You are working in an extended care facility ECF when MZs daughter brings her mother
Urinary Tract Infection
Difficulty: Beginning
Setting: Hospital
Index Words: urinary tract infection (UTI), assessment, skin care, patient education
Scenario
You are working in an extended care facility (ECF) when M.Z.’s daughter brings her mother in for a week’s
stay while she goes on vacation. M.Z. is an 89-year-old widow with a 4-day history of dysuria, suprapubic pain, incontinence, new onset mental confusion, and loose stools. Her most current vital signs (VS) are
118/60, 88, 18, 99.4° F (37.4° C).
The medical director ordered a postvoid catheterization, which yielded 100 mL of cloudy urine that had
a strong odor, and several lab tests on admission. The results were as follows:
Laboratory Test Results
Complete metabolic panel (CMP): Within normal limits except for the following results:
BUN 25 mg/dL
Sodium 131 mEq/L
Potassium 3.2 mEq/L
White blood cell count 11,000/mm 3
Urinalysis
Appearance Cloudy
Odor Foul
pH 6.9
Protein Negative
Nitrites Positive
Crystals Negative
WBC 6 per low-power fi eld
RBC 3
Urine culture and sensitivity results are pending.
1. What condition do the assessment findings and lab reports point toward?
2. The medical director makes rounds and writes orders to start an IV of D5½ NS at 75 mL/hr
and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral meds, the
medical director ordered ciprofloxacin (Cipro) 400 mg q12h IV piggyback (IVPB). Is the type
of fluid and rate appropriate for M.Z.’s age and condition? Explain.
3. While administering the IVPB ciprofloxacin, which adverse effects might occur? (Select all that
apply.)
a. Hypotension
b. Headache
c. Drowsiness
d. Restlessness
e. Nausea
f. Tendon rupture
4. You enter the room to start the IV and insert the Foley catheter and find that the NAP has
taken the patient to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you
open the door, you observe the patient wiping herself from back to front. What do you need to
do at this time?
5. Because M.Z. has been having diarrhea, what special instructions should you give the NAP
assigned to give basic care to M.Z.?
CASE STUDY PROGRESS
The next day, you are the nurse assigned to M.Z.’s care. You notice that the NAP emptying the gravity drain
is not wearing personal protection devices. You also observe that the drainage port of the drainage bag was
contaminated during the process because the NAP allowed it to touch the floor.
6. What issues need to be considered in protecting M.Z.’s safety? Describe your actions in
working with the nursing assistant.
7. As you assess M.Z., you notice that her catheter tubing is not secured. Why does the tubing
need to be secured, and where is the correct placement of the catheter tubing?
CASE STUDY PROGRESS
On the third day after M.Z.’s admission, the urinary culture and sensitivity (C&S) results were as follows:
Escherichia coli , more than 100,000 colonies, sensitive to ciprofloxacin, trimethoprim-sulfamethoxazole, and
nitrofurantoin.
8. What changes, if any, will be made to the antibiotic therapy?
9. The NAP reports that M.Z.’s 8-hour intake is 520 mL and the output is 140 mL. Is this
significant? Identify two possible reasons that could account for the difference, and explain how
you would assess each.
CASE STUDY PROGRESS
M.Z. has completed her antibiotic therapy. Her mental status has cleared, the Foley catheter has been
discontinued, and she is ready for discharge.
10. What instructions should you discuss with the daughter?
