Case Study: Urinary Tract Infection
You are working in an extended care facility when M.Z.'s
daughter brings her mother in for a week's stay while she goes on a
planned vacation. M.Z. is an 89-year-old widow with a 4-day history
of non- localized abdominal pain, incontinence, new-onset mental
confusion, and loose stools. Her most current vital signs are
118/60, 88, 18, 98.4° F (37.4° C). The medical director ordered a
post void catheterization, which yielded 100mL of cloudy urine that
had a strong odor, and several lab tests on admission. Urine
culture and sensitivity results are pending; the other results are
shown in the chart.
Chart View Laboratory Test Results:
Complete metabolic panel: Within normal limits except for the
following results:
BUN 25mg/dL Sodium 131mEq/L
Potassium 3.2mEq/L
White blood cell count 11,000/mm3
Urinalysis Appearance Cloudy Odor Foul
pH 6.9
Protein Negative
Nitrites Positive
Crystals Negative
WBCs 6 per low-power field
RBCs 3
What condition do the lab reports point toward?
Which assessment findings are typical of an older adult with
the condition in Question 1?
Considering her history and laboratory results, what other
condition is a possibility?
4.The medical director makes rounds and writes orders to start
an IV of D5 ½NS at 75mL/hr. and insert a Foley catheter to gravity
drainage. Because M.Z. is unable to take oral medications, the
medical director orders ciprofloxacin (Cipro) 400mg q12h IV
piggyback (IVPB). Are the type of fluid and rate appropriate for
M.Z.'s age and condition? Explain.
While the IVPB ciprofloxacin is being administered, which
adverse effects might occur?
You enter the room to start the IV infusion and insert the
Foley catheter and find that the nursing assistive personnel (NAP)
has taken M.Z. to the bathroom for a bowel movement. M.Z. asks you
to help her, and, as you open the door, you observe her wiping
herself from back to front. What do you need to do at this
time?
Because M.Z. has been having diarrhea, what special
instructions should you give the NAP assigned to give basic care to
M.Z.?
Case Study Progress:
The next day, you are the nurse assigned to M.Z.'s care. You
notice that the NAP emptying the gravity drain is not wearing
personal protection devices. You also observe that the drainage
port of the drainage bag was contaminated during the process
because the NAP allowed it to touch the floor.
What issues need to be considered in protecting M.Z.'s safety?
Describe your actions in working with the nursing assistant.
As you assess M.Z., you notice that her catheter tubing is not
secured. Why does the tubing need to be secured, and where is the
correct place for the catheter tubing?
What changes, if any, will be made to the antibiotic
therapy?