1.  Integrate lab skills and tests to identify an unknown.

2.  Justify the lab procedures used, identification, and treatment of the patient.

3.  Evaluate the patient in light of the unknown identification and patient's immune status.

4.  Determine the proper care and treatment for the patient using and citing valid references.

 Unknown Number______________ 

Patient’s Name____________________ 

                                    Assignment:

1.      assess your patient’s condition

2.      propose a differential diagnosis from the history

3.       determine the necessary tests for a definitive diagnosis

4.       identify the etiologic agent infecting your patient

5.      propose a treatment and long-term care for the patient

Prepare a chart for your patient. The first page should include the patient history and any relevant research you do with regards to any of your patient’s conditions relevant to the history. This page should also include a differential diagnosis.

The second page should include any tests that you determine are necessary for the proper identification and treatment of the patient. You are to order and perform only the necessary tests, you will lose points of you do any tests that are unnecessary or do the shotgun method using every test you have ever done or read about. If there are other tests you feel are necessary, but they can not realistically be performed in our lab, indicate these and why they would be important. In addition to microbiological tests you may want to include orders for a CBC, X-Ray, skin test, etc.

The third page should be a record of every test you performed (and the date), the rationale for doing the test, and the results of the test (and the date the test was completed). Explain how these tests helped to rule out the differential diagnosis.

The fourth page will include a summary of the definitive diagnosis, identification of the etiologic agent, information about the agent, a proposed course of treatment and long-term care.

 

Step 1 Getting Started (Beginning on this page, you will fill out and turn in these charts showing the logical progressive thinking and lab work you have done along with the final report that should respond to the rubric.)

Before you begin observe your specimen. Using the checklist make important observations from the clinical specimen.

Specimen Checklist
Source	List significant concerns or comments about the specimen source.
Condition of specimen	What characteristics may be important concerning the original specimen? Is there blood? Is it moist? Are there any foreign objects, pus, clots etc?
Time specimen taken   Time Cultured	How recently was the specimen taken and will this have any influence on the results? Are there any transportation concerns regarding this type of specimen and culture?
Differential diagnosis or hypothesis	What are the most likely pathogens found in this type of specimen?
Normal flora	Would you expect to find normal flora present in specimens from this source location? If so, what would be most common?
Media	What types of media are commonly used for this specimen?
Incubation Considerations	Considering the location of the specimen are there any special incubation conditions you should consider?

Step 2           Fill in the table below.

Media Inoculated	Rationale for using this media	Date Inoculated/Date read	Results/ Notes/ Thoughts

Record the Gram stain reaction of each different colony type found on the media.

Gram Stain (create a number to identify the colonies and mark it on the plate)/ Colony description	Recovered from which plate/On what date	Notes (Is this potentially normal flora? Is this a typical result? Anything unexpected? Does the colony morphology match the Gram stain and media selectivity?)

Determine the appropriate lab tests you will need to continue the investigation. In addition, if you think there should be other tests, such as a cbc or x-ray, that we can not do, indicate that you would order those tests.

Step 3 Test Results

Lab test	Date inoculated/date read	rationale for lab test	Result and interpretation

 

 

 

Step 4 – Identification and Sensitivity

Determine the identification of your etiologic agent.

What particular types of pathogenic capabilities (if any) does this pathogen display?

Using the Sanford Guide select at least 8 antibiotics in order to test the sensitivity of the agent. Remember to consider cost, narrow and broad spectrum, target agent, target tissue, and administration as well as any side-effects.

Antibiotics available for testing will include the following and any additional mentioned in class:

Amoxicillin/ Clavulanic Acid	Ceftriaxone	Impenem	Tetracycline
Amikacin	Cefotaxime	Levofloxacin	Ticarcillin
Ampicillin	Chloramphenicol	Oxacillin	Tobramycin
Azithromycin	Ciprofloxacin	Penicillin	Vancomycin
Bacitracin	Clindamycin	Pipericillin
Cefaclor	Doxycycline	Nitrofurantoin
Cefazolin	Erthromycin	Sulfasoxazole
Cefixime	Gentamicin	Sulfa-Trimeth SXT

 

Step 5- Resolution, Treatment and Prognosis