Implement droplet precautions for the first 24 hours after initiating antibiotic therapy if group A Streptococcus is suspected; also implement standard precautions, especially if the patient has vaginal discharge or lesion drainage.
Institute hemodynamic monitoring and continuous cardiac monitoring as indicated. Note any changes in arterial waveforms, hemodynamic parameters, or cardiac rhythm and report them immediately.
Assist with removal of the tampon if tampons are the suspected cause.
Plan your care to allow frequent rest periods, and provide as much privacy as possible. Allow the patient's family to visit and comfort her as much as possible.
Obtain daily weights.
Check skin turgor.
Insert an indwelling urinary catheter to evaluate hourly urine output as ordered; notify a practitioner if urine output is less than 30 mL/hour.
Auscultate heart and lung sounds for changes.
Initiate I.V. access if not already available, and maintain I.V. patency. Assist with insertion of a central venous line as appropriate.
Give prescribed I.V. fluids and blood products.
Administer I.V. antibiotics as ordered; if vancomycin is ordered, administer it slowly over 2 hours to prevent red man syndrome.
Inspect the skin and mucous membranes for signs of bleeding or bruising; check urine and stool for occult or frank bleeding.
Administer DOPamine as a continuous I.V. infusion, titrating the dose as ordered until the optimal response is obtained.
Evaluate the patient's level of consciousness (LOC) for changes.
Turn and reposition the patient frequently as appropriate. Inspect bony prominences for areas of pressure, and provide pressure relief and reduction devices to reduce the risk of skin breakdown.
Provide cooling measures such as sponge baths and a hyperthermia blanket as indicated.
Encourage the patient and family to verbalize their feelings and concerns. Provide explanations and reassurance for the patient and family as appropriate. Encourage the use of positive coping strategies and participation in care and decision making, as appropriate.
Obtain specimens for laboratory testing, such as CBC, coagulation studies, serum electrolyte levels, and arterial blood gas levels, as ordered.
disorder, underlying cause, and diagnosis, and treatment, including the use of and rationales for equipment and devices, such as hemodynamic monitoring, a central venous access device, and continuous cardiac monitoring
prescribed medications, including drug names, dosages, rationales for use, frequency and duration of administration, and possible adverse effects, such as GI upset
importance of taking the full course of prescribed antibiotic therapy (at least 10 days)
risks associated with transfusion therapy
importance of avoiding superabsorbent tampons, because of the risk of recurrence
measures for TSS prevention, including avoiding continuous tampon use during menstruation, changing tampons frequently during the day if used, using sanitary pads as night, and seeking early medical treatment for infected wounds
wound care measures and signs and symptoms of infection, emphasizing the need to report them immediately to the practitioner.
skin protection measures, such as avoiding the use of harsh soaps and alcohol that would dry the skin
energy-conservation measures and that fatigue may persist for several weeks
signs and symptoms of recurrence
need for continued follow-up and assessment.