Question

You are working in an extended care facility when M.Z.'s daughter brings her mother in for a week stay while she goes no vacation. M.Z. is an 89-year-old widow with a 4-day history of dysuria, back pain, incontinence, severe mental confusion and loose stools. Her physician discontinued her hormone replacement therapy 1 month ago. He most current vital signs are: 118/60, 88, 18, 99.4.

The medical director ordered several lab tests on admission. The results were as follows: WBC:11 thou/cmm, complete metabolic panel within normal limits. Post void catheterization yielded 100 mL, and urinalysis showed: WBC 100+/HPF, RBC 3 to 6/HPF, bacteria rare. the urinary culture and sensitivity results were as follows: Escherichia coli, more than 100,000 colonies, sensitive to ciprofloxacin, trimethorprim-sufamethoxazole, and nitrofurantoin. M.Z. is diagnosed with a urinary tract infection (UTI).

1. What are the cues in this scenario? (In other words, what sticks out to you as important to note in the above scenario; this could be normal or abnormal findings). Please include an explanation as to why these findings are important. You must list at least 5, although there are more. (5 points)

2. What risk factors for a UTI does M.Z. have? Include a rationale regarding WHY these factors increase the risk of developing a UTI. Please list at least 3 (3 points)

The medical director makes rounds and writes orders to start an IV of 0.9% NS @ 75mL/hour and insert a Foley catheter. The provider also orders ciprofloxacin 200 mg bid IVPB.

3. Is a foley catheter an appropriate order for this patient at this time? Justify your answer. (1 point)

4. What education would you provide to the patient receiving IV ciprofloxacin? (1 point)

You enter the room to start the IV but find that the aide has taken the patient to the bathroom for a bowel movement. You open the door to observe the patient wiping herself from back to front.

5. What is the significance of this observation, and how do you respond? (1 point)

6. It has been 8 hours and M.Z. has not voided. What should your next action be? Justify your answer. (1 point)

7. When a patient has an indwelling foley catheter, what care must be done to prevent catheter associated urinary tract infections? Please list at least 5 interventions. (5 points)

Answer 1

1. What are the cues in this scenario? (In other words, what sticks out to you as important to note in the above scenario; this could be normal or abnormal findings). Please include an explanation as to why these findings are important. You must list at least 5, although there are more. (5 points)

h/o dysuria,back pain ,urinary incontinence	symptoms of UTI
LOOSE STOOLS	DEHYDRATION
POST VOID CATHTERIZATION 100ml	Obstruction to urine flow
Urine routine wbc 100	urinary infection
RBC 3 to 6	haematuria
urine c & s	E.Coli

2. What risk factors for a UTI does M.Z. have? Include a rationale regarding WHY these factors increase the risk of developing a UTI. Please list at least 3 (3 points)

menopause	changes the Ph of vaginal region
urinary incontinence	age related changes
female gender	short urethra

The medical director makes rounds and writes orders to start an IV of 0.9% NS @ 75mL/hour and insert a Foley catheter. The provider also orders ciprofloxacin 200 mg bid IVPB.

3. Is a foley catheter an appropriate order for this patient at this time? Justify your answer. (1 point)

- yes , it prevents incontinence and further bacterial growth

4. What education would you provide to the patient receiving IV ciprofloxacin? (1 point)

- this is to kill the bacteria causing urinary tract infection

You enter the room to start the IV but find that the aide has taken the patient to the bathroom for a bowel movement. You open the door to observe the patient wiping herself from back to front.

5. What is the significance of this observation, and how do you respond? (1 point)

- this is the wrong way , it is to clean from front to back as bacterial flora can reach urethral opening if not properly cleaned and ascend further to the urinary bladder worsening the infection

6. It has been 8 hours and M.Z. has not voided. What should your next action be? Justify your answer. (1 point)

-inspect for bladder

-apply hot bags over the pubic region

- if still not passing cathterize

7. When a patient has an indwelling foley catheter, what care must be done to prevent catheter associated urinary tract infections? Please list at least 5 interventions. (5 points)

- it is to be inserted in full aseptic precaution

- the catheter and surrounding urethral opening to be cleaned properly with iodine daily

- regularly discard urine

-change catheter after every 3 months.