{"id":619,"date":"2023-12-04T10:27:03","date_gmt":"2023-12-04T15:27:03","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/chapter\/day-4-medical-ward\/"},"modified":"2023-12-04T10:27:03","modified_gmt":"2023-12-04T15:27:03","slug":"day-4-medical-ward","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/chapter\/day-4-medical-ward\/","title":{"raw":"Day 4: Medical Ward","rendered":"Day 4: Medical Ward"},"content":{"raw":"\n
Day: 4<\/h5>\n
Time: 10h30<\/h5>\n
Place: Medical Ward<\/h5>\n\u201cHi Tracie, I\u2019m here to review a couple of patients for discharge.\u201d\n\n\u201cHi Dr. Hunicutt, I would also like to talk about Mrs. Erin Johns.\u201d\n\n\u201cOh the lady with pneumonia and COPD. She is doing better, yes?\u201d\n\n\u201cMuch better it seems, her C&S results are in along with the rest of her morning lab work. I have her assessment here to review. The RT has moved her to Optiflow again and Physio is seeing her daily, and ambulating her in the hallway starting today.\u201d\n\n\u201cThat sounds good. Big improvement. Ok, the discharges I will get to. Let\u2019s look together at the C&S results.\u201d\n\nDr. Hunicutt pulls up the lab results for Erin and immediately goes to the C&S.\n\n\u201cOk Tracie, what antibiotic is Mrs. Johns on?\u201d\n\nTracie pulls up the MAR. \u201cShe is on ceftriaxone<\/a> 1 gram IV q 24 hours, and azithromycin<\/a> 500mg IV q 24 hours.\u201d\n\n\u201cExcellent. That is the recommended coverage. Now let's look at her C&S.\u201d\n\nOn the computer screen, Tracie sees a list of about 10 antibiotics with either R or S beside each. For the antibiotics that Erin is on, she sees an S beside each one. \u201cThe antibiotics Mrs. Johns is on are appropriate for her as the bacteria is sensitive to them,\u201d says Tracie.\n\n\u201cCorrect,\" states the doctor. \"And since Mrs. Johns is doing well and you are mobilizing her, I would like to get rid of her IV to make that job easier.\u201d\n\n\u201cHow are you going to do that? I know azithromycin comes in PO form, but ceftriaxone is only IV.\u201d\n\n\u201cTake a look at the list and see if there is another antibiotic that you recognize that can be given PO.\u201d\n\nTracie considers the list again, thinking, No, gentamycin<\/a> is IV, cefotaxime<\/a> is IV... Oh wait, here is levofloxacin.<\/a><\/em> She speaks up, \u201cOk, Dr. Hunicutt, I think levofloxacin can be given PO.\u201d\n\n\u201cThat\u2019s correct, and since the two antibiotics are different classes and work slightly differently, we are cross-covering Mrs. Johns so she should continue to get better.\u201d\n\n\u201cI think she will be happy to have the IV capped<\/a>.\u201d\n\n\u201cMost patients are. So I am going to write the orders for levofloxacin 750mg PO q 24 hours and azithromycin 250mg PO daily. Has she had her antibiotics today?\u201d\n\n\u201cYes. She should be just finishing now on the IV pump.\u201d\n\n\u201cGreat. I will state to start these with breakfast tomorrow. Now let\u2019s go see her and then I\u2019ll see the discharge patients and write their orders.\u201d\n\nBoth Dr. Hunicutt and Tracie get up and move towards Erin\u2019s room. As they get closer to the room they can hear the occasional bark. Coming into the room they see a small hairless dog sitting on Erin\u2019s lap and Erin\u2019s son sitting on the edge of the bed. Erin is playing tug of war with a face cloth and the dog.\n\nTracie looks at the whole scene and shakes her head, thinking, That is one ugly dog but wow, Mrs. Johns seems really happy today.<\/em>\n\n\u201cHi Mrs. Johns, do you remember me?\u201d\n\nErin slowly looks up from her game of tug of war with Trixie to consider the man standing before her. \u201cYou are my doctor, I believe?\u201d\n\n\u201cThat is correct, at least for the time that you are in the hospital. I don\u2019t have an office, but the whole hospital could be considered my office. Tracie and I have reviewed your chart and your treatment regimen and we will be making some adjustments to your IV. With your improvement and walking, it looks like we can cap your IV <\/a>and start you on oral <\/a>antibiotics.\u201d\n\nErin looks at both of them. \u201cI've had oral antibiotics before and they upset my stomach.\u201d\n\n\u201cWell, if your stomach is not upset now with the IV antibiotics, I don\u2019t expect you will be upset with the oral ones, because it\u2019s the same medication. Let's try it and see.\u201d\n\n\u201cOh, so I get rid of this?\u201d Erin indicates the IV in her left arm.\n\nTracie, shakes her head. \u201cMrs. Johns, I will remove the tubing, but we will leave the rest in your arm in case something changes. I am sure you don\u2019t want another IV started. I will wrap it up with a dressing, and it will be less bothersome without the tubing attached.\u201d\n\nErin\u2019s son looks up at Dr. Hunicutt. \u201cWhen can she come home?\u201d\n\n\u201cThat\u2019s a good question. I would like to do another chest X-ray today. Your mom needs a couple of more days of antibiotics and to be completely off any oxygen therapy for 24 hours. Once that is met, I would be pleased to see her go home with you.\u201d\n\n\u201cHow long will that be?\u201d\n\n\u201cOral antibiotics start tomorrow so the earliest for home would be three days from now maybe two if your mom tolerates no oxygen starting tomorrow. I don\u2019t think we need to rush. She is getting great care here.\u201d\n\n\u201cTrue, but I need some help at home too.\u201d\n\n\u201cThat may be, but your mom is pretty sick. When she goes home she will not be up to helping out very much and you will need to take care of her a bit longer.\u201d\n\nThomas looks down at his feet and seems resigned to what Dr. Hunicutt says.\n\nDr. Hunicutt looks at both of them. \u201cAny questions?\u201d\n\nWhen neither of them makes eye contact or speaks, the doctor adds, \u201cAll right then, I will order the chest X-ray and let Tracie cap off your IV. I will see you tomorrow.\u201d\n\nDr. Hunicutt leaves.\n\nTracie goes outside and grabs supplies to cap off Erin\u2019s IV. Just as she is finishing, Gladys comes in and says, \u201cReady for a walk Mrs. Johns?\u201d\n\n\u201cNo, but Trixie is. Can we take her?\u201d\n\n\u201cOh, we're not going outside. Let\u2019s just walk up and down the hall a bit. We need to build up your stamina.\u201d\n\nThomas reaches out and picks up Trixie. \u201cI'll take her outside. I have to go to work anyway. Trixie is staying with the next door neighbors so she will be ok. I will see you tomorrow, mom.\u201d\n\nGladys and Tracie reposition Erin and get her standing<\/a>. Tracie follows behind with the oxygen tank as Gladys encourages Erin to walk.\n\nErin looks around the hallway as she leaves her room, and says, \u201cI can\u2019t believe I need two people to help me walk. This getting old really is not what I expected.\u201d\n\n\u201cYou are doing well. Let\u2019s keep going.\u201d\n\nTracie and Gladys navigate Erin to the lounge and back to her room. Just as they get her back, Glen, the X-ray porter comes in with a wheelchair. \u201cHey, it\u2019s picture time. Ready to smile, Mrs. Johns?\u201d\n\nErin looks up at Glen and thinks, He does look familiar. He is striking, maybe another doctor?<\/em> She answers him, \u201cI sort of remember you.\u201d\n\nGlen smiles \u201cI am the lovely gentleman who will escort you to the Radiology Department. Gurpreet is awaiting your presence to take a picture.\u201d\n\n\u201cOh right, I remember you. You drive a wheelchair like a race car.\u201d\n\nTracie and Glen laugh. Gladys helps Glen get Erin into the wheel chair. Glen hangs the oxygen tank on the back of the chair. \u201cAll right, let\u2019s see if we can set a record to the department.\u201d\n\n\u201cOh, no\u2014you take it slow, you whipper-snapper. I am just feeling fine and don\u2019t need to crash into anything.\u201d\n\n\u201cI'm a safe driver.\u201d Glen maneuvers the wheelchair out into the hallway and to the elevators. They take the elevator to the second floor which opens directly facing the doors of the Radiology Department.\n\nGlen pushes Erin in and around to X-ray Room 2. \u201cHey Gurpreet, Mrs. Johns is here.\u201d Her chest X-ray is completed <\/a>after which Glen wheels Erin to the elevator and back to the seventh floor.\n\nTracie sees Glen and Erin coming down the hallway and meets them in Erin\u2019s room. Tracie helps Erin from the wheelchair to a chair at the bedside and covers her with a blanket. \u201cDo you need anything right now?\u201c\n\n\u201cNo. I am a bit tired but should be good.\u201d\n\nGlen and Tracie leave Erin to herself.\n","rendered":"
Day: 4<\/h5>\n
Time: 10h30<\/h5>\n
Place: Medical Ward<\/h5>\n

\u201cHi Tracie, I\u2019m here to review a couple of patients for discharge.\u201d<\/p>\n

\u201cHi Dr. Hunicutt, I would also like to talk about Mrs. Erin Johns.\u201d<\/p>\n

\u201cOh the lady with pneumonia and COPD. She is doing better, yes?\u201d<\/p>\n

\u201cMuch better it seems, her C&S results are in along with the rest of her morning lab work. I have her assessment here to review. The RT has moved her to Optiflow again and Physio is seeing her daily, and ambulating her in the hallway starting today.\u201d<\/p>\n

\u201cThat sounds good. Big improvement. Ok, the discharges I will get to. Let\u2019s look together at the C&S results.\u201d<\/p>\n

Dr. Hunicutt pulls up the lab results for Erin and immediately goes to the C&S.<\/p>\n

\u201cOk Tracie, what antibiotic is Mrs. Johns on?\u201d<\/p>\n

Tracie pulls up the MAR. \u201cShe is on ceftriaxone<\/a> 1 gram IV q 24 hours, and azithromycin<\/a> 500mg IV q 24 hours.\u201d<\/p>\n

\u201cExcellent. That is the recommended coverage. Now let’s look at her C&S.\u201d<\/p>\n

On the computer screen, Tracie sees a list of about 10 antibiotics with either R or S beside each. For the antibiotics that Erin is on, she sees an S beside each one. \u201cThe antibiotics Mrs. Johns is on are appropriate for her as the bacteria is sensitive to them,\u201d says Tracie.<\/p>\n

\u201cCorrect,” states the doctor. “And since Mrs. Johns is doing well and you are mobilizing her, I would like to get rid of her IV to make that job easier.\u201d<\/p>\n

\u201cHow are you going to do that? I know azithromycin comes in PO form, but ceftriaxone is only IV.\u201d<\/p>\n

\u201cTake a look at the list and see if there is another antibiotic that you recognize that can be given PO.\u201d<\/p>\n

Tracie considers the list again, thinking, No, gentamycin<\/a> is IV, cefotaxime<\/a> is IV… Oh wait, here is levofloxacin.<\/a><\/em> She speaks up, \u201cOk, Dr. Hunicutt, I think levofloxacin can be given PO.\u201d<\/p>\n

\u201cThat\u2019s correct, and since the two antibiotics are different classes and work slightly differently, we are cross-covering Mrs. Johns so she should continue to get better.\u201d<\/p>\n

\u201cI think she will be happy to have the IV capped<\/a>.\u201d<\/p>\n

\u201cMost patients are. So I am going to write the orders for levofloxacin 750mg PO q 24 hours and azithromycin 250mg PO daily. Has she had her antibiotics today?\u201d<\/p>\n

\u201cYes. She should be just finishing now on the IV pump.\u201d<\/p>\n

\u201cGreat. I will state to start these with breakfast tomorrow. Now let\u2019s go see her and then I\u2019ll see the discharge patients and write their orders.\u201d<\/p>\n

Both Dr. Hunicutt and Tracie get up and move towards Erin\u2019s room. As they get closer to the room they can hear the occasional bark. Coming into the room they see a small hairless dog sitting on Erin\u2019s lap and Erin\u2019s son sitting on the edge of the bed. Erin is playing tug of war with a face cloth and the dog.<\/p>\n

Tracie looks at the whole scene and shakes her head, thinking, That is one ugly dog but wow, Mrs. Johns seems really happy today.<\/em><\/p>\n

\u201cHi Mrs. Johns, do you remember me?\u201d<\/p>\n

Erin slowly looks up from her game of tug of war with Trixie to consider the man standing before her. \u201cYou are my doctor, I believe?\u201d<\/p>\n

\u201cThat is correct, at least for the time that you are in the hospital. I don\u2019t have an office, but the whole hospital could be considered my office. Tracie and I have reviewed your chart and your treatment regimen and we will be making some adjustments to your IV. With your improvement and walking, it looks like we can cap your IV <\/a>and start you on oral <\/a>antibiotics.\u201d<\/p>\n

Erin looks at both of them. \u201cI’ve had oral antibiotics before and they upset my stomach.\u201d<\/p>\n

\u201cWell, if your stomach is not upset now with the IV antibiotics, I don\u2019t expect you will be upset with the oral ones, because it\u2019s the same medication. Let’s try it and see.\u201d<\/p>\n

\u201cOh, so I get rid of this?\u201d Erin indicates the IV in her left arm.<\/p>\n

Tracie, shakes her head. \u201cMrs. Johns, I will remove the tubing, but we will leave the rest in your arm in case something changes. I am sure you don\u2019t want another IV started. I will wrap it up with a dressing, and it will be less bothersome without the tubing attached.\u201d<\/p>\n

Erin\u2019s son looks up at Dr. Hunicutt. \u201cWhen can she come home?\u201d<\/p>\n

\u201cThat\u2019s a good question. I would like to do another chest X-ray today. Your mom needs a couple of more days of antibiotics and to be completely off any oxygen therapy for 24 hours. Once that is met, I would be pleased to see her go home with you.\u201d<\/p>\n

\u201cHow long will that be?\u201d<\/p>\n

\u201cOral antibiotics start tomorrow so the earliest for home would be three days from now maybe two if your mom tolerates no oxygen starting tomorrow. I don\u2019t think we need to rush. She is getting great care here.\u201d<\/p>\n

\u201cTrue, but I need some help at home too.\u201d<\/p>\n

\u201cThat may be, but your mom is pretty sick. When she goes home she will not be up to helping out very much and you will need to take care of her a bit longer.\u201d<\/p>\n

Thomas looks down at his feet and seems resigned to what Dr. Hunicutt says.<\/p>\n

Dr. Hunicutt looks at both of them. \u201cAny questions?\u201d<\/p>\n

When neither of them makes eye contact or speaks, the doctor adds, \u201cAll right then, I will order the chest X-ray and let Tracie cap off your IV. I will see you tomorrow.\u201d<\/p>\n

Dr. Hunicutt leaves.<\/p>\n

Tracie goes outside and grabs supplies to cap off Erin\u2019s IV. Just as she is finishing, Gladys comes in and says, \u201cReady for a walk Mrs. Johns?\u201d<\/p>\n

\u201cNo, but Trixie is. Can we take her?\u201d<\/p>\n

\u201cOh, we’re not going outside. Let\u2019s just walk up and down the hall a bit. We need to build up your stamina.\u201d<\/p>\n

Thomas reaches out and picks up Trixie. \u201cI’ll take her outside. I have to go to work anyway. Trixie is staying with the next door neighbors so she will be ok. I will see you tomorrow, mom.\u201d<\/p>\n

Gladys and Tracie reposition Erin and get her standing<\/a>. Tracie follows behind with the oxygen tank as Gladys encourages Erin to walk.<\/p>\n

Erin looks around the hallway as she leaves her room, and says, \u201cI can\u2019t believe I need two people to help me walk. This getting old really is not what I expected.\u201d<\/p>\n

\u201cYou are doing well. Let\u2019s keep going.\u201d<\/p>\n

Tracie and Gladys navigate Erin to the lounge and back to her room. Just as they get her back, Glen, the X-ray porter comes in with a wheelchair. \u201cHey, it\u2019s picture time. Ready to smile, Mrs. Johns?\u201d<\/p>\n

Erin looks up at Glen and thinks, He does look familiar. He is striking, maybe another doctor?<\/em> She answers him, \u201cI sort of remember you.\u201d<\/p>\n

Glen smiles \u201cI am the lovely gentleman who will escort you to the Radiology Department. Gurpreet is awaiting your presence to take a picture.\u201d<\/p>\n

\u201cOh right, I remember you. You drive a wheelchair like a race car.\u201d<\/p>\n

Tracie and Glen laugh. Gladys helps Glen get Erin into the wheel chair. Glen hangs the oxygen tank on the back of the chair. \u201cAll right, let\u2019s see if we can set a record to the department.\u201d<\/p>\n

\u201cOh, no\u2014you take it slow, you whipper-snapper. I am just feeling fine and don\u2019t need to crash into anything.\u201d<\/p>\n

\u201cI’m a safe driver.\u201d Glen maneuvers the wheelchair out into the hallway and to the elevators. They take the elevator to the second floor which opens directly facing the doors of the Radiology Department.<\/p>\n

Glen pushes Erin in and around to X-ray Room 2. \u201cHey Gurpreet, Mrs. Johns is here.\u201d Her chest X-ray is completed <\/a>after which Glen wheels Erin to the elevator and back to the seventh floor.<\/p>\n

Tracie sees Glen and Erin coming down the hallway and meets them in Erin\u2019s room. Tracie helps Erin from the wheelchair to a chair at the bedside and covers her with a blanket. \u201cDo you need anything right now?\u201c<\/p>\n

\u201cNo. I am a bit tired but should be good.\u201d<\/p>\n

Glen and Tracie leave Erin to herself.<\/p>\n","protected":false},"author":103,"menu_order":13,"template":"","meta":{"pb_show_title":"","pb_short_title":"","pb_subtitle":"","pb_authors":["glynda-rees","rob-kruger",null,"glynda-kruger","rob-morrison","janet"],"pb_section_license":"cc-by-sa"},"chapter-type":[],"contributor":[115],"license":[54],"class_list":["post-619","chapter","type-chapter","status-publish","hentry","contributor-janet","license-cc-by-sa"],"part":605,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/users\/103"}],"version-history":[{"count":0,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/619\/revisions"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/parts\/605"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/619\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/media?parent=619"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapter-type?post=619"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/contributor?post=619"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/license?post=619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}