A patient has been admitted with a fever of 102.8 F (39.3 C), with an unknown origin.
The patient’s urine is cloudy, foul-smelling, and dark amber.
Orders have been given to obtain urine and blood cultures immediately and to administer an antibiotic intravenously.
In what order should the nurse complete these orders?
A.
Administer the antibiotic dose, then obtain blood and urine cultures.
B.
Obtain urine culture, administer the antibiotic dose, then obtain blood culture.
C.
Obtain blood culture, administer the antibiotic dose, then obtain urine culture.
D.
Obtain blood and urine cultures, then administer the antibiotic dose.
The Correct Answer and Explanation is:
The correct answer is:
D. Obtain blood and urine cultures, then administer the antibiotic dose.
Explanation:
In this scenario, the patient presents with a fever of 102.8°F (39.3°C) and signs of a possible infection, such as cloudy, foul-smelling, and dark amber urine. These symptoms suggest a potential urinary tract infection (UTI), sepsis, or another systemic infection. The patient’s condition necessitates prompt medical attention to identify the source of the infection and initiate appropriate treatment.
Order of Steps:
- Obtain Blood and Urine Cultures: Before administering any antibiotic, it is critical to obtain blood and urine cultures. This step is essential because cultures help identify the causative organism(s) responsible for the infection. If cultures are taken after the administration of antibiotics, the antibiotics can interfere with the growth of bacteria in the culture, leading to false-negative results or altering the identification of the causative organism. Accurate culture results are vital for tailoring antibiotic therapy to the specific pathogen and ensuring effective treatment.
- Administer the Antibiotic: After obtaining the blood and urine cultures, the nurse should administer the prescribed intravenous antibiotic. Initiating antibiotic therapy quickly is crucial in treating the infection and preventing complications, especially in cases where sepsis is a concern. Early administration of antibiotics can significantly reduce morbidity and mortality associated with severe infections.
Rationale:
- Timing of Cultures: Blood and urine cultures must be collected before antibiotic administration to ensure that the samples are not contaminated by the antibiotic, which could suppress bacterial growth in the culture medium and lead to inaccurate results.
- Prompt Antibiotic Therapy: Administering the antibiotic immediately after obtaining cultures ensures that the patient receives timely treatment, which is critical in managing infections, particularly those with the potential to progress rapidly.
In conclusion, obtaining cultures before administering antibiotics is a key step in managing infections. This practice allows for accurate identification of the pathogen, which guides appropriate antibiotic therapy, ultimately improving patient outcomes.