Question

Case Study – Urine Elimination

            Mrs. D. is an 86-year old widow who lives alone in an apartment.  Her son found her at home, confused and disoriented.  She had been sick and hadn’t been eating or drinking much but took her diuretic medication.  Mrs. D. wears a pad because she occasionally has leakage of urine when coughing or getting up from a chair.  Her son made an appointment with her physician.  As part of the exam, she had a urinalysis ordered.  Results are as follows:

Components                            Results                                    Normals

Appearance                             turbid, dark amber                  clear yellow

ph                                            7.5                                           4.6-8.0 (average 6.0)

specific gravity                       1.032                                       1.010-1.025

ketones                                    +2                                            none

protein                                     neg.                                         none

RBC’s                                     few                                          <2

WBC’s                                    many                                       0-4

Glucose                                   negative                                  none

Casts                                       many                                       none

Discuss the results of the Urinalysis.  What concerns you the most about the results and why?

What may be the cause of her confusion?

What type of incontinence does she have?

Write a nursing diagnosis and add interventions.

What are the education needs to prevent further complications?

Write a F-DAR note for her chart.

You are going to call the physician to report the above findings.  Write out the SBAR using the information provided.

Answer 1

1. Results of urinalysis :-

colour - turbid, dark amber

ph - 7.5   

specific gravity - 1.032

ketones - +2

protein - negative

RBC’s - few

WBC’s - many

Glucose - negative   

Casts - many

#. The results which concerns the most are :-

- colour , specific gravity , ketones ,RBC's , WBC , and casts because they are not with in normal range .

2. Confusion is caused due to ketoacidosis

3. The type of incontinence she is having is stress incontinence

It is involuntary loss of urine related to an increase in intra-abdominal pressure. Occurs during coughing, sneezing, laughing, or other physical activities.

4. Nursing diagnosis and Interventions :

- Risk for Infection r/t risk factors such as malnutrition and Diabetes mellitus.

NI: Assess temperature every four hours. Notify physician if fever occurs. Fever is a sign of an infection. Infection is the most common cause of diabetic ketoacidosis (DKA). Monitor for signs of infection (e.g., fever, rhonchi, dyspnea, and/or cough). These are indicators of pneumonia which is common among patients with DM. Teach the patient and family about infectious process, routes, pathogens, environmental factors, and aspects of prevention. Provides basic knowledge for self-help and self-protection.

- Deficient fluid Volume r/t excessive gastric losses as evidenced by dry skin and vomiting for 1 week.

NI: Monitor vital signs, Note orthostatic BP changes, monitor I & O and note urine specific gravity. Maintain fluid intake of at least 2500 mL/day within cardiac tolerance when oral intake is resumed. Investigate changes in LOC.

- Imbalanced nutrition: less then body requirements r/t decreased oral intake: anorexia, and altered consciousness. Evidenced by history of flu for 1 week with vomiting and anorexia.

NI: Weigh daily or as ordered. Provide liquids containing nutrients and electrolytes as soon as patient can tolerate oral fluids then progress to a more solid food as tolerated. Observe for signs of hypoglycemia: changes in LOC, cold and clammy skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness.