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Vancomycin Administration
Vancomycin Administration
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Vancomycin administration
BA is a 66year female admitted to the inpatient department for intravenous antibiotics, wound debridement, and management of his right great toe. She has past cellulitis ulcers, which complicated with wound culture positive for MRSA
The subjective data:
The patient stepped on an exposed carpet tack while walking two months ago at his home, which caused a cut at his right toe. She reports that the area has never healed fully, and the wound seems to be getting bigger. She reports that there has been increased redness and fowl whitish-yellow discharge on his socks over the past week. She complains of fever, chills, and sweats over several days. She has been on ibuprofen for the pain without any relief. The patient reports not self-monitoring her blood glucose levels often at home. She reports no known allergies.
She denies weight loss, weakness, or fatigue on a systematic review. Regarding the HEENT system, she denies visual loss or changes, and no signs of upper respiratory tract infection are reported. She denies chest pain, discomfort, and pressure on the cardiovascular system review. Respiratory-wise, no signs of DIB or lower respiratory tract infection. She is a known diabetic and hypertensive patient taking lisinopril 5mg once a day and metformin 850mg twice a day.
Socially, she is a retired teacher who lives with her husband. She quit smoking 32years ago and denies consuming alcohol. she is very active in the community and would like to resume her driving after going back to her volunteer work
Objective data
No distress was noted on observation. The patient is communicating and comprehending verbal instructions. On taking vitals, the patient is stable with a temperature of 101f, pulse rate of 93b.p.m, respiratory rate of 19b.p.m, and blood pressure of 123/70mm/hg. She weighs 13Olbs. On auscultation, there are scattered expiratory wheezes. s1 and s2 of the heart record regular rate and rhythm. On palpation, the abdomen is soft and non-tender. Bowel sounds were noted four times. The extremities are bilateral with one pitting edema. A 3cm necrotic concentric wound on the plantar surface of the right hallux, first metatarsal head. Local wound symptoms were noted, including cellulitis. Black Escher noted around edges with a soft yellow appearance towards the center of the wound. The wound produces a moderate amount of creamy yellow purulent exudate.
An x-ray of the right foot shows minimal soft tissue swelling on the dorsum of the foot. Question of mild cortical irregularity at first MTP joint .more investigations are pending to confirm the diagnosis. An MRI done confirms osteo edema and osteomyelitis. Concerning the lab works, no indication of signs of AKI. The goal of treatment on osteomyelitis is to eradicate the infection
while preserving the soft tissue, healing the bone segment, and preserving the length function of the limb
Assessment
A: IBW(ideal body weight)
Patient height 5feet 3inches
IBW=45.5+2.3(each inch over 5feet)
=45.5+2.3(3)
=45.5+6.9
=52.4kgs
B: choice of body weight this is the adjusted body weight
ADJBW=IBW+0.4*(ABW-IBW)
ABW=130Pounds
1pound=0.454
130pounds=?
130*0.454/1
=59.02kgs
ADJBW=52.4+0.4*(59.02-52.4)
=52.4+0.4*(6.62)
=52.4+2.648
=55.048
C: creatinine clearance(CrCl)
CrCl=[114-(0.8*age)]/creatinine level In mg/dl
=[114-(0.8*66)]/1.9
=[114-52.8]/1.9
=61.2/1.9
=32.21
D:ke
=0.00083*CrCl+0.0044
=0.00083*32.21+0.0044
=0.0267+0.0044
=0.0311
E:half life(T1/2)
=0.693/Ke=0.693/0.0311
=22.28
F_Tau=6*{72/[(10*cl)+1.9]}
CL=(CrCl*0.0075)+0.004
=(32.21*0.0075)+0.004
=0.2416+0.04
CL=0.2816
Tau=6*{72/[(10*0.2816)+1.9]}
=6*{72/[2.816+1.9]
=6*{72/4.716}
=6*15.2672
=91.6032
G: loading dose
a) standard loading dose
25-30mg/kg
=25*52.4
=1310mgs
Approximately 1500mgs
30*52.4
=1572
Approximately 1750mgs
b) modified loading dose
Applies when CrCl is less than 30 and no signs of AKI, plus the patient shouldn’t be on CRRT
20-25mg/kg
=20*52.4
=1048mgs
Approximately 1250mgs
25*52.4
=1310mgs
Approximately 1500mgs
H: maintenance dose
For CrCl of (30-50), dose of 10-15mg/kg
10*52.4
=524mgs
Approximately 750mgs
Or
15*52.4
=786
Approximately 1000mgs
I: expected trough and peak concentrations for maintenance doses
The expected peak is an hour after the 3rd dose
The expected trough is 30mins before 3rd dose
The infusion rate is two to three doses daily within the standard rate. One gram runs over 60mins. The standard infusion rate is important to prevent erythematous rash on the upper body and face. Vancomycin is intravenous as it has low oral bioavailability. Treatment is given for a period between 7 days and 21 days. Vancomycin causes nephrotoxicity; hence close monitoring is essential.
Van Gogh Mental Sickness
Van Gogh Mental Sickness
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Vincent van Gogh was an author and a painter who suffered hallucinations, and it is believed that he had nightmares. In his writing, Vincent complained about his stomach and poor digestion, which resulted in him cutting off his ear (Van Gogh-Bonger et al. 2018). This shows that Vincent had suffered mental illness and because the illness was passed from generation because it is seen in his bloodline that the mental sickness was present from his fore-parents, he thought that cutting off his ear would make him well. He had also had reported cases in his letters talking of suicide. He was mentally ill, and all he wanted was to end his life because he thought that even after having diseases including acute epilepsy, gonorrhea and other diseases, he would not live a happy life but would suffer before dying. This shows that the painter was mentally sick, and he wanted to die to end his suffering.
The artist at that time felt that he had been rejected. The presence of his brother and other people around his could not give him happy moments because he only thought that everything would be fine after his death (Walker et al. 2017). In his many letters before his mental sickness elevated, he used to write sad letters and frequently talking about his death which was suicidal. It was later discovered that Vincent had and insomnia and bipolar disorder which was not treated on time; hence the disease became worse.
Vincent was depressive and was always bothered by very small issues that have happened in his life. He is reported to have been bothered by as small issues as finding out that his painting has been tampered with. This depressive state of this painter may have caused him to increase his sickness and to be sicker with time. He also had been involved in an issue at a younger age when he was in love with the landlord’s daughter, and the lady refused to marry him, making him experience his first mental breakdown.
It is not possible to diagnose someone based on the pictures that were taken before they died. This is because some of these pictures were taken before they became mad or some people took pictures of themselves in a place they thought these picture would never be seen (Turkheimer et al. 2020). Due to the mistake or the carelessness of these people, the pictures find their way and seen by the people who were to see. When these people see the picture, they get the different perception that the people on the pictures suffer from a certain disease they are not suffering from.
Among the challenges the scholars the violent artists. Some artists are violent when they are asked about critical issues in their lives. Their past may have been very cruel, and they do not wish to be reminded, or they may have encountered issues which, when reminded they feel bad. Moreover, some artist does not disclose their lives’ past events because they feel that their past should not be dug out for issues they may have encountered.
References
Turkheimer, F. E., Fagerholm, E. D., Vignando, M., Dafflon, J., Da Costa, P. F., Dazzan, P., & Leech, R. (2020). A GABA Interneuron Deficit Model of the Art of Vincent van Gogh. Frontiers in psychiatry, 11, 685.
Van Gogh-Bonger, J., & Gayford, M. (2018). A Memoir of Vincent Van Gogh. Getty Publications.
Walker, F., Bucker, B., Anderson, N. C., Schreij, D., & Theeuwes, J. (2017). Looking at paintings in the Vincent Van Gogh Museum: Eye movement patterns of children and adults. PloS one, 12(6), e0178912.