Question

Case Narrative

Case details given to participants (can be given freely or must be asked for by participants)

Patient Description& Chief complaint:

A 68-year-old woman is admitted with fever, nausea, vomiting, and abdominal pain. She informs you that she is a “borderline diabetic” and “only has to watch what she eats.” She tells you that she has not eaten for 3 days and has had difficulty “keeping liquids down.” While doing the nursing history, she describes her urine as dark and foul smelling. Upon further questions, she states she does have some burning upon urination. She describes her abdominal pain as constant, generalized, and rates it as a 5 or 6 on a scale of 0 to 10.

Weight: 75

Height: 183

History of Current Illness: 3 days

Pertinent Past Medical History: Diabetes Mellitus

Past surgical History: Free

Family/Social History: Free

Medication History Profile and Allergies: Nothing known about

Lifestyle: (occupation, diet, income, educational level, marital statues): Nothing known about

Critical thinking questions: -

Pre starting any scenario the student will prepare to answer the following questions: -

1. Doctor orders IV fluids and an antibiotic with first dose to be given STAT. You have not obtained urine specimen yet. Which has priority (e.g., starting IV, administrating antibiotic, or obtaining urine specimen) and why?

2. Three days later, client has following laboratory results: Hct = 39.2 and WBC = 10.8 × 103/mL3. What do those results indicate to you?

3. Abdominal x-ray shows a possible mass. An MRI of abdomen is ordered. Client is quite anxious because she has heard from her friend that procedure is difficult for people who are claustrophobic. How will you respond?

Answer 1

In first question, we have to collect urine sample in first place, then have to give antibiotics and then start iv fluids. Because if we collect urine sample after administration of antibiotics, it would possibly have started its action and might have decreased bacterial load which will give us falee result on urine examination.

In 2nd question, hematocrit of 39.2 and WBC count showing leukocytosis will mostly points toward acute bacterial infection. Further confirmation should be done by performing urine bacterial culture and urine examination. Since patient is 68 yr old female, diabetic complaining of burning micturition, this is case of urinary tract infection. Females are more prone to UTI because they have short urethra as compared to males.

Now patient uas to undergo MRI which is performed in closed room (Faraday's cage). We have to counsel patient about the procedure, about its need in her diagnosis, time required for procedure, and all other aspects. As there is no history mentioning patient is claustrophobic, we can we perform it. Claustrophobia is relative contraindication of MRI.