Urinary Tract Infection Case Study (45 min)
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Outline
Mrs. Phillips is an 84 year old female who arrived to the Emergency Department from a nursing home, where caregivers report she has altered mental status, confusion, and weakness that they just noticed this morning. The nurse inserts 2 large bore PIV’s and draws blood for a chemistry and complete blood count, as ordered by the Provider, who is concerned she may be having a stroke.
What initial nursing assessments should be performed??
What diagnostic testing do you anticipate for Mrs. Phillips?
Mrs. Phillips’s vitals are as follows:
HR 122 RR 24
BP 92/58 SpO2 92%
Temp 103.6°F
Her NIHSS score is 2, CT scan is negative for an intracranial bleed, and the neurologist believes she is NOT having a stroke. The nurse is called into the room by the caregivers as the patient has wet herself. The nurse notes a foul, sour odor to the urine. Mrs. Phillips’ blood pressure is now 88/52. The nurse notifies the Provider.
What orders do you anticipate from the provider?
What may be going on with Mrs. Phillips physiologically?
The provider places orders for the following:
Keep SpO2 > 92%
Blood Cultures x 2
Urinalysis
Urine Culture
500 mL NS IV bolus STAT
100 mL/hr NS IV continuous infusion
Vancomycin 1,000 mg IV x 1 dose NOW.
Which order should be implemented first? Why?
The nurse obtains 2 sets of blood cultures and the UAP obtains a sterile urine sample via I&O cath. The UAP reports cloudy, foul-smelling urine. The nurse initiates the IV fluid bolus and requests the Vancomycin from the Pharmacy. Mrs. Phillips’ caregiver asks why she is so confused?
Why is Mrs. Phillips presenting with Altered Mental Status?
After 3 days of treatment with IV antibiotics, Mrs. Phillips is awake and oriented x 2-3 (she has dementia at baseline and occasionally thinks it’s 1946). She is calm, conversing with staff, and able to ambulate the halls. She will be discharged home with PO antibiotics tomorrow.
What discharge teaching should be provided to Mrs. Phillips and to the caregivers at Mrs. Phillips’ nursing home?
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Adaptive Brain SIMCLEX 1 Study Plan
Concepts Covered:
- Documentation and Communication
- Legal and Ethical Issues
- Perioperative Nursing Roles
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Communication
- Fundamentals of Emergency Nursing
- Preoperative Nursing
- Basics of NCLEX
- Medication Administration
- Vascular Disorders
- Upper GI Disorders
- Urinary Disorders
- Renal Disorders
- Central Nervous System Disorders – Brain
- Studying
- Emergency Care of the Neurological Patient
- Postpartum Complications
- Liver & Gallbladder Disorders
- Factors Influencing Community Health
- Community Health Overview
- Immunological Disorders
- Integumentary Disorders
- Male Reproductive Disorders
- Pregnancy Risks
- Prioritization
- Childhood Growth and Development
- Musculoskeletal Trauma
- Terminology
- Respiratory Disorders
- Cognitive Disorders
- Adulthood Growth and Development
- EENT Disorders
- Concepts of Population Health
- Basic
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Tissues and Glands
- Emergency Care of the Trauma Patient
- Cardiovascular
- Lower GI Disorders
- Circulatory System