Question

Questions 7-10 Please !

PN 200 Fundamentals of Nursing II Urinary Tract Infection You are working in an extended care facility, when Marlo Zippo's daughter brie aughter brings her mother in for a week stay while she goes on vacation. Ms. Zippo is an 89 year old wide 4 day history of dysuria, back pain, incontinency, severe mental confusion, and loose soola on, and loose stools. Her physician has recently discontinued her hormone replacement therapy one month ago current vital signs are 118/60, 88, 18, 99.4. The medical director ordered several lab test admission. The results are as follows: WBC 11,000; complete metabolic profile is within 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: Ecoli > 100,000 colonies, sensitive to ciprofloxacin, trimethoprim sulfamethoxazole, and nitrofuradanti 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 salinea 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? S. 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 o. What issues need to be considered in protecting Ms. Zippo's safety?

Answer 1

1) Escherichia coli is a normal flora present in gastrointestinal system. It can become pathogenic and affect urinary system and develops urinary tract infection. Women are at a risk of developing UTI as the anatomical location of urethra to the anus is short and UTI can results from spread of infection from the anus to the urethra. Laboratory value indicates an elevated count of E coli >100,000, urine culture and sensitivity test reveals presence of E coli in the urine sample.

2) Intravenous fluids helps to restore circulation to vital organs incase of fluid volume deficit resulting from bleeding,plasma loss,fluid and electrolyte loss. Circulatory overload is the common complications related to intravenous therapy in elderly. Dextrose 5% in .25 normal saline is a hypotonic solution helps in treating rehydration. The rate of 75 ml/hr is a ideal fluid rate in elderly patients.

3) Intravenous Infiltration refers to the excessive accumulation of intravenous fluid in the surrounding tissues. It results from dislodgment of iv catheter. Common signs and symptoms of IV infiltration includes edema,blanching,cool skin,pain while infusing iv medications,leaking of iv fluid.

4) Intravenous therapy is infusing iv fluids in greater rate than the recommended fluid calculation. Excess fluid circulating enters the pulmonary circulation results in pulmonary edema and causes shortness of breath (dyspnea). Circulatory overload results in congestive heart failure.

5) On observation after defecation the patient following an improper technique in cleaning that is wiping from back to front. Rectum is a often contaminated with e coli,though e coli is a normal flora in gastro intestinal system. If it enters urinary tract results in UTI. Proper cleaning after a bowel movement wipe front to back prevents the spread of bacteria from rectum to urethra.