Conference Detail

Nursing Conference Details

AONE 2014 Annual Meeting CME

March 12-15, 2014
Orlando, Florida 32789, United States
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Related Quizzes From Smartest Doc

Question: Which infection would cause the higher mortality in hospitalized patients aged ≥65 years?

Question: A disease-specific management strategy improves which outcome among patients hospitalized for chronic, nonvalvular AF?

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.

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