Case Study: Urinary Tract Infection You are working in an extended care facility when M.Z.s daughter brings her mother in for a weeks 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 What condition do the lab reports point toward? Which assessment findings are typical of an older adult with the condition in Question 1? 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?
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