1 American organization of nurse executives nurse leader survey: Compensation trends and satisfaction levels The Journal of Nursing Administration, May 13, 2014
2 Assessing the professional development needs of experienced nurse executive leaders The Journal of Nursing Administration, January 22, 2014
3 Conceptualizing clinical nurse leader practice: An interpretive synthesis Journal of Nursing Management, February 9, 2015
4 Challenges and facilitators to nurse use of a guideline-based nursing information system: Recommendations for nurse executives Applied Nursing Research, February 12, 2014
5 Nurse leaders' perceptions of the ethical recruitment of study subjects in clinical research Journal of Nursing Management, August 14, 2014
Question: Recall that a gynecologist found a certified registered nurse anesthetist (CRNA) conscious but disoriented in the physicians’ lounge bathroom between surgical cases. The CRNA had appeared well and in his usual state of health during a surgical case 15 mins earlier. The 44-year-old was transported to the ER where these vital signs were measured: T, 40.1oC; BP, 78/40 mmHg; pulse, 140 bpm; and respiration, 30 per min. O2 saturation was 94% on room air; blood glucose, 96 mg/dL. He responded to commands, but was disoriented to place and time.
Physical examination was significant for diffuse petechiae, a rash on the palms of both hands and abdomen, splinter hemorrhages, and splenomegaly. There was a questionable pericardial rub without murmur. He could not provide a medical history, but a CRNA colleague believes he is divorced and lives alone. The colleague thinks he was in good health, but did notice that the patient left a number of tissues with spots of blood in the trash can of the physicians’ lounge bathroom approximately 2 weeks ago.
Fever, hypotension, tachycardia, and tachypnea suggested an infectious process. His state of confusion also may be linked to an infectious process, but it is possible that this is drug-related given his easy access to medications and the reported bloody tissues.
A CBC revealed a hemoglobin of 25 g/dL, an elevated WBC, a platelet count of 88,000, an elevated ESR, and RF was positive. Urinalysis revealed proteinuria and microscopic hematuria. The toxin screen was negative.
Given the strong suspicion of an infectious process, you ordered that 2 sets of blood cultures be performed 30 minutes apart.
The two sets of blood cultures grew Staphylococcus aureus. An echocardiogram revealed an oscillating intra-cardiac mass and vegetations involving the tricuspid valve.
The CRNA’s significant other, while visiting him in the ICU, mentioned to the attending physician that her partner had been abusing IV narcotics for approximately 18 months.
Now what would you like to do?
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