Question

66 y/o male presents to ED with fever, malaise, generalized weakness, intermittent fever and chills, nausea. Patient had an indwelling urinary catheter inserted in the ED 7 days ago forurinary retention.

Medical history: BPH, kidney transplant 3 years ago, lupus

Vitals: HR 112 BP 78/48 RR 24 Temp 101.4 O2 Sat 90%

Laboratory results: WBC 16.4 RBC 4.8 HGB 14.1 HCT 42% PLT 254,000 Na+ 141 Cl- 112 K+ 4.5 BUN 18 CREAT 1.8

Urinalysis results: Appearance: CLOUDY Color: AMBER pH: 8.4 Leukocyte esterase: POSITIVE Nitrites: POSITIVE Glucose: NEGATIVE WBCs: 25 WBC casts: POSITIVE RBCs: 4

Medications:

Flomax 0.8 mg PO daily

Prednisone 40 mg PO daily

Imuran 200 mg PO daily

Nexium 20 mg PO daily

Senna 8.6 mg PO daily

Cozaar 50 mg PO daily

Crestor 10 mg PO daily

1. What are the priority actions of the nurse and why? (2pts)

2. Which medications should be administered and why? (2pts)

3. What procedures will the nurse prepare to assist with? (2pts)

4. How do the abnormal laboratory values correlate with the patient’s symptoms? (2pts)

5. What additional medications/interventions should be ordered for this patient? (2pts)

6. What are the important nursing considerations for each of the medications to be administered to the patient? (2pts)

7. What is the underlying pathophysiology causing the patient’s symptoms? (2pts)

8. Which tests may be ordered for the patient? (2 pts)

9. Create an appropriate 5-minute care plan for this patient to address the immediate health needs. Be sure to utilize correctly two formatted nursing diagnoses. (9 pts)

Answer 1

1. Here the vitals of the patient shows:

BP: 78/48

RR: 24

Temp: 101.4

O2 Sat 90%

First of all the nurse has to immediately inform the vital signs to the emergency doctor and get advice to stop Tab: Tab Cozaar, why because already the patient is in the stage of hypotension and as well as administer oxygen after getting an ABG or if needed.

2. Administer antipyretics and antibiotics for control infection after sending a culture for urine. The urine reports show there is a presence of leukocytes, nitrates, WBC and RBC casts shows that the patient is suffered from urinary tract infection.

3. Here there is a presence of WBC and RBC casts in the urine. Some times this casts results in worsening of the condition or blocks the urinary tract results in decreased urine output. Here the nurse prepares to assist with bladder Irrigation.

4. The blood reports show WBC 16.4 and increased chlorine level suggests that the patient is suffered from infection.as well as in the urine is cloudy in appearance with amber colour, presence of leukocytes, nitrates, WBC and RBC casts shows infections with the patient shows the symptoms of fever and chills, lethargy and nausea.

5. The additional medications such as administration of IV fluids, administration of oxygen and antipyretics should be administered. To control the temperature, manage dehydration and to improve the saturation level.

6. While administering the antipyretics the nurse has to watch for the temperature frequently and as well as check for the B.P why because of the patient in the stage of hypotension during the admission and as well as check the saturation level of the patient.

7. Already the patient is on immunosuppressants after the kidney transplant, as well as the patient, is on an indwelling catheter 7 days ago for urinary retention and has a history of lupus. Thus the patient is more prone to get the infection than a healthy one.

8. In the blood and urine, there is an increase in Wbc and presence of leucocytes. To find out the specific organism and sensitivity we can order for a blood and urine culture.

9. Fatigue related to the disease condition.

Hyperthermia related to the infectious process

*Monitor the client's vitals frequently

*Promote a calm and quiet environment to promote comfort

* Maintain a clean and sterile environment for the patient because the patient is a immunosuppressants stage.

*Strictly follow surgical techniques while during the priority procedures.

*Administer medications as prescribed.

*Strictly maintain the patient input and output chart.

*Take the measures to control dehydration.

*Administer IV fluids as per order.

*Send the blood and urine for culture.

*Administer oxygen, if needed

*Educate the patient regarding the importance of taking medications and fluids.

*Give psychological support to the patient by explaining the disease condition and the measure for complee cure in an understandable way.