Bethany is a 20-year-old nursing student. Although she has practiced the intra- muscular injection technique in the nursing laboratory, she is nervous about giving her first intramuscular injection to a “real” client.

 

 

This case requires that the student nurse recognize the appropriate interventions following a needle stick injury. Her or his risk of blood-borne pathogen exposure is considered. Testing, treatment, suggested follow-up, and the cost associated are discussed. An incident (occurrence or variance) report is completed.

The student should refer to the following websites:

http://www.cdc.gov/niosh/topics/bbp/emergnedl.html (Links to an external site.)

http://www.who.int/occupational_health/activities/2needguid.pdf (Links to an external site.)

http://www.the-hospitalist.org/article/what-should-i-do-if-i-get-a-needlestick/2/?singlepage=1 (Links to an external site.)

http://www.nursingworld.org/DocumentVault/OccupationalEnvironment/Needles/7-Responses.pdf (Links to an external site.)

https://www.osha.gov/SLTC/etools/hospital/hazards/sharps/sharps.html (Links to an external site.)

Case study answers should be 40 to 60 words, please include reference page using APA format.

Bethany

Gender Female

Age 20

Setting Hospital

Ethnicity Asian American

Socioeconomic Cost of needle stick injury testing, treatment and follow up.

Pharmacologic: Zidovudine (Retrovir), Iamivudine (Epivir) didanosine (Videx), Indinavir Sulfate (Crixivan)

Legal Blood-borne pathogen exposures; incident (occurrence or variance) report.

Prioritization: immediate assessment of injury is necessary

Client Profile:

Bethany is a 20-year-old nursing student. Although she has practiced the intra- muscular injection technique in the nursing laboratory, she is nervous about giving her first intramuscular injection to a “real” client.

Case Study:

Bethany has reviewed the procedure and the selected intramuscular site landmark technique. She follows all the proper steps, including donning gloves. The syringe was equipped with a safety device to cover the needle after injection, but after giv- ing the injection, before the instructor can stop her, Bethany attempts to recap the needle and sticks herself with the needle through her glove. She is embarrassed to say anything in front of the client so she removes her gloves and washes her hands. Once outside the client’s room, Bethany shows the nursing instructor her finger. There is blood visible on her finger where she stuck herself.

1. What should Bethany do first?

2. Discuss the appropriate interventions that the clinical agency should initiate following Bethany’s needle stick injury.

3. What is the recommended drug therapy based on the level of risk of HIV exposure?

4. Which form(s) of hepatitis is Bethany most at risk for contracting? Discuss her level of risk of the form(s) of hepatitis you identified, as well as the risk of infection with HIV resulting from this needle stick.

5. Can the client’s blood be tested for communi- cable diseases if the client does not give consent?

6. What will be the recommendations for Bethany’s follow-up antibody testing?

7. HIV test results are reported as positive, negative, or indeterminate. What does each result mean?

8. What is an incident (occurrence or variance) report, and why should Bethany and her nursing instructor complete one?

9. Discuss how Bethany could have prevented this needle stick injury.

10. Bethany’s nursing instructor decides to share information with the nursing students about OSHA’s Needlestick Safety and Prevention Act. Explain OSHA’s role and the safety and prevention act.

11. Discuss who is most likely responsible for the expense of Bethany’s care immediately following the needle stick and any follow-up care. What risks are presented if the expense is prohibitive?

12. Identify three potential nursing diagnoses appropriate for Bethany. ( label, related to


 

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