Essay Sample: 12-Year-Old Male Diagnosed With Skin Rashes and Cellulitis

Introduction

Skin rashes could be seen on the body of the 12-year-old male after he was given one dose of the acetaminophen prescription with codeine as well as another order for Augmentin as he was diagnosed to be allergic to penicillin (Nurses Service Organization, 2018). Two days after being discharged from the hospital, the patient was again diagnosed with cellulitis because of the methicillin-resistant staphylococcus aureus (MRSA) that reacted with his body and was administered some intravenous antibiotics. Additionally, three days after the injury, the right extremity of the patient seemed edematous and slightly discolored while he was consistently complaining of movement pain (Nurses Service Organization, 2018). As time progressed, the patient developed an abscess on his right knee and was forced to go to for surgery where on further diagnosis, the tissues that were surrounding the wound seemed to be discolored and grey.

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Four days after the fall and with inadequate medical treatment from the nurse practitioner, the extremity of the male patient became severely edematous, completely discolored which further led to limited movement and more pain (Nurses Service Organization, 2018). Therefore, due to the necrotizing fasciitis which was gradually advancing, the patient underwent numerous surgeries and fasciotomies to re-route and repair the dislocated and painful muscles, ligaments and tendons to his sacra area and his extremity. As time progressed, the patient's condition continued to worsen, which further led to a state of comatose, only responding to painful stimuli. And, while still in the state of coma, he was again diagnosed with uncontrolled recurrent seizures (Nurses Service Organization, 2018).

Appropriate Medication to Administer

For the 7-year-old male, the best action that the nurse practitioner would have taken was to cleanse the wound first then plan for the administration of the local anesthesia which might be appropriate for the closure of the wound. A mixture of first-generation vancomycin or cephalosporin and an aminoglycoside would have been administered. The nurse would have used Lidocaine to infiltrate the wounds, which in most cases, often have a faster onset and a duration of approximately one to two hours (Lambert, & Goldman, 2018). Then, the nurse would have used other techniques to reduce the pain which might be associated with infiltration such as buffering the lidocaine through the addition of sodium bicarbonate, injection through the wound instead of the skin, using finer gauge needles, warming the solution of the anesthetic and slowing the injection speed (Brown et al., 2016). After the administration of the local anesthesia, cleansing of the wound takes place to help in the prevention of various bacterial infection through the addition of clindamycin to remove any foreign objects as well as reducing the multiplication of bacteria in the wound. The injured knee shall then be irrigated using normal saline to rinse any possible micro debris from the wound. The nurse is then supposed to suture the wound after ensuring that it is clean for it to be free from contamination (Navanandan, Renna-Rodriguez, & DiStefano, 2017).

Teaching the Nurse Should have Given the Child's Parents

The teaching that the nurse practitioner should have given the parents of the seven-year-old male is to monitor the wound closely for any signs of infection in case the prescribed drugs fail to work and report immediately to the medical center. Also, if the wound was repaired using tissue adhesives, the parents should always ensure that they are dry and the application of antibiotic ointment should be avoided to prevent the dehiscence of the wound (Navanandan et al., 2017). The parents should then advise their child to avoid any activities which might open or re-injure the wound. Stitches should also be observed to ascertain that they are intact and are keeping the edges of the wound together. In case of any abnormalities, the parents should report immediately to the relevant pediatrician for proper medical attention (Brown et al., 2016).

How the Malpractice Lawsuit Could Have Been Avoided

The malpractice lawsuit could have been curbed if the nurse practitioner prescribed the right drug to the right patient, in the correct dosage, route, duration, and indication. Also, if the nurse had identified and addressed the questions or concerns regarding the care treatments of the patient, the child would not have encountered the numerous complications that led to surgery (Brown et al., 2016). Moreover, in case the nurse had documented all the patient-related consultations, discussions, and clinical information, he or she would have known that the child was allergic to penicillin and thus, would not have prescribed the wrong medicine that led to reactions such as skin rash.

The parents would have also reported in time and acted upon any adverse response to their child's treatment and pursued the case through the institutions administrative or clinical command chain until the appropriate resolution was made (Navanandan et al., 2017). Other health professionals, as well as the organization, should also act as the advocate of the patient to ascertain that patient safety is considered and quality care services received through requesting for the patient's feedback before discharge. The authorized family members or the patient are always advised to follow up with the treatment team regarding their medication or that of their relatives to ascertain that the right procedures are being followed (Lambert, & Goldman, 2018).

References

Brown, J. C., Tuuri, R. E., Akhter, S., Guerra, L. D., Goodman, I. S., Myers, S. R., ... & Conners, G. P. (2016). Lacerations and embedded needles caused by epinephrine autoinjector use in children. Annals of emergency medicine, 67(3), 307-315. Doi: 10.1016/j.annemergmed.2015.07.011

Lambert, C., & Goldman, R. D. (2018). Pain management for children needing laceration repair. Canadian Family Physician, 64(12), 900-902. Retrieved from https://www.cfp.ca/content/64/12/900.abstract

Navanandan, N., Renna-Rodriguez, M., & DiStefano, M. C. (2017). Pearls in Pediatric Wound Management. Clinical Pediatric Emergency Medicine, 18(1), 53-61. Doi: 10.1016/j.cpem.2017.01.006

Nurses Service Organization, (2018). The case of a pediatric patient at a walk-in clinic with leg laceration and subsequent infection. Nurses service organization. Retrieved from https://canvas.olivet.edu/courses/16026/files/2031754/download?wrap=1