Name: Kirstin Ansley Date: 12/15/2024
Scenario
You are working in a long-term care facility reviewing the record of A.S., a 94-year-old resident with
frailty. The AP voiced to you that A.S. has been incontinent of urine and stool, which was unusual for
her, and that her urine seems foul-smelling. You see that A.S. has had a few loose stools the past 3
days. Your assessment reveals nonlocalized abdominal discomfort and the new-onset confusion.
Vital signs are 118/60, 88, 18, 99.4° F (37.4° C).
1. Underline or highlight the assessment findings that concern you.
2. Based on these findings, you recognize that A.S. may be experiencing _______1______ and
anticipate the HCP will order _____2_____ and _____2_____ to determine if this problem is the cause of
her symptoms.
Options for 1 Options for 2
GI infection BMP
COVID-19 infection CBC
Urinary tract infection Rapid COVID test
Stool cultures
Urinalysis with culture and sensitivity (C &
S)
CASE STUDY PROGRESS
You discuss A.S.'s condition with the medical director. She orders a postvoid catheterization, which
yields 100 mL of cloudy urine with a strong odor, and several lab tests. Urine culture and sensitivity
(C&S) results are pending. Complete metabolic panel (CMP) is within normal limits. The white blood
cell count is 11,000/mm3 (11 x 109/L).
Chart View
Laboratory Test Results
Complete metabolic panel (CMP): Within normal limits except for the following results:
BUN 25 mg/dL (8.9 mmol/L)
Sodium 131 mEq/L (131 mmol/L)
Potassium 3.2 mEq/L (3.2 mmol/L)
White blood cell count 11,000/mm3 (11 x 109/L)
Urinalysis
, Appearance Cloudy
Odor Foul
pH 8.9
Protein Negative
Nitrites Positive
Crystals Negative
WBCs 6 per low-power field
RBCs 3
3. Based on the assessment findings, what problem is likely present?
UTI. Within her urinalysis it shows that her urine is cloudy and foul odor, elevated pH level, nitrates
are present as well as WBCs are present in the urine, these point toward a UTI diagnosis. Her BUN is
also elevated which indicates the kidneys are not working properly and her WBCs are also elevated
in her blood work which indicates infection.
4. Considering her history, what other condition is a possibility?
She could also be experiencing dehydration because of her decreased lab levels of Potassium and
sodium and a elevated BUN level.
5. The medical director makes rounds and writes orders to start an IV of D5 0.45 at 75 mL/hr and
ciprofloxacin 400 mg q12h IV. Are the type of fluid and rate appropriate for A.S.'s age and condition?
Explain.
Yes, this is an appropriate fluid and rate because her electrolytes are only slightly low and she has
also has not stated any previous history of diabetes which in that case I would not choose a fluid
with dextrose.
6. You would safely administer the ciprofloxacin by performing which action?
a. Storing the medication in the refrigerator.
b. Infuse the solution slowly over 60 minutes.
c. Use special filtered tubing with the infusion pump. x
d. Infuse diluted as a slow intravenous push medication.
7. You enter the room to start the IV infusion and find that a new AP had taken A.S. to the bathroom
for a bowel movement. A.S. asks you to help her, and, as you open the door, you observe her wiping
herself from back to front. What would you do?
Scenario
You are working in a long-term care facility reviewing the record of A.S., a 94-year-old resident with
frailty. The AP voiced to you that A.S. has been incontinent of urine and stool, which was unusual for
her, and that her urine seems foul-smelling. You see that A.S. has had a few loose stools the past 3
days. Your assessment reveals nonlocalized abdominal discomfort and the new-onset confusion.
Vital signs are 118/60, 88, 18, 99.4° F (37.4° C).
1. Underline or highlight the assessment findings that concern you.
2. Based on these findings, you recognize that A.S. may be experiencing _______1______ and
anticipate the HCP will order _____2_____ and _____2_____ to determine if this problem is the cause of
her symptoms.
Options for 1 Options for 2
GI infection BMP
COVID-19 infection CBC
Urinary tract infection Rapid COVID test
Stool cultures
Urinalysis with culture and sensitivity (C &
S)
CASE STUDY PROGRESS
You discuss A.S.'s condition with the medical director. She orders a postvoid catheterization, which
yields 100 mL of cloudy urine with a strong odor, and several lab tests. Urine culture and sensitivity
(C&S) results are pending. Complete metabolic panel (CMP) is within normal limits. The white blood
cell count is 11,000/mm3 (11 x 109/L).
Chart View
Laboratory Test Results
Complete metabolic panel (CMP): Within normal limits except for the following results:
BUN 25 mg/dL (8.9 mmol/L)
Sodium 131 mEq/L (131 mmol/L)
Potassium 3.2 mEq/L (3.2 mmol/L)
White blood cell count 11,000/mm3 (11 x 109/L)
Urinalysis
, Appearance Cloudy
Odor Foul
pH 8.9
Protein Negative
Nitrites Positive
Crystals Negative
WBCs 6 per low-power field
RBCs 3
3. Based on the assessment findings, what problem is likely present?
UTI. Within her urinalysis it shows that her urine is cloudy and foul odor, elevated pH level, nitrates
are present as well as WBCs are present in the urine, these point toward a UTI diagnosis. Her BUN is
also elevated which indicates the kidneys are not working properly and her WBCs are also elevated
in her blood work which indicates infection.
4. Considering her history, what other condition is a possibility?
She could also be experiencing dehydration because of her decreased lab levels of Potassium and
sodium and a elevated BUN level.
5. The medical director makes rounds and writes orders to start an IV of D5 0.45 at 75 mL/hr and
ciprofloxacin 400 mg q12h IV. Are the type of fluid and rate appropriate for A.S.'s age and condition?
Explain.
Yes, this is an appropriate fluid and rate because her electrolytes are only slightly low and she has
also has not stated any previous history of diabetes which in that case I would not choose a fluid
with dextrose.
6. You would safely administer the ciprofloxacin by performing which action?
a. Storing the medication in the refrigerator.
b. Infuse the solution slowly over 60 minutes.
c. Use special filtered tubing with the infusion pump. x
d. Infuse diluted as a slow intravenous push medication.
7. You enter the room to start the IV infusion and find that a new AP had taken A.S. to the bathroom
for a bowel movement. A.S. asks you to help her, and, as you open the door, you observe her wiping
herself from back to front. What would you do?
