00:00
A client is started empirically on ampicillin but is then switched to clindamycin
48 hours later. When the client asked why the antibiotic was changed, which is the
best answer by the nurse? Okay, so first sentence, a client is started, ahh there's our
word, empirically. Do you remember what that means? So they started empirically
on ampicillin but is then switched to clindamycin. So, what's going to be the best
answer for why we switched from ampicillin to clindamycin 48 hours later when it
was empirically prescribed? Okay, there's your topic. You got 4 answer choices,
we're going to go ahead and bring those answer choices in now so you can see
them. There they are. So, use your scratch paper; numbers 1, 2, 3, and 4; eliminate
your answer choices and make sure you say why and we'll see you back here. Hey,
how'd you do? Were you able to get it down to 1 answer choice? Alright, make
sure you own that answer choice because that's where the benefit comes for use
when you think about how you got to that particular answer. So, I'm really not as
much interested if you got it right or if you got it wrong as I want you to learn
more about how you got to the answer you chose and things that you can learn
about your thinking to help you pick better next time. Alright. So let's take a look.
01:33
So, I know empirically means hey you came in with some type of infection, we
don't have a culture and sensitivity on it because that takes time to come back so
what we're going to do is just give you based on what we know in the community
what is most likely causing this, we're going to give a broad-spectrum antibiotic.
01:52
Alright, so that's one that whoah it's the big guns, now we want to give you the
most narrow spectrum that we can that will be effective because we're trying to
limit the new bugs that come out that are resistant like you know VRE is
vancomycin resistant or MRSA which is methicillin-resistant staphylococcus
aureus. So, we don't want any more of those nasty bugs. So that's why empirically
we know we have to treat it, we start with something broad. And then when we get
an idea of what's a better choice, we'll switch to another medication that hopefully
is more narrow spectrum and effective. So, what can we get rid of? Well, based on
what we just talked about, number 3 you're gone. Right? The first medication
which was ampicillin was a narrow-spectrum antibiotic while the second one is a
broad spectrum, no that's not true and that is the opposite of what we want. We
want to start with a broad spectrum because we don't know what's really going to
be effective. When we get the culture and sensitivity back, it'll show us exactly
what antibiotics will be effective and we'll switch to one of those that has a more
narrow spectrum. Why? we're trying to prevent antibiotic resistance. Okay, so
number 3 you're out. Now, number 2. Antibiotic choice is effective by many
factors including cost, availability, and potential for side effects. That's true. So,
but what is the topic of the question why the antibiotic was changed? We're saying
it's affected by a lot of factors; cost, availability, and potential side effects. Well,
that may come in to play but the antibiotic has to be effective, that doesn't explain
why we changed it because cost would not be why we changed it. Availability, this
both should be available. Potential side effects, no. So, number 2 you're out.
03:50
Number 1, we received your blood culture and sensitivity report and it showed the
new antibiotic will be more effective. Okay, there you go. That sounds like a good
answer, I'm going to keep it in but I'm not ready yet to say that's the correct answer
because I have one that I haven't evaluated. So, 2 was out, 3 was out. Number 4,
the first medication was stronger to start the eradication, I love that word, to start
the eradication of the infection followed by a not quite as strong. Well, besides not
being the best kind of response, right, it's kind of a vague response, number 1 is
clearly better. We got your blood culture and sensitivity report back and it showed
the new antibiotic will be more effective and hopefully more of a narrow spectrum.
04:42
So number 1 is the best answer by the nurse. How do we find that? We eliminated
answer choices that were clearly wrong and then we kept comparing relative to the
other answers to figure out which one was the priority answer or the best answer.
04:58
So, take a second and write in your notebook any notes you need for yourself,
think about your thinking, what can you learn from this question that you can take
to another question. But while we're here, remember what is the order for starting
an antibiotic and getting a blood culture? Which should come first? If at all
possible, get the blood culture first and then start the antibiotic. Now, you want that
done really quickly because the quicker we get the antibiotic in, the more effective
it's going to be at slowing down that infection but get a blood culture first or a
sputum culture or whatever you're culturing, if at all possible.