Nursing Case Study: Urinary Tract Infection

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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

  1. What condition do the lab reports point toward?
  2. Which assessment findings are typical of an older adult with the condition in Question 1?
  3. 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.

5. While the IVPB ciprofloxacin is being administered, which adverse effects might occur?

6. 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?

7. 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.

8. What issues need to be considered in protecting M.Z.’s safety? Describe your actions in working with the nursing assistant.

9. 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?

10. What changes, if any, will be made to the antibiotic therapy?

Explain the psychometric properties of the rating scale you were assigned.

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  • make a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Why is HDL considered the “good” cholesterol?

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Take Test: Module 2 Knowledge Check

Test Information

DescriptionInstructionsMultiple AttemptsNot allowed. This test can only be taken once.Force CompletionThis test can be saved and resumed later.

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QUESTION 1

  1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
    HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
    Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
    His diagnosis is an acute inferior wall myocardial infarction.
    1 of 2 Questions:
    Why is HDL considered the “good” cholesterol?

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2 points  

QUESTION 2

  1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
    HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
    Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
    His diagnosis is an acute inferior wall myocardial infarction.
    2 of 2 Questions:
    Explain the role inflammation has in the development of atherosclerosis.

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3 points  

QUESTION 3

  1. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

    Question:

    What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

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1 points  

QUESTION 4

  1. A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work. States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).

    Question:

    Explain how a positive strep test has caused the patient’s symptoms.

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1 points  

QUESTION 5

  1. The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
    Question:
    Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.

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1 points  

QUESTION 6

  1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.

    Question:

    Explain why a large pulmonary embolus interferes with oxygenation.

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1 points  

QUESTION 7

  1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.

    Question:

    Explain why a large pulmonary embolism causes right ventricular strain.

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1 points  

QUESTION 8

  1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

    Question 1 of 2:

    Explain early asthmatic responses and the cells responsible for the responses.

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2 points  

QUESTION 9

  1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.
    Question 2 of 2:
    Explain late asthmatic responses and the cells responsible for the responses.

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2 points  

QUESTION 10

  1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
    Question 1 of 2:
    Explain the pathophysiology of emphysema and how it relates to COPD.

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2 points  

QUESTION 11

  1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
    Question 2 of 2:
    Explain the pathophysiology of chronic bronchitis and how it relates to COPD.— Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

2 points  

QUESTION 12

  1. Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler.

    Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).
    Question:

    Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.

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1 points  

QUESTION 13

  1. A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.

    Question:

    The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition.

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1 points  

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Care Of Older Adults

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Title of Paper

 

Your Name

Rasmussen College

COURSE#: Course Title

Professor’s Name

Assignment Due Date

 

· Analyze the increased complexity of care among older adults.

Your supervisor needs to make sure that each of the in-service topics will be covered by someone, so she is asking the staff to communicate their topic preference. Below is the list of problems your supervisor wants the nursing staff to be able to teach older adult clients (and/or their family members) about.

In-service Topic Options:

· Hypertension

· Diabetes

· Coronary artery disease

· Depression

· Dementia

· Polypharmacy

· Increased risk of falls

· Vison/hearing impairment

· Nutrition and hydration

Your supervisor has asked you to submit a 1-page proposal, written using proper spelling, grammar, and APA, which addresses the following:

1. Identify the client problem your in-service will address.

2. Describe at least 5 consequences of the client problem as it relates to the health, safety, and well-being of older adults.

3. Explain your rationale for choosing the client problem you selected.

 

 

 

 

 

 

Practice Issue

 

Consequences and Rationales

 

Conclusion

 

 

· From the rubric: (remove all purple prior to submitting assignment): Identifies client problem in-service will address. Thoroughly describes 5 or more relevant consequences for older adult clients’ health, safety, and well-being. Thoroughly explained rationale for selecting the particular client problem.

· One page- proposals are meant to be short and concise

 

 

 

 

 

 

 

 

 

References

Author’s Last Name, First initial. Middle initial. (Year). Title of article. Journal Title, Volume Number(Issue number), Page numbers.