Question

Demographics:

Client Name: Charles Jones            Gender: Male                    Race: Black

Age: 68               Weight: 180 lbs               Height: 183 cm (72 in)                    Location: SIM 319

Physician: Dr. Carl Smith

                            

Client Information: Mr. Jones is a newly diagnosed hypertensive patient that started having problems with CHF. He works as a school maintenance supervisor and states that he is too busy to go to the bathroom. Unfortunately, he has omitted take his fluid pills. Dr. Smith initially admitted Mr. Jones to the SIMs unit to treat his CHF. He is now complaining of trouble passing his water, feelings of fullness, and burning upon urination. An order was obtained to insert a catheter and send a specimen to the lab.  

Past Medical History: Hypertension, CHF

Allergies: Unknown

Social History: Works as a school maintenance supervisor. Lives with his wife. Has adult children

Surgeries/Procedures: Unknown

Potential Skills for Scenario: Insertion of urinary catheter; send specimen to lab

*Students are expected to review these skills prior to simulation in order to perform them independently during the scenario.

Insert urinary catheter – In & Out, obtain a specimen, send specimen to lab

Medication List: None

Questions:

1. Complete pathophysiology for urinary tract infection:

Etiology
Changes to Normal A&P
Clinical Manifestations

2. Complete the following related to medications:

Medication	Mechanism of Action	Intended Effects for this Patient	Side Effects	Nursing Considerations/Administration Technique(s)

3. What labwork and/or diagnostic testing should the nurse anticipate to be performed for this patient on admission? What would be the significance of abnormal findings?

4. Select 3 high priority nursing diagnoses based on demographic information.

Answer 1

INTRODUCTION

Urinary tract infection is commonly seen in women and it is the infection or inflammation of the upper and lower urinary tract, UTI are categorized into the following

-SIGNIFICANT BACTERIURIA

-ASYMPTOMATIC BACTERIURIA

   -URETHRITIS

-ACUTE PYOELNEPHRITIS

-CHRONIC PYELONEPHRITIS

MEANING

-It is defined as infection or inflamation in any part of urinary systems,it includes,KIDNEYS,URETER,BLADDER AND URETHRA

RISK FACTOR

-It means ,the persons who are more prone to get urinary tract infections,

1-IATROGENIC DRUGS

-Indwelling catheter

-Antibiotic use

-Spermicides

2-AGEING

-Diabetes mellitus

-Urine retension

-Impaired immune system

3-FEMALES

-Shorter urethra

-Sexual intercourse

-Use of contraceptive pills

-Incomplete bladder emptying

4-MALES

-Prostatic hypertrophy

-Age

-Bacterial prostitis

5-BEHAVIOURAL

-Voiding dysfunction

-Frequent sexual intercourse

6-ANATOMIC OR PHYSIOLOGIC

-Female sex

-Pregnancy

-Vesiculo-ureteral reflux

7-GENETIC

-Family history

ETIOLOGICAL FACTORS

-Etiological factors are categorized into tje following,

-GRAM-NEGATIVE BACTERIA

-Most often causes

-Escherichia coli-80-90% is caused byE.coli

-Klebsiella

-Proteus

-Pseudomonas

-GRAM POSITIVE BACTERIA

-Less often causes

-5-10% is caused by gram positive bacteria

-Examples are;

-STREPTOCOCCUS

-STAPHYLOCOCCUS

-ENTEROCOCCUS

-VIRUSES

-Less common causes

-Examples are'

-RUBELLA

-MUMPS

-HIV

-FUNGI

-Less common cause

-Examples are;

-CANDIDA

-HISTOPLASMA

-CAPSULATUM

-PROTOZOA

-Less common

-Examples are;

TRACHOMONAS VAGINALIS

OTHER CAUSES ARE;

-stone or obsruction or tumour in the urinary tract

-renal impairement

-neurogenic bladder

-urinary tract calculi

-catheterization

-congenital defects in genital tract

-fistula

-obesity

-constipation

-voiding dysfunction

-poor personal hygeiene

CHANGES TO NORMAL ANATOMY AND PHYSIOLOGY or PATHOLOGICAL CHANGES

Anatomical and physiological changes or pathological mechanisms are listed below

1-ASCENDING INFECTION

2-BLOOD BORNE SPREAD

3-LYMPHATOGENOUS BLOOD

4-DIRECT EXTENSION FROM OTHER BLOOD

-Changes are;

-pH level-Alkaline elevated

-Urine colour become cloudy

-Blood may be present

-The presence of white blood cells

-The presence of bacteria

-Foul smelling urine

-The presence of red blood cells also

-Kidney tubular obstruction and damage

-Infections of the renal parenchyma

-Bacterial colonization

CLINICAL FEATURES

-Clinical features are depends on the site of infection and age of the patient

Listed below'

-urgency of urination

-frequency of urination

-incontinence of urination

-nocturnal urination

-hesistancy

-intermittency

-post void dribbling

-dysuria

-hematuria

-high fever

-acute abdominal pain

-nausea or vomiting

-back pain

-pelvic dyscomfort

-pyuria

-pelvic pressure

-burning with urination

MEDICATION-ANTIBIOTIC THEARPY

Antibiotics are;

-AMOXYCILLIN

-CEFTRIAXONE

-CEPHALEXIN

-CIPROFLOXACIN

-LEVOFLOXACIN

-TRIMETHOPRIM

-The drug of choice is-ciprofloxacin

-mechanism of action-it is a bactericidal activity and inhibits the DNA synthesis of bacteria

-side -effects-are-rashes,diarrhoea,nausea and vomoting,headache,nerve damage,abdominal discomfort

-route of administration-intravenous adminisatration

-nursing consideration are,

-assess for current health stastus

-maintain standard precautions

-identify the oatients

-assess for ten routes of administarion

-follow strict aseptic techniques

DIAGNOSTIC ENALUATIONS

1 -Microscopic examination of urine

-findings are the presence of pus cells,bacteria,blood,white blood cells

2-Urine culture

-findings are ; the confirmation tests for micro-organism

3-KUB ultra sound

-findings are;kidney size ,shape,locations,urinary tract obstructions,dialations

4-Computed tomography

-findings are;

-renal damage ,obstructions

5-Blood and urine culture

-findings ar;'pH level,creatine level,pus cells,WBC'

NURSING DIAGNOSIS

-Impaired bowel and bladder pattern related to tissue damage

-Hyperpyrexia realted to inflammatory responses

-Impaired hydration status related to vomiting

CONCLUSION

Urinary tract infections can be treated by the administration of antibiotics,,,UTI can be prevented by following good personal hygiene.proper intake of water,avoid multiple sexual partnership etc

  

  

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