsis
SKINNY Reasoning
Minnie Taylor, 62 years old
Primary Concept
Infection/Inflammation
Interrelated Concepts (In order of emphasis)
Perfusion
Clinical Judgment
Patient Education
Communication
Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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%
© 2019 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Minnie Taylor is a 62-year-old African-American female with a history of diabetes mellitus type II, hypertension, and
peripheral arterial disease who had a left below the knee amputation (LBKA) three days ago. She had two small loose,
watery stools last night and a third large watery brown stool this afternoon that had a distinct foul odor. Minnie is now
complaining of generalized lower abdominal cramping that she rates 3/10. She does not have an appetite and does not feel
like drinking fluids. Minnie was awake and alert after lunch, but later that afternoon just before supper you note that
Minnie is sleepy and once aroused, falls right back to sleep.
Personal/Social History:
Minnie is a retired teacher who never married and has no close friends. She lives alone in her own apartment.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
62-year-old African American female/ history of
diabetes mellitus type II, hypertension, and
peripheral arterial disease who had a left below Pt may be on antibiotics as a precaution due to the LBKA
the knee amputation (LBKA) three days ago. Chief • Distinct foul odor may indicate C. Diff infection
complaint of two small loose, watery stools last • Change in her physiological state may be from fluid imbalance due to
night and a third large watery brown stool this fecal output, consistency of fecal matter, lack of fluid intake, and no
afternoon that had a distinct foul odor. appetite.
Generalized lower abdominal cramping with
pain rated 3/10
RELEVANT Data from Social History: Clinical Significance:
Retired teacher who was never married and has
no close friends. She lives alone in her own provide care taker to help with ADL
apartment •Social worker needs to be contacted so assign coordinate help with
ADLs
.
As part of your pre-clinical prep you review her medication record
and note the following scheduled medications:
Pantoprazole 40 mg PO daily
Lisinopril 20 mg PO BID
Metoprolol 50 mg PO BID
Vancomycin 1000 mg IVPB daily
Metformin 1000 mg PO BID
Which medication(s) are clinically significant and have a relationship to the current problem?
RELEVANT Medication(s): Clinical Significance:
Vancomycin is commonly used to treat C. Diff as an antibiotic therapy.
Vancomycin 1000 mg IVPB daily Adverse effects of Vancomycin are low blood pressure, indigestion, dizziness, hives, itching,
and possible “red man syndrome” if meds are infused to fast.
Patient Care Begins:
Current VS: 4 Hours Ago: Current PQRST:
T: 100.8 F/38.2 C T: 98.7 F/37.1 C Provoking/Palliative: Movement provokes pain
P: 98 (reg) P: 84 (reg) Quality: Cramping
R: 20 (reg) R: 18 (reg) Region/Radiation: Generalized lower abdomen
BP: 92/64 MAP: 73 BP: 118/74 MAP: 89 Severity: 3/10
© 2019 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
SKINNY Reasoning
Minnie Taylor, 62 years old
Primary Concept
Infection/Inflammation
Interrelated Concepts (In order of emphasis)
Perfusion
Clinical Judgment
Patient Education
Communication
Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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%
© 2019 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Minnie Taylor is a 62-year-old African-American female with a history of diabetes mellitus type II, hypertension, and
peripheral arterial disease who had a left below the knee amputation (LBKA) three days ago. She had two small loose,
watery stools last night and a third large watery brown stool this afternoon that had a distinct foul odor. Minnie is now
complaining of generalized lower abdominal cramping that she rates 3/10. She does not have an appetite and does not feel
like drinking fluids. Minnie was awake and alert after lunch, but later that afternoon just before supper you note that
Minnie is sleepy and once aroused, falls right back to sleep.
Personal/Social History:
Minnie is a retired teacher who never married and has no close friends. She lives alone in her own apartment.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
62-year-old African American female/ history of
diabetes mellitus type II, hypertension, and
peripheral arterial disease who had a left below Pt may be on antibiotics as a precaution due to the LBKA
the knee amputation (LBKA) three days ago. Chief • Distinct foul odor may indicate C. Diff infection
complaint of two small loose, watery stools last • Change in her physiological state may be from fluid imbalance due to
night and a third large watery brown stool this fecal output, consistency of fecal matter, lack of fluid intake, and no
afternoon that had a distinct foul odor. appetite.
Generalized lower abdominal cramping with
pain rated 3/10
RELEVANT Data from Social History: Clinical Significance:
Retired teacher who was never married and has
no close friends. She lives alone in her own provide care taker to help with ADL
apartment •Social worker needs to be contacted so assign coordinate help with
ADLs
.
As part of your pre-clinical prep you review her medication record
and note the following scheduled medications:
Pantoprazole 40 mg PO daily
Lisinopril 20 mg PO BID
Metoprolol 50 mg PO BID
Vancomycin 1000 mg IVPB daily
Metformin 1000 mg PO BID
Which medication(s) are clinically significant and have a relationship to the current problem?
RELEVANT Medication(s): Clinical Significance:
Vancomycin is commonly used to treat C. Diff as an antibiotic therapy.
Vancomycin 1000 mg IVPB daily Adverse effects of Vancomycin are low blood pressure, indigestion, dizziness, hives, itching,
and possible “red man syndrome” if meds are infused to fast.
Patient Care Begins:
Current VS: 4 Hours Ago: Current PQRST:
T: 100.8 F/38.2 C T: 98.7 F/37.1 C Provoking/Palliative: Movement provokes pain
P: 98 (reg) P: 84 (reg) Quality: Cramping
R: 20 (reg) R: 18 (reg) Region/Radiation: Generalized lower abdomen
BP: 92/64 MAP: 73 BP: 118/74 MAP: 89 Severity: 3/10
© 2019 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
