Chronic Urinary Tract Infections Treatment Case Nursing Essay

Chronic urinary Tract Infections Treatment Case Nursing EssayRP, a 72-year-old ovalbumin female, was brought to the emergency room (E.R) from Hillcrest Adult Foster C ar via ambulance. Preadmission report to F-300 decl ared that she came to E.R confused, lethargic and weak, complaining of acute pain upon micturition. She besides urinated sm all amounts (Upon stretch to F-300 RPs labs revealed signifi digesttly lower thyroid stimulation endocrine gland (TSH), a lowered red blood cell (RBC) count, along with decreased hemoglobin and haematocrit (HH). Her white blood (WBC) count was elevated, as expected with a urinary portion infection (UTI).Primary Diagnosis and Priority Secondary diagnosisThe primary medical diagnosis was chronic urinary tract infections, with a secondary diagnosis of hypothyroidism.Patient HistoryRP has a history of chronic UTIs, hypothyroidism, chronic kidney disease (stage III), and chronic anemia. She has several admissions the past few months associate mainly to UTIs and dehydration.PATHOPHYSIOLOGY/ETILOGY OF THE PRIMARY diagnosis AND PRIORITYSECONDARY DIAGNOSISUTIs are the terminuss of infection, mainly from bacteria, fungi, viruses, or parasites. This tierces to a condition referred to as cystitis (inflammation of the bladder). Most parking area of the UTIs are from infection known as pathogenic cystitis. A bacterium, the about common cause of infectious cystitis, is from the external urethra, this spreads inwards to the bladder (distal to proximal). erstwhile a bacterium migrates to the bladder and starts the process of growing, it can migrate to new(prenominal)(a) parts of the form (Ignatavicius Workman, 2006).UTIs present with symptoms that hold frequency, neural impulsency, retention, burning, foul odor, and incontinence.According to Wikipedia, 4 stages must be met in order for bacteria to grow. These include an infectious agent, one that must be able to grow, multiply and enter the body. one time we have the agent, the bacteria must find a portal of entry, (how it enters the body). erstwhile in the body it needs an adequate reservoir, a place where organisms can thrive and multiply and the susceptibility of host, how bacteria doctors the body after entry. Determents include age, overall health and other co-morbidities of the host and the susceptibility to pathogens.Most UTIs start grow in the perineal area due to irritation in RPs case this may have been caused by lack of personal hygienics due to being overly fatigued, brought on by her hypothyroidism.Minton (2009) stated, Thyroid is the roughly important hormone in the body. Because it kick ups the production of cellular energy, production of all other hormones allow for be negatively impacted when thyroid hormone levels are less than optimal. Every aspect of health is affected by low thyroid function. Hypothyroidism is signaled by fatigue and loss of energy.According to textbook, hypothyroidism is the result of decreased metab olism from low levels of thyroid hormones (THs). Low levels of THs may be a result of several different reasons thyroid cells may relegate to produce sufficient amounts, or the cells themselves are damaged. The long-suffering role may non be ingesting enough of the substances needed to make THs, especially iodide and tyrosine.Low levels of THs affect most tissue and organs ca development decreased cellular energy. The affected role could become confused, lethargic, and have slowing of intellectual functions.ACTUAL OR potence IMPACT OF RELEVANT MEDICAL HISTORY ON THE PRIMARY DIAGNOSIS AND PRIORITY SECONDARY DIAGNOSISRP has a history of chronic UTIs that has caused m all admits to the hospital over the last few months. UTIs that are left untreated may and can cause damage to the kidneys and start the process of renal failure. Chronic infection of the kidneys causes scar tissue, which decreases the function of the renal system. With renal failure, the body cannot rid itself of cer tain toxins that may contribute to UTIs. Chronic UTIs may lead to chronic pyelonephritis, repeated upper tract infection of bacteria that migrates from the bladder superior (toward the kidney) to the kidneys. RPs diagnosis of chronic renal failure may be heightened by the chronic UTIs.Hypothyroidism and anemia, that cause fatigue and loss of energy, allow for deter you from providing adequate hygiene. This pass ons bacterial growth, which may start the chain of events leading up to a UTI.RP resides at an extended care facility that may not have adequate module to assure that she receives the necessary amounts of iodide and tyrosine needed stimulate TH production. She is also very confused which would decrease her understanding of the grandeur of proper nutritional intake.MEDICAL guidance CHRONIC URINARY parcel INFECTIONS And HypothyroidismA weewee sample must be obtained either by a clean catch method or if client unable, by straight catheter method. A catheter method was us ed on RP, due to her perplexity and retention.Urinalysis testing for leukocyte esterase (n=negative) and nitrate (n=none), along with a WBC (n= 0-4) are specifically for diagnosis of a UTIs (Mosbys 2006). Normal urine should appear complete with a yellow tint present (Mosbys 2006). A noticeable sense of smell should not be present in uninfected urine RPs urine had a pungent odor noted. RPs leukocyte esterase was 3+ and her nitrate was positive. WBCs were to numerous to count. These results heady that RP did have a UTI.Blood work was noted that RPs thyroid elating hormone (TSH) was 0.05 (n=2-10). This confirmed the diagnosis of hypothyroidism. care for MANAGEMENT URINARY packet INFECTIONRecommended textbook intervention is to monitor for signs of UTIs. This includes, but not extra to frequency, urgency, dysuria, incontinence, pyuria. In some older adults the only sign may be an increase in mental confusion or frequent, unexplained crepuscules.RP was on Q-4 hour vital sign ass essment, paying close attention to any increase in temperature and/or heart rate. The long-suffering remained afebrile passim admission. Heart rate remained between 80-90 beats per minute. Respiratory rate remained between 16-20 breaths per minute.Due to her confusion, bed alarms and padded side rails were used. She had a high school fall risk assessment therefore fall risk precautions were enforced upon admission.She was placed on strict intake and output (IO), and her fluids were monitored. She was instilled to drink unavoidable amount of fluid per day (1500ml). Staff portion offered bedside commode every two hours to encouraging voiding. She and family members were informed as to the importance of RP to remain change. This will limit the environmental factors needed for bacterial growth. RN (preceptor) communicated with adult treasure care on the needs of the client after discharge. Lab results were also monitored closely for any change that would indicate worsening infe ction.PHARMACOLOGICAL MANAGEMENT URINARY TRACT INFECTION AND HYPOTHYROIDISMTextbook recommends medications that treat bacteria and the progression of client comfort. Cure is dependent on the antibiotic level achieved in the urine. Long-term antibiotic therapy is recommended for chronic UTIs (Ignatavicius Workman, 2006).RP received, via intravenous therapy (IV), Azactam (antibiotic) per Dr. order, to treat her infection. Paroxetine mesylate (antianxiety agent, antidepressant) 30 mg by mouth daily, used to decrease anxiety. Also granted Levothyroxine (hormone) as a thyroid supplement.PROVIDER AND MANAGER intention NURSING CARE PLANPriority Nursing DiagnosisP damage urinary eliminationR Incontinence due to urinary tract infectionC Acute lower tract pain 7/10 upon urination, Priority Patient GoalThe patient will be able to state absence of pain or excessive urination by discharge AEBPain upon urination 0/10, Decreased urge to void, Empting bladder completelyThree Priority Nursing I nterventionsThe nurse will monitor patient for incomplete emptying of bladder by using bladder scan post void. The nurse will encourage patient to drink water at each meal. The nurse will instruct patient on the signs and symptoms of a urinary tract infection.Evaluation of make headway toward Patient GoalThe patient was able to recite some signs of UTIs to nurse. She recognised pain on urination and foul odor as signs of an infection. The patient was reluctant to drink water at any one time. She proceed to have incontinent periods, but this was less frequent on day of discharge. The patient partially met the goals put forth for her.PROVIDER AND MANAGER ROLEMember of the discipline and the map of the Multi-Disciplinary TeamAs a member of the discipline I was inclined to have verbal interactions with the ER staff before RP had arrived to F-300. Consulted with housekeeping to assure the RPs room was cleaned and ready for admission. Ward shop assistant assured that tests were ordere d. Dietician was consulted to help with nutritional needs. Discharged planner do transportation arrangement to return patient to long care facility. social worker discussed local community resources of support with the family.Provider of Care affairAs provider of care for this patient, I kept this patient cleaned and dry when incontinent. I utilized the fall risk precautions to provided safety. Implemented steps to encourage patient to accept and understand a bladder training routine. Monitored patient labs and reported abnormal results to the doctor.Manager of Care RoleAs charabanc of care I evaluated the client for her fall risk and implemented fall risk precautions. Delegated the placement of bed alarms and tabs to the LPN assigned to us. My preceptor and I discussed the possible ways to teach client prevention of developing UTIs. Collaborated with nurse home staff on ways to improve clients care at extended care facility.Growth in the Manager of Care RoleIn completing these tasks I was able to see the complete attend of the patient. I was educated on the disease process and the effect other co-morbidities had on providing an environment that encourages an infection. In caring for RP I was able to substantial and strengthen my delegating skills, learning to rely on others and not unaccompanied on myself.