Urinary Tract Infection/Urosepsis
Primary Concept
Infection
Interrelated Concepts (In order of emphasis)
1. Perfusion
Jean Kelly, 82 years old
UNFOLDING Reasoning Case Study: STUDENT
Sepsis History
of Present Problem:
Jean Kelly is an 82-year-old woman who has been feeling more fatigued the last three days and has had a fever the last
twenty-four hours. She reports a painful, burning sensation when she urinates as well as frequency of urination the last
week. Her daughter became concerned and brought her to the emergency department (ED) when she did not know what
day it was. She is mentally alert with no history of confusion. While taking her bath today, she was weak and unable to get
out of the tub and used her personal life alert button to call for medical assistance.
© 2016 Keith Rischer/www.KeithRN.com
, Personal/Social History:
Jean lives independently in a senior apartment retirement community. She is widowed and has two daughters who are
active and involved in her life.
What data from the histories are important and RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Feeling fatigued the last three days. Clinically significant when clustered with the other symptoms of fever
this is indicating that there is a likely an infection present
Fever the last 24-hours Fever reflects the systemic inflammatory response initiated by the
immune system to help the body fight off infection
Reports painful burning when urinating as
well as frequency for the last week The patient’s symptoms are classic with a UTI.
Suspecting a urinary infection, the nurse needs to know that if a patient
meets the SIRs criteria, they should suspect sepsis. Request for a UA is
indicated
Did not know what day it was, with no
history of confusion New onset of confusion is always a clinical red flag in the elderly, and
when combined with other symptoms it is not usually a neurologic
problem. Confusion is commonly seen with a UTI infection.
While taking her bath today, she was weak
and unable to get out of the tub and used the This confirms the weakness and fatigue she has had the past 3 days. It is
help button to call for medical assistance. severe weakness if she is unable to get out of the bath tub and needed to
call for assistance
RELEVANT Data from Social History: Clinical Significance:
Jean lives independently in a senior The patient is able to function at a high level for her age and capable of
apartment retirement community. independent living. Therefore, her current symptoms are abnormal.
She is widowed and has two daughters who Jean has a supportive family and will have a is a positive influence that
are active and involved in her life. will increase her ability to maintain her independence and freedom.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
-Diabetes type 2 1. Allopurinol 100 mg PO 1. Antigout agent 1. Patient had decreased
-Hyperlipidemia bid (Gout) (Gout) production of uric acid to
-Hypertension (HTN) reduce gout flares
-Gout
DM2 2. ASA 81 mg PO daily
© 2016 Keith Rischer/www.KeithRN.com
Primary Concept
Infection
Interrelated Concepts (In order of emphasis)
1. Perfusion
Jean Kelly, 82 years old
UNFOLDING Reasoning Case Study: STUDENT
Sepsis History
of Present Problem:
Jean Kelly is an 82-year-old woman who has been feeling more fatigued the last three days and has had a fever the last
twenty-four hours. She reports a painful, burning sensation when she urinates as well as frequency of urination the last
week. Her daughter became concerned and brought her to the emergency department (ED) when she did not know what
day it was. She is mentally alert with no history of confusion. While taking her bath today, she was weak and unable to get
out of the tub and used her personal life alert button to call for medical assistance.
© 2016 Keith Rischer/www.KeithRN.com
, Personal/Social History:
Jean lives independently in a senior apartment retirement community. She is widowed and has two daughters who are
active and involved in her life.
What data from the histories are important and RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Feeling fatigued the last three days. Clinically significant when clustered with the other symptoms of fever
this is indicating that there is a likely an infection present
Fever the last 24-hours Fever reflects the systemic inflammatory response initiated by the
immune system to help the body fight off infection
Reports painful burning when urinating as
well as frequency for the last week The patient’s symptoms are classic with a UTI.
Suspecting a urinary infection, the nurse needs to know that if a patient
meets the SIRs criteria, they should suspect sepsis. Request for a UA is
indicated
Did not know what day it was, with no
history of confusion New onset of confusion is always a clinical red flag in the elderly, and
when combined with other symptoms it is not usually a neurologic
problem. Confusion is commonly seen with a UTI infection.
While taking her bath today, she was weak
and unable to get out of the tub and used the This confirms the weakness and fatigue she has had the past 3 days. It is
help button to call for medical assistance. severe weakness if she is unable to get out of the bath tub and needed to
call for assistance
RELEVANT Data from Social History: Clinical Significance:
Jean lives independently in a senior The patient is able to function at a high level for her age and capable of
apartment retirement community. independent living. Therefore, her current symptoms are abnormal.
She is widowed and has two daughters who Jean has a supportive family and will have a is a positive influence that
are active and involved in her life. will increase her ability to maintain her independence and freedom.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
-Diabetes type 2 1. Allopurinol 100 mg PO 1. Antigout agent 1. Patient had decreased
-Hyperlipidemia bid (Gout) (Gout) production of uric acid to
-Hypertension (HTN) reduce gout flares
-Gout
DM2 2. ASA 81 mg PO daily
© 2016 Keith Rischer/www.KeithRN.com
