Question

PN 200 Fundamentals of Nursing II Urinary Tract Infection You are working in an extended care facility, when Mario Zippo's daughter brings her mother in for a week stay while she goes on vacation. Ms. Zippo is an 89 year old widow with a 4 day history of dysuria, back pain, incontinency, severe mental confusion, and loose stools. Her physician has recently discontinued her hormone replacement therapy one month ago. Her most current vital signs are 118/60, 88, 18, 99.4. The medical director ordered several lab tests on admission. The results are as follows: WBC 11,000: complete metabolic profile is within normal limits. Post voiding catheterization yielded 100 mL and the urinalysis showed E coli>100,000+ HPF, RBC 3-6 bacteria rare. The urinary culture and sensitivity results are as follows: E coli > 100,000 colonies, sensitive to ciprofloxacin, trimethoprim/sulfamethoxazole, and nitrofuradantin. 1. State the abnormal lab values and what they could represent. The medical director makes rounds and writes to start an IV of D5 in.25 normal saline @ 75 ml/hr. and insert a retention catheter (Foley catheter) to straight drainage. Because Ms. Zippo is unable to take oral medications, the physician ordered ciprofloxacin 200mg, bid IVPB 2. Is the type and rate of fluid appropriate for Ms. Zippo's age and condition? 3. What symptoms would you be looking for as to infiltration/inflammation at the insertion site as well as over hydration? You enter the room to start the IV and insert the Foley catheter but find the aide has taken the patient to the bathroom for a bowel movement. You open the door and observe the patient wiping from back to front. This is a teaching moment and you take the aide aside to speak with her. 3. What is the association between Ms. Zippo's UTI and the organism found in her urine? The aide comes to you to report that Ms. Zippo is picking at her IV and asks if she can apply wrist restraints. 4. What will be your reply? 5. If Ms. Zippo should develop diarrhea, what special instructions should you give the nursing assistant caring for the patient? You notice the nursing assistant emptying the urine drainage bag is not wearing personal protection devices. You also note that the spout becomes contaminated during the process 6. What issues need to be considered in protecting Ms. Zippo's safety?

Answer 1

The answers are as follows:

1. Ms. Zippo's abnormal lab values are :

Wbc- 11000 (slightly high) indicating some infection

Urinalysis and urine culture shows presence of E.coli indicating urinary tract infection

2. As per doctor's prescription, for hydration and flushing of bacteria D5 in 0.25%normal saline at the rate 75ml/hr which is a hypotonic solution is appropriate

3. In infiltration/inflammation, symptoms wont be clear as it maybe with or without pain. Signs include

-Blanching of the area

-Cool to touch

-Skin looks taut

-Swelling at the site

-Dressing can get wet.

4. E-coli organism lives in the intestine. As per observation, patient was wiping from back to front. In females, the distance between back and urethra is very less. So, the organism was transferred from back to urethra while wiping .As elderly patients have weak immune system they are more susceptible to infections like UTI