Ade OSCE

Question 1

To which class of drugs does Metronidazole belong?

Answer 1

Antimicrobials or Antibiotics

Question 2

Please outline how Metronidazole works?

Answer 2

Metronidazole entered the anaerobic bacteria/ protoza cell. This generates a nitroso free radical, which binds to DNA causing degradation and cell death.

Question 3

What side effects of metronidazole may add expierence?

Answer 3

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

Question 4

What is metronidazole?

Answer 4

It’s an antibiotic

Question 5

How does the metronidazole work to get rid of Ades infection?

Answer 5

Metronidazole works by entering the bacteria cells and killing them

Question 6

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

Answer 6

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

Question 7

Are there any side affects associated with taking metronidazole that I should be looking out for?

Answer 7

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

Question 8

Is there anything else I can do to help ades infection and raised temperature?

Answer 8

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 paracetomal if he’s uncomfortable
Is ades temperature is up, ensure the room is cool ( not cold ) and he has minimal clothing on

Question 9

From the history taking and assessment outline 4 physiological concerns you have for add and relate them to the Pathophysiology of appendicitis
Concern1:

Answer 9

Ade has significant abdominal pain

There could be a blockage of the appendix which can cause increased pressure and necrosis which leads to pain

There could be a risk of ulceration due to microbial growth which causes swelling and oedema then leads to pain

Question 10

From the history taking and assessment outline 4 physiological concerns you have for add and relate them to the Pathophysiology of appendicitis
Concern 2:

Answer 10

Ade has been vomiting for around 12 hours

Ade has not been replacing fluid loss or drinking maintenance fluids

Question 11

From the history taking and assessment outline 4 physiological concerns you have for add and relate them to the Pathophysiology of appendicitis
Concern 3:

Answer 11

CRT is 3 seconds and Ade has tachycardia

Ade could be dehydrated due to vomiting which could lead to a reduced circulatory volume which causes the heart to pump faster so that all body parts receive oxygen and nutrients

Question 12

From the history taking and assessment outline 4 physiological concerns you have for add and relate them to the Pathophysiology of appendicitis
Concern 4:

Answer 12

Ade has Pyrexia

The body increases temperature to stop infection if infection worsens a gangrene may develop as a immune response

Question 13

Name on concern relating to ades mental well-being

Answer 13

Ade is very anxious and stressed and needs support

Question 14

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

Answer 14

Review ades history

Review assessment and clinical observations and devised which are out with acceptable limits

Decide the ADLS with which Ade needs support

Consider priority of importance of ades needs

Write the care plan, ensuring each element is smart

Ensure evaluation date is set

Question 15

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 1: Ade has significant abdominal pain

Answer 15

Assess pain, administer analgesia as prescribed and monitor effect

Question 16

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 2: CRT is 3 seconds and he has tachycardia

Answer 16

IV fluid boils and commence IVI and monitor effect

Question 17

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 3: Ade has been vomiting for around 12 hours

Answer 17

Administer anti-emetic as prescribed and monitor effect

Question 18

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 4: Ade has a pyrexia

Answer 18

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

Question 19

For each of the five priorities of care identified what actions will you take to alleviate them?
Concern 5: Ade is very anxious and stressed and needs support

Answer 19

Provide advice and reassurance

Question 20

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

Answer 20

Ade has significant abdominal pain

CRT is 3 seconds, and he has tachycardia

Ade has been vomiting for around 12 hours

Question 21

So if ades temperature returns to normal should I stop giving him the metronidazole ?

Answer 21

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 then return

Question 22

What are the indications for using metronidazole with ade?

Answer 22

Post-appendicetomy pyrexia