Question Urinary Elimination You are working in an extended care facility… Urinary EliminationYou are working in an extended care facility when M.Z.’s daughter brings her mother in for a week’s stay while she goes on a planned vacation. M.Z. is an 89-year-old widow with a 4-day history of nonlocalized abdominal discomfort, incontinence, new-onset mental confusion, and loose stools. Her most current vital signs are 118/60, 88, 18, 98.4° F (37.4° C). The medical director ordered a post void catheterization, which yielded 100 mL of cloudy urine that had a strong odor, and several lab tests on admission. Urine culture and sensitivity (C&S) results are pending; the other results are shown in the chart.Chart ViewLaboratory Test ResultsComplete metabolic panel (CMP): Within normal limits except forthe 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)UrinalysisAppearance CloudyOdor FoulpH 8.9Protein NegativeNitrites PositiveCrystals NegativeWBCs 6 per low-power fieldRBCs 31. What condition do the lab reports point toward? 2. Which assessment findings are typical of an older adult with the condition in Question 1?a. Feverb. Hematuriac. Bladder spasmsd. Nonlocalized abdominal discomfort 3. Considering her history and lab results, what other condition is a possibility? 4. The medical director makes rounds and writes orders to start an IV of D5 NS at 75 mL/hr. Because M.Z. is unable to take oral medications, the medical director orders ciprofloxacin (Cipro) 400 mg q12hr IV piggyback (IVPB). Are the type of fluid and rate appropriate for M.Z.’s age and condition? Explain. 5. While the IVPB ciprofloxacin is being administered, which adverse effects might occur? Select all that apply.a. Nauseab. Headachec. Drowsinessd. Hypotensione. Restlessnessf. Tendon rupture 6. You enter the room to start the IV infusion and find that the UAP had taken M.Z. to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you open the door, you observe her wiping herself from back to front. What do you need to teach ? 7. Later that day, M.Z. has difficulty voiding, and palpation of the bladder reveals distention. A bedside bladder scanner indicates at least 250 mL of urine in the bladder. A Foley catheter is ordered and inserted. Because M.Z. has been havingdiarrhea, what special instructions should you give the UAPassigned to give basic care to M.Z.? Case study progressThe next day, you are the nurse assigned to M.Z.’s care. You notice that the UAP emptying the gravity drain is not wearing personal protection devices. You observe that the drainage port of the drainage bag was contaminated during the process because the UAP allowed it to touch the floor.8. What issues need to be considered in protecting M.Z.’s safety? Describe your actions in working with the UAP. 9. As you assess M.Z., you notice that her catheter tubing is not secured. Why does the tubing need to be secured? Where is the correct place for the catheter tubing? Case study progressOn the third day after M.Z.’s admission, the urinary C&S results are as follows: E. coli, more than 100,000 colonies, sensitive to ciprofloxacin, trimethoprim sulfamethoxazole, and nitrofurantoin.10. What changes, if any, will be made to the antibiotic therapy? 11. The UAP reports that M.Z.’s 8-hour intake is 520 ml and the output is 140 ml. Identify 2 possible reasons that could account for the difference and explain how you would assess each. Case study progressFurther monitoring of M.Z.’s urine output reflects adequate output amounts. After a week, M.Z. has completed her antibiotic therapy. Her mental status has cleared, the Foley catheter has been discontinued, and she is voiding without difficulty. She is ready for discharge.12. What instructions should you discuss with the daughter? 13. She needs to notify the primary care physician if her motherdevelops which problems? Name at least 6. Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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