Care of a very sick premature infant that weighed 1 kg (a little over 2 lb)

Madison Wills worked night shift on a neonatal intensive care unit (NICU) at a major medical center. She assumed the care of a very sick premature infant that weighed 1 kg (a little over 2 lb). Sylvia Smithson had been the infant’s nurse during the day shift. Sylvia had initiated the infant’s intravenous (IV) antibiotic infusion at 6:30 P.M., just before shift change. She reported that the infant’s IV line in his arm was patent and the IV site had no redness or swelling.

When Madison assessed the infant at 7:45 after the end-of-shift report, she noted that the baby’s arm was swollen and that the IV had infiltrated (was no longer in the vein). When she stopped the infusion, she also noted that the dose on the antibiotics was incorrect and was much too large for a very small infant.

1.      What is the first thing that Madison should do after discovering these two problems?

2.      Which of these problems (the infiltration or the dosing) was the most significant from a legal standpoint?

3.      What is the nurse’s responsibility when an antibiotic is prepared by the pharmacy?

4.      What safeguards are in place to protect nurses from charges of negligence?

#2 Isabella is a 4-year-old girl who showed signs of a viral illness that did not seem to get better for 2 days. Her mother, Sonia Ramirez, took her to a local walk-in clinic, where she was reassured that Isabella had a bad cold but would recover within a few days. The next day, however, Isabella was barely responsive and had numerous dark purple spots. Her mother rushed her to a local emergency department. Isabella was intubated and airlifted via helicopter to a major medical center, where she was diagnosed with meningococcemia, a life-threatening infection.

Isabella subsequently had bilateral amputations of her legs for gangrene secondary to poor perfusion. After a long hospitalization, she was transferred to a rehabilitation facility where she was fitted with prosthetic legs. Sonia quit her job to stay with Isabella throughout her illness and recovery. When Sonia quit her job, her insurance benefits ended, and she could not afford to pay for continuing insurance coverage.

1.      Describe Isabella’s illness trajectory in terms of primary, secondary, tertiary and subacute settings. What role did each of these play in Isabella’s care?

2.      Isabella’s health care bills were enormous. What is the role of private insurance in paying these bills? What is the role of public assistance?

3.      Do you think Sonia should have continued working through Isabella’s illness to continue insurance coverage?

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