Urinary Tract Infections Case
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
- Scenario
You are working in an extended care facility (ECF) when M.Z.’s daughter brings her mother in for a week’s stay while she goes on vacation. M.Z. is an 89-year-old widow with a 4-day history of dysuria, suprapu-bic pain, incontinence, new onset mental confusion, and loose stools. Her most current vital signs (VS) are 118/60, 88, 18, 99.4° F (37.4° C).
The medical director ordered a postvoid catheterization, which yielded 100 mL of cloudy urine that had a strong odor, and several lab tests on admission. The results were as follows:
- Chart View
Laboratory Test Results
Complete metabolic panel (CMP): Within normal limits except for the following results:
BUN 25 mg/dL Sodium 131mEq/L Potassium 3.2mEq/L White blood cell count 11,000/mm 3 Urinalysis Cloudy Appearance Odor Foul pH 6.9 Protein Negative Nitrites Positive Crystals Negative WBC 6 per low-power field RBC 3 Urine culture and sensitivity results are pending.
5 Genitourinary
PART 1 MEDICAL SURGICAL CASES
- What condition do the assessment findings and lab reports point toward?
M.Z.’s history of dysuria, incontinence, and suprapubic pain, along with the appearance and odor of the urine, and the elevated pH, presence of nitrites and WBCs in the urine, and elevated WBC count points to a urinary tract infection (UTI). New onset mental changes is a classic symptom associated with UTIs in an older adult. In addition, the loose stools might have led to dehydration, which might be another reason for the new onset mental confusion. The elevated BUN and decreased sodium and potassium levels might point toward dehydration.
- The medical director makes rounds and writes orders to start an IV of D5 ½ NS at 75 mL/hr and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral meds, the medical director ordered ciprofloxacin (Cipro) 400 mg q12h IV piggyback (IVPB). Is the type of fluid and rate appropriate for M.Z.’s age and condition? Explain.
Yes, the type of fluid and rate is appropriate for M.Z. She has a history of loose stools for 4 days and is slightly febrile, so the fluid rate of 75 mL/hr is not excessive. The type of fluid is appropriate because her CMP was within normal limits (WNL), and she has no stated history of comorbid conditions such as HF or DM.
- While administering the IVPB ciprofloxacin, which adverse effects might occur? (Select all that apply.)
- Hypotension
- Headache
- Drowsiness
- Restlessness
- Nausea
- Tendon rupture
Answers: B, D, E, F
Ciprofloxacin might cause headache, restlessness, nausea, vomiting, diarrhea, and even a rash.
Quinolones such as ciprofloxacin have also caused tendon rupture.
- You enter the room to start the IV and insert the Foley catheter and find that the NAP has taken the patient to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you open the door, you observe the patient wiping herself from back to front. What do you need to do at this time?
M.Z.’s UTI is probably a result of bacterial contamination of the urinary tract, which can result from improper perineal hygiene, such as wiping from front to back. This can bring fecal organisms, such as Escherichia coli, from the anus toward the vagina and urethra. This is a teachable moment where you can teach M.Z. to wipe correctly, from front to back, so that bacteria from the bowel are not dragged near the urethra.
- Because M.Z. has been having diarrhea, what special instructions should you give the NAP assigned to give basic care to M.Z.?
- Pay careful attention to perineal care. Carefully wash around the catheter with soap and water, and dry thoroughly. This cleansing should be provided at least twice a day and after each BM.
- Encourage fluid intake.
- Monitor I&O carefully.
CASE STUDY PROGRESS
The next day, you are the nurse assigned to M.Z.’s care. You notice that the NAP emptying the gravity drain is not wearing personal protection devices. You also observe that the drainage port of the drainage bag was contaminated during the process because the NAP allowed it to touch the floor.
- What issues need to be considered in protecting M.Z.’s safety? Describe your actions in working with the nursing assistant.
- Z.’s safety must be maintained. The Foley catheter is a direct route for bacterial contamination and a potential source of infection. Fortunately, the contamination of the spout should not represent
a problem because most gravity drain bags have an antireflux valve that prevents bacteria from moving through the tubing in a retrograde direction into the bladder. Urinary drainage bags have varying features. It is necessary to become familiar with the equipment and the special precautions for use.
- Approaching the NAP is a delicate matter. First, establish his or her knowledge of the specific procedure, such as the use of gloves and the correct procedure for emptying a gravity drain.
- Teach and review rationale and principles; discuss possible consequences of poor procedure, including spread of infection to either party and to other residents and staff.
- It might be necessary to report the NAP’s actions to the supervisor.
- As you assess M.Z., you notice that her catheter tubing is not secured. Why does the tubing need to be secured, and where is the correct placement of the catheter tubing?
The catheter tubing needs to be secured (with a securing device such as a Stat Lock or a Velcro leg band) and stabilized to prevent urethral friction and irritation that might occur when the catheter moves; additionally, a catheter that is not secured might pull and cause bladder or urethral damage. For women, the catheter needs to be secured to the inner thigh; for men, the catheter needs to be secured to the inner thigh or the lower abdomen, depending on the patient’s comfort.
CASE STUDY PROGRESS
On the third day after M.Z.’s admission, the urinary culture and sensitivity (C&S) results were as follows: Escherichia coli, more than 100,000 colonies, sensitive to ciprofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin.
- What changes, if any, will be made to the antibiotic therapy?
No changes will be needed because the sensitivity results show that the bacteria is sensitive to ciprofloxacin.
- The NAP reports that M.Z.’s 8-hour intake is 520 mL and the output is 140 mL. Is this significant? Identify two possible reasons that could account for the difference, and explain how you would assess each.
Tubing kinks or obstruction: Check tubing for kinks and blockage (follow agency policy regarding irrigation of catheter if needed); assess for bladder distention.
Dehydration: Assess skin turgor and mucous membranes; monitor lab values; check total record for the last several days, including M.Z.’s daily weight.
Inaccurate recording of I&O: Double-check with those caring for M.Z. about any discrepancies.
CASE STUDY PROGRESS
M.Z. has completed her antibiotic therapy. Her mental status has cleared, the Foley catheter has been discontinued, and she is ready for discharge.
- What instructions should you discuss with the daughter?
Her mother should get a repeat UA for C&S at her PCP’s office 1 week after completing the antibiotics. Ask her to increase M.Z.’s water intake to help remove bacteria from her urinary tract with increased micturition. M.Z. also needs to be taught to void when she feels the sensation and to avoid holding her urine for long periods of time. In addition, reinforce the teaching about wiping from front to back during personal hygiene after urination or a bowel movement.
She needs to notify the PCP if her mother develops:
- Fever higher than her admission temperature of 99.4° F (37.4° C)
- Chills
- Change in mental status
- Decrease in urinary output not commensurate with intake
- Increased pain on urination
- Pain in the flank or suprapubic area
- Foul-smelling urine
- Blood or pus in the urine
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. 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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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