Question

I need answers to questions 7-10 on second picture

PN 200 Fundamentals of Nurs ing II Urinary Tract Infection You are working in an extended care facility, when Marlo 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

1) Abnormal lab values of Ms Zippo are Urine culture which shows Ecoli of colony count 10^5

White blood cells are borderline as the normal WBC is 4000-11000.The lab reports are suggestive of a urinary tract infection.Ms Zippo also have a body temperature of 99 F which says that the patient is having infection

2)The solution ordered by the doctor is an hypotonic solution consisting of 0.25%of normal saline with dextrose.hypotonic solutions are generally not preferred for dehydration therapy because of the third place fluid shift which can lead to to increase in extracellular fluid causing edema .and the rate of 75 ml per hour can cause pulmonary edema or fluid overload because of the age .so a better option would be to infuse a isotonic solution of dextrose 5 and 0.9 %Normal saline as Ms Zippos metabolic lab values are within normal limits like sodium at a rate of 40 or 60 ml per hour would be enough as she doesn't have hypovolemia or hypotension.

3) inflammation at the IV insertion site is caused due to inflammation of veins which is called phlebitis.There are various reasons of phlebitis like mechanical phlebitis,chemical phlebitis,or infecive phlebitis .The signs of phlebitis are divided into different stages of phlebitis

Grade 1:erythema at the insertion site

Grade 2:Erythema with or without pain at insertion site

Grade 3:Erythema ,pain and swelling at the insertion site

Grade 4:Erythema,pain,swelling, palpable chord

Grade 5: Erythema,pain,swelling, palpable chord and oozing from the site

Once you notice the first two symptoms of phlebitis reaite the cannula .

Overhydration can be assessed by overall generalised edema with puffiness of face .

3)The organism called Ecoli which is isolated in Ms Zippo urine is a normal Flora of the gut or GI tract when this common commensal enters other system like urine ,blood, respiratory system it can be changed to pathogen which causes infection.So the association of the organism to UTI in this scenario is the transmission from stools to urine .and you also observed that she cleans from back to front post stool passing which itself is a good source for infection.so health education should be provided to the patients

4)If the aide is asking for restraints you should tell he eto wait until you take the order from physician and consent from the patient or next of kin for application of consent .you can give the aide option of two finger restraints or boxer bandage rather than wrist restraints due to the presence of IV line on the hand which can cause further inflammation at the site .boxer bandage restraints are enough as the patient is only picking at the IV line and not being Agitated.