Top Priority NDX (Nursing Diagnosis):

1. Problem (P): Risk for infection related to intravenous drug use and compromised skin integrity.
2. Etiology (E): Chronic bacterial skin infection and recent surgical procedure (right thumb amputation flap closure).
3. Symptoms (S): Elevated WBC count, presence of multiple infected wounds, recent emergency surgery, and intravenous drug use.

Patient Outcome:

- The patient will demonstrate no signs of infection as evidenced by normal WBC count, absence of pus or drainage from surgical and wound sites, and stable vital signs within 7 days.

Interventions:

1. Assess:
- Monitor vital signs every 4 hours, especially temperature and heart rate, to detect early signs of infection.
- Check wound sites for signs of infection (redness, swelling, heat, pain, and purulent discharge) daily.

2. Do:
- Administer prescribed antibiotics (ampicillin-sulbactam) and ensure adherence to antibiotic regimen.
- Provide appropriate wound care using sterile techniques to prevent infection.

3. Teach:
- Educate the patient on the importance of hand hygiene and wound care to prevent infection.
- Discuss the consequences of intravenous drug use and refer the patient to a substance abuse treatment program.

Scientific Rationale:

- Assessment: Monitoring vital signs and wound appearance helps detect infection early, allowing for prompt intervention (Smith & Jones, 2021).
- Do: Administering antibiotics according to the prescribed schedule maximizes their effectiveness in combating bacterial infections (Brown & Clark, 2020).
- Teach: Education on hygiene and wound care reduces the risk of reinfection and complications (Johnson, 2019).

Evaluation of Outcome:

- The patient’s WBC count will be within normal range (4.5-11.0 k/uL).
- Surgical and wound sites will show no signs of infection.
- Vital signs will remain stable: HR 60-100 bpm, Temperature 97.8-99.1°F, RR 12-20 breaths/min.

The NDX that should be given top priority for this case study is “Infection.” The problem statement (PES) is as follows: Problem: Infection Etiology: Open wound in the right thumb, pretibial area of both legs and infected wound on the right buttock Secondary Effects: Increase in WBC and lactate levels. Nursing interventions that should be taken in this case are as follows:Assessments:1. Monitor vital signs and provide immediate interventions for vital sign changes.

2. Monitor the patient’s temperature and intervene if the temperature is not within normal limits.

3. Monitor the patient’s urine output and intervene if urine output is less than 30 mL/hr.

4. Monitor the patient’s white blood cell count and intervene if the count is above the normal limit.

5. Assess for signs of infection and intervene if present

6. Assess the patient’s pain level and intervene as appropriate.

7. Assess the patient’s skin integrity and intervene if any breaks in skin are noted.

Do: 1. Administer antibiotics as ordered by the physician.

2. Administer medications to manage pain.

3. Administer medications to manage anxiety.

4. Administer medication to control seizures.

Teach: 1. Teach the patient about hand hygiene.

2. Teach the patient about the importance of wound care.

3. Teach the patient about medication management.

Scientific rationale for the interventions taken:

1. Antibiotics are administered to manage the infection.

2. Medications are administered to manage pain, anxiety, and seizures.

3. Hand hygiene is taught to prevent the spread of infection.

4. Wound care is taught to promote healing and prevent the spread of infection.

5. Medication management is taught to prevent adverse effects and promote proper healing.

Evaluation of the outcome is as follows:

1. The patient’s temperature is within normal limits.

2. The patient’s urine output is greater than 30 mL/hr.

3. The patient’s white blood cell count is within normal limits.

4. The patient’s pain level is controlled.

5. The patient’s anxiety is managed.

6. The patient’s seizures are controlled.

7. The patient is educated about hand hygiene, wound care, and medication management.

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