Jean Kelly _ Urosepsis _ 2020 | NURS 342 Urosepsis _ Graded A

Urosepsis Jean Kelly age 82 Name: ​Christina Hammack 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. 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: Progressively worsening fatigue, fever, and painful, burning, and frequent urination. Sudden onset of confusion (change in mental status) with no prior history Clinically significant symptoms of urinary tract infection prompting request for an order for a urinalysis. Confusion is a common presentation of UTI in the elderly, and change in mental status from baseline should always be fully investigated. RELEVANT Data from Social History: Clinical Significance: Lives in a senior retirement community with daughters who are actively involved in her life and wears a life alert button Jean has a strong support system and a safe place to return to after discharge that will provide support. Her life alert button provides the security she needs in the event of an emergency since she lives alone. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medications treat which conditions-indicate with numbers or some form that I can identify PMH: Home Meds: Pharm. Classification: Expected Outcome: Diabetes type 2 1. Allopurinol 100 mg PO 1. Antigout agent 2. Antiplatelet/salicylate 3. Thiazolidinedione/anti diabetic 4. Antihyperlipidemic 5. Beta blocker 6. Ace inhibitor 7. Loop diuretic 8. K supplement 1. Decreased production of uric acid to reduce gout flares 2. Reduce platelet aggregation and clumping to prevent clotting 3. Reduces and controls blood glucose levels 4. Reduces cholesterol/ blood lipid levels 5. Reduces blood pressure 6. Reduces blood pressure 7. Reduces BP through diuresis 8. Replaces K in the body lost through diuresis Hyperlipidemia bid Hypertension (HTN) 2. ASA 81 mg PO daily Gout 3. Pioglitazone 15 mg PO daily 4. Simvastatin 20 mg PO daily 5. Metoprolol 25 mg PO bid 6. Lisinopril 10 mg PO daily 7. Furosemide 20 mg PO daily 8. Potassium chloride 20 mEq PO dailyUrosepsis Jean Kelly age 82 Name: ​Christina Hammack One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in their life? ● Circle what PMH problem started ​FIRST • DMII ● Underline what PMH problem(s) ​FOLLOWED​ ​as dominoes • HTN, HLD (probably coexisted), Gout • Wasn’t exactly sure when Gout could have happened as it not necessarily linked to her other comorbidities Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment (5th VS): T: ​101.8 F/38.8 C (oral) P​rovoking/Palliative: Nothing/Nothing P: ​110 (regular) Q​uality: Ache R: ​24 (regular) R​egion/Radiation: Right flank BP: ​102/50 S​everity: 5/10 O2 sat: ​98% room air T​iming: Continuous The nurse recognizes the need to validate his/her concern of fluid volume deficit and performs a set of orthostatic VS and obtains the following: Position: HR: BP: Supine 110 102/50 Standing 132 92/42 What VS data are RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: Temp of 101.8F Pulse of 110 Respirations of 24 BP 102/50 Orthostatic BP changes Indicative of fever, systemic sign of infection Tachycardia, heart is beating faster - could be sign of anxiety or compensation of some sort Tachypnea could also be a sign of anxiety or compensation In combination with tachycardia, probably indicative of fluid volume deficit in which heart beats faster to maintain pressure with the decreased blood volume Orthostatic hypotension defined as a systolic change of at least 20 between supine and standing which she demonstrates. Indicative of many things but given her vitals and s/s, this is consistent with fluid volume deficit Current Assessment:Urosepsis Jean Kelly age 82 Name: ​Christina Hammack GENERAL APPEARANCE: Resting comfortably, appears in no acute distress RESP: Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort CARDIAC: Pink, warm and dry, no edema, heart sounds regular-S1S2, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks NEURO: Alert and oriented x2-is not consistently oriented to date and place, c/o dizziness when she sits up GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Dysuria and frequency of urination persists, right flank tenderness to gentle palpation SKIN: Skin integrity intact, lips dry, oral mucosa tacky dry What assessment data are RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance: Disorientation, dizziness Dysuria, frequency persist; flank pain and tenderness upon palpation Lips and oral mucosa tacky dry Orthostatic hypotension confirmed with BP measurements and her dizziness with position changes confirms this. She is not sure of the time/place which family reports is not her baseline and should be investigated further to be sure it is just part of the presentation of the UTI Consistent with UTI, flank tenderness and pain can possibly be indicative of kidney involvement/spread of infection beyond the urethra/bladder Dry mucous membranes is consistent with dehydration/fluid volume deficitUrosepsis Jean Kelly age 82 Name: ​Christina Hammack Lab Results: What lab results are RELEVANT and must be recognized as clinically significant by the nurse? Complete Blood Count (CBC): Current: High/Low/WNL? Previous: WBC (4.5-11.0 mm 3) 13.2 High 8.8 Hgb (12-16 g/dL) 14.4 WNL 14.6 Platelets (150-450x 103/µl) 246 WNL 140 Neutrophil % (42-72) 93 High 68 Band forms (3-5%) 2 Low 1 What lab results are RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT Lab(s): Clinical Significance: TREND: ​Improve/Worsening/Stable: WBC and Hgb Platelets Neutrophil Band forms WBC is increasing while Hgb remains stable. This means infection and likely rules out any sort of major traumatic blood loss contributing to fluid volume deficit. WNL but rose significantly from last draw. Can be a sign of infection; rising platelets in the setting of infection known as reactive thrombocytosis Increasing neutrophil count is a sign of infection as the body produces more to fight the existing infection. Similar to neutrophils, considered neutrophils in their early form and altered counts can indicate infection or risk of infection WBC worsening Hgb stable Stable Worsening Same - moving towards normal value- - -- - - - - - - - -- Continued