NRNP 6566F Week 4 Scenario: 84 Year Old FemaleNRNP 6566F Week 4 Scenario: 84 Year Old FemaleWeek 4Po

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NRNP 6566F Week 4 Scenario: 84 Year Old Female

NRNP 6566F Week 4 Scenario: 84 Year Old Female

Week 4

Posted on: Monday

Greetings Students,

Welcome to week 4.

Great job on your 1st knowledge check. If anyone would like to review, please send me an email and I will be happy to go over your answers.

This week you all will be learning more about arrhythmias, shock and hypertension. Please utilize the information provided under the learning resources.

For your assignments there will be another branching exercise and your second knowledge check. Both of these assignments are due 

Please remember to review the rubric and the comments I have made on your previous branching exercise to improve and receive maximum points.

Here is the information for your branching exercise:

84 y/o Female

Code Status: DNR

PMH: HTN, DM

Home meds: Metoprolol/Insulin/ASA/ Calcium

Wt: 62kg, Ht 5’5

NKDA

Critically think about where you would send this patient from the ER and write admissions orders for that unit. Remember to be specific with your orders. Especially with your nursing orders.

Remember Oxygen is a drug. We shouldn’t be placing oxygen on patients just to place it or if they have a normal O2 sat, ie: 94%. If they have an O2 sat of 92% and above O2 is not indicated. Remember if you just put oxygen on a patient routinely, if something really is going on, it could mask a problem that may warrant an investigation. 

Please email me with any you have any questions, comments, concerns. If you would like to have a zoom meeting or phone conference, please email me and we can schedule a time.

Best,

Scenario #3 84 year old female

BACKGROUND

• An 84-year-old female is brought in by family with complaints of increased confusion and lethargy.
• Patient usually lives alone and is fully functional.
• Son reports that she has been increasingly confused and sleeping a lot at home.
• Son denies any fever.
• Patient complains of pain “all over” and responds to repeated questions with “I think I’m sick”

VITAL SIGNS

• BP 105/64, HR 115, RR 24, T 96°F, SpO2 92% Room Air
• Patient is alert, and oriented to person but thinks is it 1990
• PMH: HTN: Metoprolol
• DM: Insulin
• Other meds: ASA, Calcium

Decision Point One

12 lead EKG, CBC, CMP, urinalysis, Chest x-ray

RESULTS OF DECISION POINT ONE

•  Correct!
•  Initial 12 lead EKG to assess myocardial function
•  CBC to assess WBC and potential anemia
•  BMP to assess electrolyte disturbance and potential for DKA
•  Urinalysis to assess for potential infection
•  Chest x-ray to asses for potential infection

RESULTS OF INDICATED TESTS

Complete Blood Count (CBC)

WBC 3.4 k/UL
Hgb 9.3 g/dL
Hct 28%
Platelets 250 k/UL
Differential
Neutrolphil 90%
Bands 10%
Eosinophil 0%
Basophil 0%
Lymphocyte 2%
Monocyte 3%

Basic Metabolic Profile (BMP)

Na+ 132mEq/L
K+ 3.7mEq/L
HCO3 27mEq/L
Cl- 101mEq/L
Glucose 1766 mg/dL
BUN 55 mg/dL
Creatinine 2.0 mg/dL

Urinalysis (U/A)

Color Yellow
Clarity Dark/Cloudy
Sp gravity 1.042
pH 6.2
Total Protein negative
Glucose positive
Ketone negative
Bilirubin negative
Hematuria positive
Leuk. Est. +++
Nitrite +++

Decision Point Two

Urinary Tract Infection

RESULTS OF DECISION POINT TWO

•  Urinalysis shows hematuria, positive nitrate, positive leukocyte esterase which all are indicative of a UTI.
• Elderly frequently have a low WBC and low body temperature in the presence infection.
• Chest x-ray is clear and EKG shows tachycardia but no arrhymia or myocardial hyposia.
•  The patient remains confused and is becoming more lethargic. Follow up BP is 82/42. Serum lactate level is 4.5. What is your diagnosis now?

Decision Point Three

Septic Shock

Guidance to Student

Correct!

SIRS (systemic inflammatory response syndrome) requires the presence of two of the four factors:

• Temperature less than 36.0 C or greater than 38.0 C
• Heart rate greater than 90 BPM
• Respiratory rate > 24 breaths per minute or PaCO2 < 32
• WBC less than 4,000 or greater than 12,000; or Bandemia>10%

Week 4: Hypertension and Shock

Issues with the heating and cooling system of your home can be relatively benign matters that are addressed easily enough with the help of a visiting technician. But in cases of extreme weather conditions or delayed attention, these matters can seriously threaten the health of the home or its occupants.

Similarly, extreme cardiovascular conditions can pose very serious health risks. Hypertension can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Shock can damage the body’s organs and can also be life-threatening. Effective diagnosis and treatment of hypertension and shock can, therefore, be a critically important and even life-saving endeavor.

This week, you will assess and develop management plans for patients with hypertension, including urgent and emergent conditions. You will review how to differentiate shock states and examine hemodynamic values for those shock states when evaluating treatment goals.

Learning Objectives

Students will:

• Distinguish between hypertensive urgencies and emergencies
• Develop a management plan for hypertensive emergencies
• Apply current clinical practice guidelines to address acute and chronic management of hypertension
• Distinguish shock states
• Develop patient treatment plans for shock
• Analyze pharmacologic treatments of shock
• Evaluate normal and abnormal hemodynamic monitoring values
• Develop appropriate treatment plans, including diagnostics and laboratory orders for patients with hypertension and shock
• Identify concepts related to hypertension and shock

 

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Learning Resources

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

• • Chapter 12, “Hypertension” (pp. 131–145)
  • Chapter 15, “Adjunct Therapies” (pp. 185–200)
  • Chapter 76, “Management of the Patient in Shock” (pp. 982–1012)

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), 1269-1324. doi:10.1161/HYP.0000000000000066

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2018, August 19). Vasopressors explained clearly: Norepinephrine, Epinephrine, Vasopressin, Dobutamine… [Video file]. Retrieved from https://www.youtube.com/watch?v=zf28Rjbu3VM

MedCram. (2017, November 19). Hypertension guidelines explained clearly – 2017 HTN guidelines [Video file]. Retrieved from

MedCram. (2017, November 9). Shock and sepsis explained clearly (remastered) symptoms, causes, and pathophysiology [Video file]. Retrieved from https://www.youtube.com/watch?v=sTdrIlOGnfI

MedCram. (2014, December 23). Hypertension explained clearly, 2 of 2 [Video file]. Retrieved from https://www.youtube.com/watch?v=NgMfZVEWQd8

MedCram. (2012, September 12). Hypertension explained clearly – causes, diagnosis, medications, treatment [Video file]. Retrieved from https://www.youtube.com/watch?v=OmKVteeuQj0

MedCram. (2012, July 17). Shock explained clearly – cardiogenic, hypovolemic, and septic [Video file]. Retrieved from https://www.youtube.com/watch?v=CbM4UihE1TQ

Walden University (Producer). (2019b). Branching exercise: Cardiac case 2 [Interactive media file]. Minneapolis, MN: Author.

 

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Assignment: Branching Exercise: Cardiac Case 2

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Photo Credit: yodiyim – stock.adobe.com

To prepare:

• Review the interactive media piece/branching exercise provided in the Learning Resources.
• Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
• You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

• Be sure to address each aspect of the order template
• Write the orders as you would in the patient’s chart
• Make sure the order is complete and applicable to the patient
• Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
• Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.
• A minimum of three current, evidenced based references are required.

By Day 7 of Week 4

Submit your completed Assignment by Day 7 of Week 4 in Module 2.

Admission orders: Cardiac Case 2 Example

Primary Diagnosis: 

Hypertension is the primary diagnosis. Patient is also known to be diabetic.

Status/Condition (Critical, Guarded, Stable, etc.):

The patient walks in the hospital in a stable condition.

Code Status: 

The patient is of Do-Not-Resuscitate (DNR) status.

Allergies: 

The patient has no known food or drug allergy (NKFDA)

Admit to Unit: 

To be admitted to the medical-surgical unit.

Activity Level:

The patient has no restrictions to activity.

Diet: 

The patient is on carbohydrate-controlled diet and input output control.

IV Fluids: 

• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.): 

Maintain patent IV access.

 0.9% sodium chloride 3-10mls flush in every 12 hours.

0.9% sodium chloride 3-10mls flush before and after every IV drug infusion.

Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings: 

Oxygen via nasal canula for SPO2 below 92%.

Discontinue for saturation above 93% on RA.

Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route):

Metoprolol:( 50mg – 400mg/day). 50mg administered twice a day Taken orally after meals. Increase the dose on weekly or longer intervals on need basis.

Insulin: (0.2-0.4 units/kg/day). Administer subcutaneously after measuring the glucose level. Maintain patent IV line for emergency cases. Adjust doses according to blood glucose control.

Aspirin: 162.5mg oral dose once/day. Assess for bleeding disorders and contraindications such as surgery.

Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):

Maintain an input and output record every four hours, blood pressure recording every 4 hours, AC glucose monitoring before every meal and perform daily weight checking (Jian-Hong et al, 2020), prevent falls while in hospital.

Follow-Up Lab Tests:

Perform lipid profile, electrolytes level, kidney function test, BUN, KUB and Creatinine clearance.

Urine protein, urinalysis and urine drug level.

• Diagnostic testing (CXR, US, 2D Echo, etc.):

Cardiac: echocardiogram and EKG.

Consults:

Cardiology consult: hypertensive management

Nutritionist consult: review of diet plan and weight gain

Social worker consult: conducive home-based care before discharge

Pharmacist consult: antihypertensive management

NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least a 24-hour period]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation,” or “Nutrition consult for TPN recommendations.”

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):

Diet: the patient needs to reduce on sodium related products such as salt that are likely to increase water retention. She is encouraged to take fruits and vegetables, and lower portions of carbohydrates to manage her glucose levels (Whelton et al, 2017).

Medication: She is discouraged on the use of over-the-counter drugs without review of her regimen by the pharmacist. This will intend to reduce cases of toxicity that could stress the kidney. She is also educated on importance of drug compliance, in presence of the primary caregiver.

Lifestyle: Although she is expected to ambulate while at home, precaution by the patient and the caregiver is needed to avoid any skin injury. This could expose the patient to risks of heavy bleeding due to the use of ASA, and poor wound healing due to diabetes. Prevention of falls is also a priority since her old age relates with weak bones due to bone structure breakdown.

Discharge Planning and Required Follow-Up Care:

The patient must be educated on blood pressure measurement with the help of the caregiver and mode of recording. High blood pressure values should be shared for easy identification by the caregiver. The caregiver and the patient are educated on need for compliance since at her age, she is likely to forget medication regimen frequently. The caregiver should also check with the doctor before using any additional drug to avoid possible detrimental interactions.

The patient should avoid caffeine intake, salt intake, and increase potassium rich diets. The caregiver should be educated on compliance on follow-up clinics as directed by the doctor (Franklin & McCoy, 2017). The caregiver should also be aware of signs that warrant immediate medical checkup such as unresponsiveness, sudden confusion, sweating, skin cut or fall, severe headaches and sudden changes in vision.

References

Franklin, M. & McCoy, M. (2017). A transition of care from hospital to home for patients with hypertension: Wolters Kluwer Health. 

Jian-Hong, M., Hai-Shan W., Na, L. (2020). The evaluation of a nurse-led hypertension management model in an urban community healthcare, Medicine: Volume 99 – Issue 27 – p e20967.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., … Wright, J. T. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. Hypertension, 71(6), e136-e139. 

NRNP 6566F Week 4 Scenario: 84 Year Old Female Rubric Detail

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Using the Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. Be sure to address the following:
· Identify the Correct Diagnosis.
5 (5%) – 5 (5%)
The order set includes an accurate and correct diagnosis.
4 (4%) – 4 (4%)
The order set includes a diagnosis that is an appropriate differential diagnosis.
3 (3%) – 3 (3%)
The order set includes a diagnosis that is incorrect and not supported by patient data.
0 (0%) – 2 (2%)
The order set includes and inaccurate / dangerous diagnosis.
· Identify the ‘Status/Condition’, ‘Code Status’, ‘Admit to Unit’
for the patient in the presenting case.
5 (5%) – 5 (5%)
The order set includes an accurate description / plan for condition, code status, and admission location.
4 (4%) – 4 (4%)
The order set includes an accurate description for 2 of the 3 variables.
3 (3%) – 3 (3%)
The order set includes an accurate description for 1 of the 3 variables.
0 (0%) – 2 (2%)
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
· Describe the “Allergies’, ‘Activity Level’ and “Diet” for the patient in the presenting case.
5 (5%) – 5 (5%)
The order set includes an accurate description / plan for allergies, activity level, and diet.
4 (4%) – 4 (4%)
The order set includes an accurate description for 2 of the 3 variables.
3 (3%) – 3 (3%)
The order set includes an accurate description for 1 of the 3 variables.
0 (0%) – 2 (2%)
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
· Identify any ‘IV Fluids’ needed for the patient in the presenting case.
9 (9%) – 10 (10%)
The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
7 (7%) – 8 (8%)
The order set is missing 1 element of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
5 (5%) – 6 (6%)
The order set is missing 2 elements of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is incomplete, includes wrong / dangerous fluids or flow rate, incorrect parameters for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
· Identify any ‘Respiratory’ needs for the patient in the presenting case. Be specific about oxygen (if ordered, include type and rate), pulmonary toilet needs, and ventilator settings.
5 (5%) – 5 (5%)
The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
4 (4%) – 4 (4%)
The order set is missing 1 element of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
3 (3%) – 3 (3%)
The order set is missing 2 elements of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
0 (0%) – 2 (2%)
The order set is incomplete, includes wrong / dangerous orders, or incomplete parameters for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
· Describe the ‘Medications’ including any IV drips for the patient in the presenting case.

Be specific about medications related to the reason for admission and any chronic medications the patient may be taking (ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc.). Be sure to include name, dose, route of administration, and frequency of each medication.
13 (13%) – 15 (15%)
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.
10 (10%) – 12 (12%)
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. There are incomplete orders, missing medications, or missing elements in the orders.
5 (5%) – 9 (9%)
The order set is missing essential elements of a medication order, missing medications, or are inappropriate to treat the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is incomplete, includes wrong / dangerous orders, or inappropriate medications to treat the patient in the presenting case.
· Explain any ‘Nursing Orders’ for the patient in the presenting case. Be specific about vital signs, skin care, toileting, and ambulation.
9 (9%) – 10 (10%)
The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.
7 (7%) – 8 (8%)
The order set include inaccurate or is missing 1 or 2 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
5 (5%) – 6 (6%)
The order set include inaccurate or is missing 3 or 4 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
0 (0%) – 4 (4%)
The order set include inaccurate, missing, or provides dangerous nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
· Explain the ‘Follow-Up Lab’ tests for the patient in the presenting case. Be specific about diagnostic testing (e.g., CXR, US, 2D Echo, etc.).
9 (9%) – 10 (10%)
The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
7 (7%) – 8 (8%)
The order set includes most (missing 1 or 2) laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
5 (5%) – 6 (6%)
The order set includes some (missing 3 or 4) complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
0 (0%) – 4 (4%)
The order set is missing essential laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
· Explain the ‘Consults’ for the patient in the presenting case. Be specific about how you, as an ACNP, would manage the patient’s acute needs for at least a 24-hour period. Include indication for consult (e.g., “Cardiology consult for evaluation of new-onset atrial fibrillation,” “Nutrition consult for TPN recommendations”).
5 (5%) – 5 (5%)
The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.
4 (4%) – 4 (4%)
The order set is missing one of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
3 (3%) – 3 (3%)
The order set is missing 2 or more of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
0 (0%) – 2 (2%)
The order set is missing multiple consults, rations, or accurate descriptions for consults needed to manage the presenting patient.
·.
9 (9%) – 10 (10%)
The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.
7 (7%) – 8 (8%)
The order set is missing 1 or 2 essential elements of patient education and health promotion for the patient in the presenting case.
5 (5%) – 6 (6%)
The order set is missing 3 or 4 essential elements of patient education and health promotion for the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is missing multiple essential elements of patient education and health promotion for the patient in the presenting case.
· Explain the ‘Discharge Planning and Required Follow-Up Care’ for the patient in the presenting case.
5 (5%) – 5 (5%)
The order set provides clear, accurate, and complete discharge planning and necessary follow up care for the patient in the presenting case.
4 (4%) – 4 (4%)
The order set is missing 1 or 2 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
3 (3%) – 3 (3%)
The order set is missing 3 or 4 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
0 (0%) – 2 (2%)
The order set is missing multiple essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
· Identify a minimum of three ‘References.’ Be sure that they are timely and support the admission order in following current standards of care.
9 (9%) – 10 (10%)
The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.
7 (7%) – 8 (8%)
The order set does not include a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. APA format is incorrect.
5 (5%) – 6 (6%)
The order set does not include a minimum of three references or includes non-professional level resources to support their admission order set. APA format is incorrect.
0 (0%) – 4 (4%)
The order set is missing minimum number of references or includes poor sources that do not reflect professional writing or current standard of care information. APA format is not followed.
Written orders include all elements, address all the needs of the patient, are complete, logical, and meets the complete needs of the patient.
5 (5%) – 5 (5%)
Written order set is complete, addresses all the needs of the patient, and are based on current literature.
4 (4%) – 4 (4%)
Written orders are mostly complete only missing 2 essential elements in addressing the needs of the patient.
3 (3%) – 3 (3%)
Written orders are missing 3 to 4 essential elements are reflect an incorrect standard of care.
0 (0%) – 2 (2%)
Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care.
Total Points: 100
Name: NRNP_6566_Module2_Assignment2_Rubric

Select Grid View or List View to change the rubric’s layout.

Admission Orders Sample Paper

A 68-year-old female is brought to the hospital from the acute rehabilitation facility. She complains of shortness of breath and a productive cough. The symptoms have been there for the past one week. The patient was started on ciprofloxacin three days, but her condition has just worsened. The patient is hypertensive and has a history of hypothyroidism. She recently underwent knee replacement surgery about two weeks ago. She is currently on lisinopril, ciprofloxacin and rivaroxaban. She is presently experiencing fever, chills, productive cough with green purulent sputum, and worsening shortness of breath. On examination, her vitals are recorded as T 102.6, HR 92, RR 22, and BP 128/82. Oxygen saturation is recorded as 96% on four liters of oxygen. A chest X-ray done indicates consolidation in the right lower lobe. The patient’s CBC and CMP are within the normal range. This essay aims to write down admission orders for this patient.

Treatment of the patient.

I would immediately discontinue the ciprofloxacin and initiate piperacillin/tazobactam, 5g IV every six hours, tobramycin, 5mg/kg IV every 24 hours, and vancomycin, 15mg/kg every 12 hours. The patient meets the criteria for hospital-acquired pneumonia (HAP). This is because of her surgery two weeks prior and her inpatient admission at the rehabilitation facility. A chest X-ray done shows a consolidated right lower lobe. This further increases the risk of a diagnosis of pneumonia. It is important to commence a three-drug combination for broad-spectrum coverage until a culture and sensitivity report of the patient’s sputum is available to begin de-escalation of antibiotics. This is because the patient is at risk of drug-resistant bacteria and MRSA.

In 2007, the Infectious Diseases Society of

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Solution: