Problem
Case Study
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Mary Adams is a widowed, Hispanic 84-year-old dementia patient from an assisted living facility. She has a history of frequent UTI's, type 2 diabetes, and hypertension. In the Assisted Living Facility, Mrs. Adams began showing signs of altered mental status. She was then transferred to the ED for possible UTI. According to report given from Nurse at the facility in which Mrs. Adams resides, she has become combative, and mentation has differed from baseline. Baseline is typically alert and oriented, but forgetful. Currently, Mrs. Adams is presenting with increased confusion and forgetfulness. Mrs. Adams is observed holding her abdomen at times. She is incontinent and currently is wearing depends briefs with an incontinent pad liner. Vital signs are blood pressure: 118/71, pulse 98, R-20, Temp. 99.9 F, O2 sat 96% on RA. According to the facility, they have attempted to obtain a urine culture, but specimen returned contaminated. MD ordered collection via straight cath however, patient refused.
a) What data is relevant and must be noticed as clinically significant by the nurse?
b) What is the significance about the patient having dementia, what other information is needed?
Mrs. Adams is admitted and brought into a private room.
Current Vital signs are: BP 140/80, Pulse 100, R-21, O2 sat is 95% on RA, and Temp 100.4 F.
Pain assessment using the PAINAD is a 4 (moderate pain).
a) What is relevant data and what is the clinical significance?
b) What other information can be asked to help determine if the patient has a UTI?
Current Focused Nursing Assessment:
General Survey: Thin elderly female, appears anxious and tense.
Neurological: Oriented to person only
Respiratory: Breath sounds clear, non- labored effort
Cardiac: Heart sounds regular, edema +1 to bilateral lower extremities, pulses strong and brisk capillary refill
Abdomen: Bladder is distended, tender, bowel sounds audible in all 4 quadrants
GU: Has not voided since admission to the unit
Integumentary: Skin integrity intact, pink, warm, and dry.
a) What data is relevant and clinically significant?
b) Is there anything that should be assessed for further evaluation of the situation?
c) What can be done in regard to the distended bladder?
Labs:
Urinalysis
Last Adm: Amber, Cloudy, Sp. Gravity-1.040, pH-7.8, RBC- small, WBC- plenty, Leukocytes- positive, Nitrite- positive, Bacteria- positive
• Based on these labs what can be determined?
Patient is ordered IV Levaquin until results of urine culture comes in. Urine culture returns positive for Klebsiella pneumoniae and the doctor orders 8 days of IV antibiotics Vabomere. Mrs. Adams will be transferred to a Skilled Nursing Facility until IV antibiotics are completed.
Because Mrs. Adams' family is not familiar with SNF and Medicaid, the social worker will assist family with admission to a skilled nursing facility. The goal is for Mrs. Adams to return to the ALF once the antibiotics is completed.
a) Besides the social worker, what other interprofessional team members can be called to assist prior to discharge?
b) Why is it important to know the type of insurance the patient has?