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This is A Discussion ON CASE STUDY ON UROSEPSIS- ALTERED GENITOURINARY- for class discussion and I have done my best in the research, KINDLY FOLLOW THE DETAILS AND ANSWER THEM ACCORDINGLY-

 

 

 

 

 

 

 

 

This is A Discussion ON CASE STUDY ON UROSEPSIS- ALTERED GENITOURINARY- for class discussion and I have done my best in the research, KINDLY FOLLOW THE DETAILS AND ANSWER THEM ACCORDINGLY-

 

 

 

Detail Clinical Significance/Impact
It is Saturday morning (Time 0915), and you are working in a busy Emergency Department.  

History of present illness: You are caring for Betsy, a 68-year-old female. She arrived from her nursing home because the staff there is concerned for her increase in confusion, shortness of breath, and fever. She is accompanied by her caretaker. Betsy denies pain and is confused. She has had  fever for 2 days. No medication has helped reduce the fever. The caretaker reports Betsy has a decreased appetite and malodorous urine. She denies pain but yells when her posterior flank is touched.

Allergies: bee stings (anaphylaxis)

 
Social History (from Betsy’s caretaker) Betsy has lived in a nursing care facility for 3 years after her husband died. Her caretaker has been with her for those 3 years. She noticed that Betsy had become more confused over the past week and spiked a fever 2 days ago with no relief. She decided to take Betsy to the hospital when she would no longer eat. Betsy is usually active at the nursing home and is alert and oriented. She has some short-term memory problems but is overall “with it”, according to the caretaker. Betsy has her own room with a bathroom and joins the other residents for meals in the dining hall. Betsy tries her best to stick with a low-carbohydrate diet since she is diabetic but struggles with sweets from time to time.   
Detail Clinical Significance/Impact

Medical History: Diabetes mellitus type 2, obesity

Surgical history: Cataract surgery on left eye 5 years ago.

 

 

Subjective History (from caretaker): Betsy was born and raised in a small country town. She married at a young age and was a part time substitute teacher. She has 3 children who live in another state. She and her husband were married 40 years. She has a good outlook on life but gets depressed around the anniversary of her husband’s death. He died of prostate cancer. She sees her children twice a year when they come to visit her at the nursing home. She no longer drives. She does water aerobics twice a week with the nursing home community but has missed out this week due to her illness. She does not get sick often and was diagnosed with diabetes 1 year ago. She has been compliant with medications and preventative measures. She is not up to date with vaccinations (flu or pneumonia). 

 

She takes the following RX medications:

Medication Dose Last dose taken
Insulin aspart NovoLog 5 units with meals 0730 today
Insulin Levemir 25 units at night 2100 yesterday evening

 

 

 

 

 

Nursing Assessment Clinical Significance

Nursing Assessment: What assessment data is important and why?

 

 

Vital Signs:

 

Neurological status: 

 

 

 

Circulatory status: 

 

 

 

Cardiovascular status: 

 

 

 

Respiratory status: 

 

 

 

 

 

 

Detail

Clinical Significance/Impact

Objective Data

General Appearance: Betsy appears ill and lethargic. She is lying in bed supine. She is mumbling words to herself. She is clean and well dressed. Her caretaker is at bedside with her. 

 

Temp: 39.4°C (103°F)

BP: 98/50 mmHg MAP 66

HR: 120 bpm 

RR: 30

SpO2: 91% on RA

 

NEURO: lethargic and disoriented to place/time/situation. GCS 13. Restless and agitated. PERRLA.

CARDIAC: Mucous membranes are pink. Capillary refill <3 seconds. Apical HR tachycardic. Peripheral pulses palpable x4 at +2. No edema. Murmur detected-systolic. RESP: Lungs auscultated on the anterior and posterior: RUL, LUL, RML clear, RLL, LLL diminished. No cough. No stridor. Respirations are symmetrical and labored. Tachypneic. 2L NC applied. GI: Abdomen obese and rounded. Soft and non-tender in all quadrants. NABS x4. Last BM was yesterday- small, formed, light brown. Negative for vomiting. Positive for nausea. GU: Voids with pain, urgency, and frequency. Burning sensation with each void. Urine is cloudy, pale-yellow, and malodorous. UDS negative for illicit drugs. Musculoskeletal: Moves all extremities without overt deficits. Joint pain in hands and knees. No joint swelling. Ambulates unassisted with a cane. Equal grip strength bilaterally.  Integumentary: dry and intact, no bruises, scars, or excoriations. Turgor present. Psychosocial: flat affect, caregiver at bedside. Will return to nursing home after hospitalization. What data from Betsy's assessment and recent clinical history is significant?   What diagnosis do you suspect?   Why? List symptoms associated with suspected diagnosis.       You receive the following orders from the provider. What is the clinical significance or impact of each? Blood cultures   Serum glucose    WBC   Plasma C-reactive protein (CRP)   Arterial blood gas (ABG)   Electrocardiogram (ECG)   Chest radiography   Serum creatinine   Platelet count   Serum Sodium   Serum potassium   Lactic acid   Procalcitonin   Urine Culture   The RN receives the following orders from the provider. What is the clinical significance or impact of each?  Intravenous access   Continuous cardiac monitoring   Administer fluids IV   Straight urethra Catheterization   Monitor vital signs   Administer antibiotics     Nursing physical assessment Q2 hours   Assess oxygen saturations     Monitor urine output   Fall precautions   Apply cooling blanket         Diagnostic Test Results Clinical Significance/Impact Blood cultures Gram negative bacilli and Escherichia coli.   serum glucose  150 mg/dL   WBC 20,000/ mm³   Plasma C-reactive protein 3.5 mg/dL   ABG pH: 7.2 PCO2: 55 mmHg HCO3: 25 mEq/L PO2: 40 mmHg O2 saturation: 93% on 2L Base excess: ±3 mEq/L   Electrocardiogram (ECG) Rate: 120 BPM P and T wave normal PRI: 0.10 QRS: 0.08 QTI: 0.36   Chest radiography Cardiac silhouette within normal limits. Lung bases clear, no atelectasis or pulmonary congestion seen   Serum creatinine 1.1 mg/dL   Platelet count 50,0000 microl-1   Serum Sodium 125 mmol/L   Serum potassium 5.8 mmol/L   Lactic acid 4 mmol/L   Procalcitonin 1.0 ng/mL   Urine culture + WBC +Bacteria +high pH +leukocyte esterase Sensitivities pending**       Family Education The provider informs Betsy and her caretaker that she has urosepsis. What education is essential to communicate to the caretaker about the cause of urosepsis?                   The caregiver asks, "How is urosepsis treated?" How would you respond?                               Case Study Continued Clinical Significance/Impact Betsy is being transferred to the intensive care unit to monitor her blood pressure and oxygenation status. You prepare to call report to Marvin, RN. You review Betsy's most recent labs and presenting symptoms. Betsy's oxygenation has not improved on 2L NC and she has Sp02 of 90%. The provider is preparing to increase her mode of oxygen with a BiPAP machine (8/10/50%). Her BP is stable, but low. She is lethargic and confused. She has bilateral 18g upper arm peripheral IVs with NaCl 0.9% infusing at 150 mL/hr in the left arm. She was given a 2L bolus of NaCL 0.9%. She is lethargic and opens eyes to speech. Her caregiver has been escorted to the ICU waiting area.         Considering Betsy's history, what information is important to include in handover?  Practice using the SBAR format.  Situation:            Background:            Assessment:              Recommendation:                  Medication Administration   What medication orders will Marvin anticipate and why?                                                             Medication Administration   What are some side effects of antibiotic therapy?        What are the indications for administering a pneumococcal polysaccharide vaccine (PPSV23)?               What nursing interventions will Marvin implement and why? Administer medications     Monitor vital signs     IV fluid administration   Incentive spirometry   Respiratory assessment Q4 hours     Administer oxygen as needed   Monitor telemetry   Assist patient with ADL's (nutrition, elimination, hydration, personal hygiene).    Test your knowledge! What can urosepsis lead to?         What effect does diabetes and obesity have on urosepsis?                       Discharge Instructions You are preparing Betsy to discharge back to the nursing home. The case manager and social worker have verified that the nursing home will accept Betsy back and transfer is set up. Betsy was treated for urosepsis and stayed in the ICU for 4 days and the medical unit for an additional 3 days. She is alert and oriented. Denies pain. Is ambulatory back to baseline and eating meals without assistance. She is not going home on any new medications as her antibiotic course was completed while in the hospital. She has follow-up appointments with her geriatric nurse practitioner and  PCP already scheduled. She is on a low-carbohydrate diet restriction. The caregiver has been phoned by the provider and updated on the plan. Non-emergent transportation is on their way to pick up Betsy and take her back to the nursing home.   The following are prescription medications for Betsy at the time of discharge:   Medication Dose Last dose taken Insulin aspart NovoLog 5 units with meals 0830 today Insulin Levemir 25 units at night 2000 yesterday evening   What instructions will be included for her at discharge?         What educational/discharge PRIORITIES will be needed to develop a teaching plan for this patient and/or family?  ● Educate the patient on how to wash the perineal parts from back to front, refrain from using bathtubs and wear cotton underwear. Optimum fluid intake to facilitate renal blood flow and to flush the bacteria from the urinary system. ● Inform the patient to adhere to the antibiotic medication administered by the physician.  ● Inform the patient to void frequently, after every 2 to 3 hours to completely empty the bladder in order to reduce the bacteria count in the urine and prevent re-infection.  ● Educate the patient to avoid urine contaminants such as alcohol, coffee, tea, and colas.  ● Educate the patient about any warning signs and symptoms associated with UTI that they should report to the doctor immediately if they experience any.         References Center for Disease Control and Prevention. (2020). Vaccines and preventable diseases: For healthcare professionals. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/hcp/PCV13-adults.html#:~:text=All%20adults%2065%20years%20or,fluid%20leak%2C%20or%20cochlear%20implant.   Hinkle, J.L., & Cheever, K.H. (2018). Management of patients with urinary disorders. Brunner & Suddarth's textbook of medical-surgical nursing (1615). Philadelphia: Wolters Kluwer.   Neviere, R., Parsons, P., & Finlay, G. (2020). Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate. Philadelphia: Wolters and Kluwer Pagana, K.D (2020). Mosby's diagnostic and laboratory test reference. St. Louis: Elsevier Mosby   Photo credit: "Senator Stabenow" by lauritadianita is licensed under CC BY-NC-ND 2.0         SCIENCE HEALTH SCIENCE NURSING NUR 412

 

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