Question

Case Study: Urinary Tract Infection Scenario 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 nonlocalized 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 postvoid catheterization, which yielded 100 mL 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.

Lab Test results Complete:

metabolic panel BUN 25 mg/dL Sodium 131mEq/L K+ 3.2 mEq/L White blood count 11,000 /mm3 Urinanalysis Appearance Cloudy Odor Foul pH 6.9 Protein Negative Nitrites Positive Crystals Negative WBC’s 6 per low-power field RBC’s 3

1. What condition does the lab report point toward? What are some signs and symptoms of this condition? Case study progress: The medical director makes rounds and writes orders to start an IV of D5½NS at 75 mL/hr and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral medications, the medical director orders ciprofloxacin (Cipro) 400 mg q12h IV piggyback (IVPB). Are the type of fluid and rate appropriate for M.Z.'s age and condition? Explain. Yes, the type of fluid and rate are appropriate for M.Z. She has a history of loose stools for 4 days, so the fluid rate of 75 mL/hr is not excessive. The type of fluid is appropriate because her CMP was within normal limits, and she has no stated history of comorbid conditions such as heart failure or diabetes mellitus.

2. While the IVPB ciprofloxacin is being administered, which adverse effects might occur? (Learning Objective 2) Case study progress: M.Z.'s UTI is probably a result of bacterial contamination of the urinary tract, which can result from improper perineal hygiene, such as wiping from back to front. This can bring fecal organisms, such as Escherichia coli, from the backside toward a women private parts and urethra. This is a teachable moment where you can teach M.Z. to wipe correctly, from front to back, so that bacteria from the bowel are not dragged near the urethra.

3. Because M.Z. has been having diarrhea, what special instructions should you give the NAP assigned to give basic care to M.Z.?

Answer 1

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