Chronic Urinary Tract Infections Treatment Case Nursing Essay

Chronic Urinary Tract Infections Treatment Case breast feeding EssayRP, a 72-year-old Caucasian female, was brought to the fate room (E.R) from Hillcrest Adult Foster Care via ambulance. Preadmission report to F-300 stated that she came to E.R confused, lethargic and weak, complaining of acute disorder upon urination. She also urinated small amounts (Upon arrival to F-300 RPs labs revealed significantly move thyroidal stimulation hormone (TSH), a lowered red blood cell (RBC) wait, along with decreased hemoglobin and hematocrit (HH). Her white blood (WBC) count was elevated, as expected with a urinary tract infection (UTI).Primary Diagnosis and Priority Secondary diagnosisThe primary medical diagnosis was continuing 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 bypast hardly a(prenominal) months related mainly to UTIs and dehydration.PATHOPHYSIOLOGY/ETILOGY OF THE PRIMARY DIAGNOSIS AND PRIORITYSECONDARY DIAGNOSISUTIs are the forgets of infection, mainly from bacterium, fungi, viruses, or parasites. This leads to a condition referred to as cystitis (inflammation of the bladder). almost common of the UTIs are from infection known as infectious cystitis. A bacterium, the most common cause of infectious cystitis, is from the external urethra, this spreads inwards to the bladder (distal to proximal). at once a bacterium migrates to the bladder and starts the process of growing, it can migrate to other parts of the body (Ignatavicius Workman, 2006).UTIs present with symptoms that include frequency, urgency, retention, burning, foul odor, and incontinence.According to Wikipedia, four stages mustiness 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. Once we be possessed of the agent, the bacteria mu st find a portal of entry, (how it enters the body). Once in the body it needs an adequate reservoir, a place where organisms can thrive and multiply and the power of host, how bacteria affects the body after entry. Determents include age, overall health and other co-morbidities of the host and the susceptibility to pathogens.Most UTIs first grow in the perineal orbital cavity due to irritation in RPs case this may have been caused by lack of personal hygiene due to being overly fatigued, brought on by her hypothyroidism.Minton (2009) stated, Thyroid is the most important hormone in the body. Because it stimulates the production of cellular energy, production of all other hormones will 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 metabolism from low levels of thyroid hormon es (THs). Low levels of THs may be a result of several different reasons thyroid cells may fail to bring out sufficient amounts, or the cells themselves are damaged. The patient may not be ingesting enough of the substances needed to make THs, especially iodide and tyrosine.Low levels of THs affect most create from raw stuff and organs causing decreased cellular energy. The patient could become confused, lethargic, and have slowing of intellectual functions.ACTUAL OR POTENTIAL IMPACT OF RELEVANT medical HISTORY ON THE PRIMARY DIAGNOSIS AND PRIORITY SECONDARY DIAGNOSISRP has a history of chronic UTIs that has caused numerous 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 certain 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, will reprove you from providing adequate hygiene. This elevates bacterial growth, which may start the chain of events leading up to a UTI.RP resides at an extended heraldic bearing facility that may not have adequate staff 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 impressiveness of proper nutritionary expenditure.MEDICAL MANAGEMENT CHRONIC URINARY parcel of land INFECTIONS And HypothyroidismA urine sample must be obtained either by a clean nip method or if client unable, by straight catheter method. A catheter method was used on RP, due to her c onfusion 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 clear with a yellow tint present (Mosbys 2006). A noticeable 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 determined that RP did have a UTI.Blood work was noted that RPs thyroid stimulating hormone (TSH) was 0.05 (n=2-10). This confirmed the diagnosis of hypothyroidism.NURSING MANAGEMENT URINARY TRACT INFECTIONRecommended textbook intervention is to monitor for signs of UTIs. This includes, but not limited to frequency, urgency, dysuria, incontinence, pyuria. In some older adults the only sign may be an summation in mental confusion or frequent, unexplained falls.RP was on Q-4 hour vital sign assessment, paying close attention to any increase in temperature and/or heart rate. The patient remained afebrile throughout 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 fall risk assessment therefore fall risk precautions were implemented upon admission.She was placed on strict intake and output (IO), and her fluids were monitored. She was instructed to drink required amount of fluid per day (1500ml). Staff member offered bedside commode every two hours to encouraging voiding. She and family members were informed as to the importance of RP to remain dry. This will limit the environmental factors needed for bacterial growth. RN (preceptor) communicated with adult foster care on the needs of the client after discharge. research laboratory results were also monitored closely for any change that would indicate worsening infection.PHARMACOLOGICAL MANAGEMENT URINARY TRACT INFECTION AND HYPOTHYROIDISMTextbook recommends medications that treat bacteria and the packaging 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 given Levothyroxine (hormone) as a thyroid supplement.PROVIDER AND MANAGER ROLE NURSING CARE proposalPriority Nursing DiagnosisP Impaired 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 InterventionsThe nurse will monitor patient for inc omplete 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 march on toward Patient GoalThe patient was able to recite some signs of UTIs to nurse. She recognized pain on urination and foul odor as signs of an infection. The patient was loath to drink water at any one time. She continued to have incontinent periods, but this was less frequent on day of discharge. The patient part met the goals put forth for her.PROVIDER AND MANAGER ROLEMember of the discipline and the Role of the Multi-Disciplinary TeamAs a member of the discipline I was tend 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 clerk assured that tests were ordered. Dietician was consulted to help with nutritional needs. Discharged pla nner made transportation arrangement to return patient to long care facility. Social worker discussed local community resources of support with the family. supplier of Care RoleAs 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 travel 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 carriage 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 attainable ways to teach client prevention of developing UTIs. Collaborated with nursing 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 picture of the patient. I was ed ucated 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 developed and strengthen my delegating skills, learning to rely on others and not solely on myself.