Patient X is a 54-year-old client who was bitten on the right ankle by the neighbour’s dog 4 days ago. Client is currently on the surgical unit as the wound became infected and required debr

Wound Care
SCENARIO
Patient X is a 54-year-old client who was bitten on the right ankle by the neighbour’s dog 4 days ago. Client is currently on the surgical unit as the wound became infected and required debridement in the OR yesterday. You have just received report from the night nurse and it is 0800. Last vitals at 05:30 were: BP 120/84, HR 90, RR 18, T 37.5, O2 98% on room air, pain 3/10. Dressing has not been changed since OR, due to be changed this morning, there was some drainage noted at 05:30. Please complete nursing assessment and initiate appropriate nursing care.
DOCTORS ORDERS: See Below
MAR: See below
OBJECTIVES:
Priority and focused assessments
Appropriate interventions based on orders and assessment
Safely prepare and administer medications based on orders and client needs, rights of medication administration
IV therapy
Wound care
HEALTH CARE PROVIDER ORDERS
Allergies: Sulpha
Diagnosis: Infected wound from a dog bite
VS every 4 hours and PRN
Cefazolin 1 Gram IV every 8 hours X 5 days (give in 100 mls over 30 mins)
Acetaminophen 650 mg by mouth, every 6 hours as needed, for pain or T> 38.5
Morphine 2mg by mouth every 2 hours as needed for pain
Change wound dressing every day and as needed, cleanse with normal saline and apply wet to dry dressing, sterile
DR. A Sampson