Question

CASE 85 yo AAF, English speaking, admitted to your nursing unit from NH with dx of UTI and AMS. AAOx1, to name only, Rt UE/LE weakness, limited body mobility. NH reports wt loss of 10 lbs. in last month and decreased nutritional intake. Latest labs: Hgb 9, low Protein, low Albumin, UTI confirmed. DX: UTI, PMX: Diabetes type II, HTN, CVA 1 yr ago, Dementia. YOUR ASSESSMENT AAOx1, name only, unable to follow instructions. Ate approx. 50% of food on tray x3 meals, fluid intake approx. 240 mL for shift. Incontinent of urine/bowel. Needs repositioning in bed. MD ORDERS OOB as tolerated, Finger sticks before meals, Assist with all meals, F/C F18 to bedside drainage Meds: Antibiotics for UTI IV, Lasix (Furosemide) 40mg PO QD, Metoprolol 50mg PO QD, Glucophage 500mg PO BID, IVF NS @ 43 mL/hr, I&O Q Shift.
NURSING ASSESSMENT CONSIDERATIONS
What are 2 main risk factors for this patient? Why did you choose these risk factors? How will you assess these risk factors? Once risk
factors are assessed, what preventative measures will be instituted?
5)WHAT ASSESSMENTS WILL YOU PERFORM TO: Monitor UTI improvement? Monitor glucose levels? Monitor nutritional intake Monitor I & O
6)WHAT PREVENTATIVE MEASURES WILL YOU IMPLEMENT TO PREVENT NOSOCOMIAL TRANSMISSION OF PATHOGENS?
Please explain 5 and 6

Answer 1

5) ans) patient presents to a complaining of symptoms of UTI, the nurse should further assess to confirm the symptoms that the patient is experiencing. If a patient has been prescribed an antibiotic for a presumed UTI, the nurse should also assess here to confirm the appropriateness of treatment. Patients should be asked about symptoms such as dysuria, frequency, urgency, suprapubic pain, flank pain or tenderness, fever, or hematuria in noncatheterized patients. In catheterized patients, symptoms suggestive of UTI include fever, rigors, flank pain or tenderness, acute hematuria, purulent discharge from catheter site and new or worsening mental status (in the presence of leukocytosis) If the patient has had a urinalysis or urine dipstick showing pyuria, or a urine culture with a significant amount of uropathogen(s) present, in the absence of symptoms.

Elderly patients can be more difficult to assess for UTI for several reasons. Some may have baseline cognitive impairment that limits their ability to recall or communicate their symptoms. They may have concurrent illnesses that present with nonspecific symptoms, such as urinary incontinence, that can interfere with the ability to assess for acute symptoms.

Nutritional intake - iv fluids and fruit juices, water intake.

These foods include cranberries, blueberries, oranges, dark chocolate, unsweetened probiotic yogurt, tomatoes, broccoli and spinach. Smart drink choices are decaf coffee; cranberry, blueberry, or pomegranate juices; and black and green tea. Of course, plenty of water is also essential when fighting off a UTI. Avoid sugar juices to people with diabetes.

6) ans. urinary tract infection (UTI), there are steps you can take to prevent another one:

•Use the bathroom as soon as you feel the urge to urinate. Don’t hold urine in.

• Drink plenty of fluids each day. This will dilute the urine and keep it moving through the urinary tract, making it more difficult for bacteria to adhere to the walls of the urethra and bladder.

• Sexual intercourse is associated with recurrent UTIs, especially in younger women. Urinating after sex may help prevent UTIs. Avoiding the use of spermicidal foams and jellies, products (such as condoms) containing spermicides, and barrier methods of birth control (such as diaphragms) may reduce the frequency of UTIs. Talk to your healthcare practitioner about other birth control methods that are less likely to cause UTIs.

• Some people drink cranberry juice or take cranberry supplements to prevent UTIs, but studies on this have not been conclusive. You may choose to drink cranberry juice or take cranberry supplements if you find it helpful and it won't cause harm. However, people with diabetes should avoid sugary drinks.