ADE

Question 1

Ade has significant abdominal pain.
(2 marks)

Answer 1

This is due to a blockage in the appendix which causes increased pressure and necrosis which results in pain.

Question 2

Ade has been vomiting for around 12 hours.
(1 mark)

Answer 2

Ade has not been replacing fluid loss or drinking maintenance fluids.

Question 3

CRT is 3 seconds and Ade has tachycardia.
(2 marks)

Answer 3

This is due to being dehydrated because of vomiting which results in a reduced circulatory volume which makes the heart pump faster for the body to recieve oxygen and nutrients.

Question 4

Ade has a pyrexia.
(2 marks)

Answer 4

This is due to the infection worsening which is a result of developing gangrene causing the increase of temperature to destroy the infection.

Question 5

Name one concern relating to Ade’s mental wellbeing.

Answer 5

Ade is very anxious and stressed and needs support.

Question 6

Explain the process you would follow in preparation for prioritising care and writing a plan of care

Answer 6

Review Ade’s history.
Review assessment and clinical observations and decide which are out with acceptable limits.
 Decide the ADLs with which Ade needs support.
 Consider priority of importance of Ade’s needs.
 Write the care plan, ensuring each element is SMART.
Ensure evaluation date is set.

Question 7

For each of the five priorities of care identified in Station 2, what actions will you take to alleviate them?

Answer 7

Ade has significant abdominal pain - Assess pain, administer analgesia as prescribed and monitor effect.

Ade has a pyrexia - Monitor pyrexia and administer anti-pyretic as prescribed if Ade is uncomfortable.

Ade is very anxious and stressed and needs support - Provide advice and reassurance.

Ade has been vomiting for around 12 hours - Administer anti-emetic as prescribed and monitor effect.

CRT is 3 seconds, and he has tachycardia - IV fluid bolus and commence IVI and monitor effect.

Question 8

Of those five priorities of care, which three are the most urgent.

Answer 8

Ade has significant abdominal pain.
CRT is 3 seconds, and he has tachycardia.
Ade has been vomiting for around 12hrs

Question 9

To which class of drug does Metronidazole belong?

Answer 9

Antimicrobials or Antibiotics

Question 10

Please outline how Metronidazole works (pharmacodynamics & pharmacokinetics)

Answer 10

Metronidazole enters the protozoa cell. This generates a nitroso free radical, which binds to DNA causing degradation and cell death.

Question 11

What are the indications for using Metronidazole with Ade?

Answer 11

Post-appendicectomy pyrexia

Question 12

What side effects of Metronidazole may Ade experience?

Answer 12

Most side effects are rare, but there can be GI disturbances.
Reduce dose if hepatic impairment present.

Question 13

What is Metronidazole?

Answer 13

Metronidazole is an antibiotic.

Question 14

Why does Ade need Metronidazole?

Answer 14

Ade’s temperature has gone up since his surgery, so we think he may have an infection.

Question 15

How does the Metronidazole work to get rid of Ade’s infection?

Answer 15

Metronidazole works by entering the bacteria cells and killing them.

Question 16

How often will I need to give Ade the medicine when we go home?

Answer 16

Ade will need it three times per day until the end of the course.

Question 17

So, if Ade’s temperature returns to normal should I stop giving him the Metronidazole?

Answer 17

No, it’s very important that you continue to give him the Metronidazole until the end of the course. Even though Ade seems well, there may still be some bacteria in the blood, and as soon as you stop giving the Metronidazole they will reproduce, and the infection will return.

Question 18

What do I do if his temperature gets worse, not better?

Answer 18

It may be the Metronidazole isn’t working and he may need to change to a different antibiotic, so speak to your doctor.

Question 19

What happens if I forget to give a dose?

Answer 19

It’s important to try not to miss doses, but it happens. Don’t worry, just give him his next dose when its due. Don’t give him a double dose.

Question 20

Are there any side effects associated with taking Metronidazole that I should look out for?

Answer 20

Some children can have some stomach problems, such as diarrhoea, nausea, vomiting.
If any of these happen, please speak to your doctor.

Question 21

If he has any such reactions or the medication doesn’t work, is there something else he can be given?

Answer 21

Yes, there are different types of antibiotics that Ade could be given, if necessary. That’s why it’s important to speak to your doctor if he has any side effects.

Question 22

Is there anything else I could do to help Ade’s infection and raised temperature?
(Alternative methods of temp. management)

Answer 22

Keep the wound clean and dry
Keep the dressing clean and dry
Encourage Ade not to touch/ scratch the area
Encourage Ade to rest to encourage recovery.
Give paracetamol if he is uncomfortable
If Ade’s temperature is up, ensure the room is cool (not cold) and he has minimal clothing on.

Question 23

Is there anywhere I can find out more about Metronidazole, appendicectomy and infections?

Answer 23

We have an information leaflet that I can get for you. Also, there are some websites that may help, for example, NICE Guidelines or NHS Inform.

Question 24

What is Ade’s PEWS Score?

Answer 24

PEWS = 7

Question 25

What action will you take?

Answer 25

Level 3 review immediately- inform senior staff.
Consider 2222 if unable to review immediately.