Catheter-acquired urinary tract infections

Labs

Vitals

Medications

Misc. Nursing Notes

Medical History

Physical assessment

Nursing Diagnosis

54- year-old spanish speaking patinet with history of rheumatoid arthritis that is controlled with prednisone and NSAIDs. She lives with family that assist with daily living activities. Neighbor called 911 when they found patient had fallen outside an hour prior.

5/7/2021 1245
M. Houston, SVN TCC

Rheumatoid arthritis

Acute pain

Infection

Prednisone

Ketorolac

Cefazolin

4/6

4/7

0200

0815

1310

2050

0030

RR 14

Sats 99% 2 L/NC

HR 105

Temp 100.7F

BP 110/75

Pain 2/10

RR 16

Sats 96% 1 L/NC

HR 100

Temp 99.0F

BP 108/67

Pain 3/10

RR 22

Sats 95% RA

HR 110

Pain 7/10

BP 145/88

RR 16

Sats 94% RA

HR 88

Temp 97.2F

BP 127/78

Pain 4/10

RR 18

Sats 95% RA

Pain 3/10

BP 100/76

HR 90

1635

1905

RR 22

Sats 94% RA

HR 92

Temp 98.0F

BP 110/72

Pain 8/10

RR 20

Temp 100.0F

Sats 94% RA

HR 88

BP 115/70

Pain 5/10

4/8

2200

RR 18

Sats 94% RA

HR 86

Temp 97.0F

BP 110/75

Pain 2/10

1620

2110

0800

RR 20

Sats 95% RA

HR 98

Temp 98.0F

BP 118/75

RR 22

Sats 92% RA

HR 110

Temp 100.5F

BP 98/56

Pain 6/10

RR 24

Sats 95% 1 L/ NC

HR 114

Temp 101.2F

Pain 5/10

BP 89/50

Potassium (3.5-5.0 mEq/L)

Glucose (70-100 mg/dL)

Calcium (9-10.5 g/dL)

BUN (8-20 mg/dL)

Platelets (150000-350000 uL)

CPK (30-170 U/L)

RBC (4.2-5.9 cells/L)

Hematocrit (36.0-51.0%)

Hemoglobin (12.0-17.0g/dL)

LDH (60-100 U/L)

Cholesterol (<200 mg/dL)

Triglycerides (<150 mg/dL)

WBC (4000-10000 uL)

15000 H (4/6)

11.0 L (4/5)

6.9 L (4/6)

35L (4/5)

28L (4/6)

2.5 L (4/6)

3.8 L (4/5)

102000 L (4/6)

145000L (4/5)

198 H ( 4/5)

188 H (4/6)

259H (4/5)

246 H (4/6)

154 H (4/5)

422 H (4/5)

304 H (4/6)

39 H (4/5)

25 H (4/6)

267 H (4/6)

189 H (4/5)

3.3 L (4/6)

3.2 L (4/5)

8.8 L 4/5)

8.7 L ( 4/6)

The doctor ordered: orthopedic surgical consult, change to "surgical consent ORIF, chlorhexidine surgical scrub before surgery, IV with 0.9% sodium chloride at 50 mL/hr, Labs (CBC, CMP) now and in the morning, Type and Hold 2 units PRBC, CXR, EKG-12 lead, Prednisone 10mg daily, Ketorolac 30 mg IV every 6 hours, Cefazolin 1 g IV on call to surgery, Diet as tolerated-NPO after midnight, BG monitoring AC andHS call if >200mg/dL, indwelling catheter, and I&O

After labs are complete WBC, Hemoglobin/Hematocrit, Potassium, Glucose, Cholesterol/Triglycerides and Platelet counts are concerning and surgery is postponed. Patient is started on IV antibiotics, Potassium and receives 1 unit PRBC. Patient is started on short-acting insulin. A PICC is place due to poor venous access.

Then next day patient is improving and is taken to surgery for ORIF of left Hip. 24 hours postop patient's BP drops to 89/50 and fluids are given. Dr. is called with report of BP 89/50, Temp 101.2F, She had elevated WBC and has been on cefazolin IV, Her would site is slightly red with clear, serous drainage, lungs are diminished in the bases, and has been placed on 1L/NC sats at 95%. WBC are at 13000. Indwelling catheter is draining concentrated, cloudy urine

Dr. prescribes: Urine C&S and discontinue indwelling catheter. chest x-ray, IV fluids, acetaminophen, ciprofloxacin. Results: Bilateral atelectasis and bladder and kidney infection. An increase of CAUTI has been noticed on this unit.

Ciprofloxacin

Acetaminophen

Chronic use of corticosteroids

Wound site is slightly red, serous drainage and staples are intact.

BP 89/50, Temp 101.2F

Lungs are diminished in the bases

Take as directed

Avoid alcohol

Discontinue and contact provider if rash occurs

Do not take more than 10 days

Side effects

Stevens-Johnson syndrome

Hypokalemia

Hepatotoxicity

renal failure

Report signs of superinfection and allergies

Side effects

Notify provider if rash, fever or diarrhea occur

Allergic reaction

Stevens-Johnson syndrome

Diarrhea, nausea, vomiting

Seizures

Take as directed

Side effects

Photosensitivity/ Rash

Abdominal pain, diarrhea, nausea

Hyper/Hypoglycemia

Hypersensitivity reactions

Increase fluid intake to 1500-2000 mL/day to prevent crystalluria

Space from antacids or calcium, magnesium, aluminum, iron, zinc about 4 hours before and 2 hours after taking this medication

Avoid alcohol, aspirin, NSAIDs, acetaminophen or other OTC

Take exactly as directed do not double dose if dose is forgotten

Side effects

HF, MI, Stroke

Asthma, dyspnea

Drowsiness

GI bleeding, diarrhea, dry mouth

Hypersensitivity

Take as directed, take missed dose as soon as possible but do not double dose

Side effects

can cause immunosuppression

Depression

Fluid retention, hypokalemia, hypokalemic alkalosis

Susceptibility to infection

Hypertension

Peptic ulceration

Asses client's description of pain (quality, nature and severity)

This will help determine treatment of pain

Encourage increased fluid intake

To flush out the bacteria and toxins

Patient's pain will lessen

Voiding the bacteria will help reduce pain

Caused from Catheter

Give appropriate antibiotics

Remove catheter as soon as possible

Monitor labs for reduced infection

Sign of infection

Severe anemia

anemia

Low RBC due to the large number of WBC (anemia)

Sign of kidney disease

Iron deficiency/ Side effect of medication

can signal a condition in the kidneys or pancreas

medication side effect

Kidneys are not working properly/ Urinary tract obstruction

Indicates injury or stress to muscle tissue

Indication of tissue damage

279H (4/6)

Indication of tissue damage

Heart attack, peripheral artery disease or stroke

Heart disease or sign of metabolic syndrome