Question

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 as well as over hydration? sto infiltration/ inflammation at the insertion site You enter the room to start the IV and insert the Foley cathete the patient to the bathroom for a bowel movement. You open th wiping from back to front. This is a teaching mo and insert the Foley catheter but find the aide has taken wel movement. You open the door and observe the patient ent and you take the aide aside to speak with her

Answer 1

1. The abnormal lab value is the presence of E.coli in urine above 100000 which means the patient has serious UTI . The normal limit of E.coli in urine is upto 10000.

3. The signs and symptoms of infiltration include:

Inflammation at or near the insertion site with swollen, taut skin with pain.

Blanching and coolness of skin around IV site.

Damp or wet dressing.

Slowed or stopped infusion.

No backflow of blood into IV tubing on lowering the solution container.

4. The association between the Mr's Zippos UTI and organism found in urine is that she has UTI and her urine sample culture and sensitivity is positive for E.coli. Causative agent of her UTI is E.coli

5. No ,until the physician orders for restraints we can't apply restraints .