HESI Urinary Tract Infection Case Study

A nursing student asks the nurse why there is a difference in the total intake for each shift. Based on the I&O chart in the EMR, what is the best response for the nurse to give to the nursing student?

"There is an increase in IV fluid amount on the day shift due to the antibiotic given." There is an increase of IV fluid during the day shift because the dose is given in the morning.

What would be appropriate nursing diagnoses for this client?

-Alteration in hydration status related to history of fever, vomiting, and diarrhea over the last 48 hours. -Parental anxiety related to change in child's health, as evidenced by appearing anxious and questioning why her daughter is not better. -At risk for alteration in skin integrity related to increase frequency of stools and diaper use. These relate to the clients current health status, so it is considered an appropriate nursing diagnosis)

The nurse conducts an admission interview with the mother. What additional questions should the nurse ask the mother?

-Are her daughter's immunizations up to date? -Has the client been exposed to anyone else who has been sick? (It is important to establish if the client has been exposed to anyone else who has been sick because gastroenteritis can be transmitted by an infected person) -Does the client attend daycare? (It is important to determine the possibility of increased risk of exposure to other individuals) -Where did the family travel for their vacation? (It is important to establish whether the client and her mother traveled to an area that would be considered "high risk" exposure for certain illnesses)

Which lab values from the urinalysis are indicative of a urinary tract infection?

-Bacteria (There should be no bacteria present) -Leukocyte (Presence of leukocytes or nitrates is a product of the WBC's and is usually indicative of a UTI) -WBC (Presence of WBC's is usually indicative of a UTI)

Based on Yon's history, physical exam, and presenting signs and symptoms, which diagnostic tests would the nurse anticipates the HCP to prescribe?

-CBC with differential. (The CBC with differential reveals anemia, hydration status, and the presence of infection caused by a virus, bacteria, or parasite) -Basic metabolic panel. (Because of the episodes of vomiting and diarrhea, this test indicates abnormal electrolytes that might require intervention) -Stool culture (A stool culture determines if the gastroenteritis is caused by a parasite, virus, bacteria, or ova. Other stool specimens can be collected for undigested sugar, fat, pus, or blood)

Which interventions are important for the nurse to provide during Yon's hospitalization to ensure the best outcome for Yon and her mother?

-Involve the mother in all aspects of Yon's care throughout hospitalization. (Keeping the mother involved will help her to feel a part of her child's care and will prepare her to care for her child following discharge) -During hospitalization, teach the mother the proper way to clean/wipe Yon's perineum area after a bowel movement and observe her performing the task as she changes Yon's diapers prior to discharge. (It is important to review and have the mother demonstrate the proper way of wiping from front to back when changing her daughters diaper, to help minimize the risk of E.coli exposure into her urethra from the stool in her diaper) -Arrange time for play therapy for Yon with the appropriate practitioners. (The Child Life Specialists are often trained in psychology and can develop a plan of of care through play therapy to minimize the negative effects of being hospitalized)

Which statements are true about urine culture and sensitivity tests?

-Isolation of organisms takes at least 48 hours to be identified. (A preliminary result can be given within 24 hours, but it requires at least 48 hours to isolate organisms) -A urine sample collected upon rising in the morning yields the most organisms' concentration. (Urine specimens collected in the early morning, ideally the first void of the day, yield the highest concentration of microorganisms)

The healthcare provider (HCP) recommends a bland diet. Which foods are included on a bland diet?

-Toasted white bread. -Cooked white rice. Current best practice recommendations are to reintroduce a regular, bland diet that is easily digested and supplies the necessary protein and energy. Avoid fruit juices, carbonated drinks, and gelatin, which are high in sugar.

Which steps ensure the integrity of the lab specimen and results?

-Verify the specimen labels with the client's identification bracelet. -Verify the accuracy of the client's information with the parent before the specimen is collected. Verifying the accuracy of the information on the specimen and the client's bracelet is extremely important to ensure the safety and proper delivery of care to the client

Which statements are true about gastroenteritis?

-Young children and older adults are more susceptible to dehydration from gastroenteritis. (The intestinal walls become inflamed. The viral form is the second most common illness in the U.S.The norovirus is the main cause or viral gastroenteritis.) -Most people can recover on their own at home. (Most people can recover on their own. They need to let the condition run its course. Young children, the elderly, and those who are immunocompromised are at greater risk for requiring medical intervention)

Impaired tissue perfusion as related to: 1. decreased hydration status as evidence by cool skin extremities, mottled skin, and delayed capillary refill. 2. gastrointestinal losses as evidence by frequent episodes of vomiting and watery stools 3. Frequent loose, watery stools 4. Frequent loose, watery stools as evidence by excoriated skin on buttocks

1. decreased hydration status as evidence by cool skin extremities, mottled skin, and delayed capillary refill.

The nurse contacts the HCP and states the child's weight is 9.45 kg and that the recommended dose is 10 mg/kg/dose every 24 hours which calculated would be 94.5 mg every 24 hours. The HCP thanks the nurse for the clarification and changes the prescription to levofloxavin 94 mg every 24 hours. The pharmacy dispenses an IV piggy bag labeled NS 100 mL with 425 mg of cefotaxime. What rate should the nurse set the infusion pump to infuse the prescribed medication? (Enter numerical value only. If rounding is necessary, round to the whole number.)

100 100mL/1hr= 100mL/hr

Based on the I&O chart in the EMR, what is Yon's total intake for the 24-hour period? (Enter numerical value only. If rounding is necessary, round to the tenth.)

1525.6 Total during day shift: 585.2 mL (6oz+415.2mL) Total during evening shift: 252.2 mL (7oz+315.2mL) Total during night shift: 402.2 mL (3oz+315.2mL) 585.2 + 252.2 + 402.2= 1525.6mL

Imbalanced nutrition: less than body requirements 1. decreased hydration status as evidence by cool skin extremities, mottled skin, and delayed capillary refill. 2. gastrointestinal losses as evidence by frequent episodes of vomiting and watery stools 3. Frequent loose, watery stools 4. Frequent loose, watery stools as evidence by excoriated skin on buttocks

2. gastrointestinal losses as evidence by frequent episodes of vomiting and watery stools

Risk for electrolyte imbalance related to: 1. decreased hydration status as evidence by cool skin extremities, mottled skin, and delayed capillary refill. 2. gastrointestinal losses as evidence by frequent episodes of vomiting and watery stools 3. Frequent loose, watery stools 4. Frequent loose, watery stools as evidence by excoriated skin on buttocks

3. Frequent loose, watery stools

Using Yon's weight as reported by her mother from the HCP's office visit prior to becoming dehydrated (20.8 pounds), what are Yon's daily maintenance fluid requirements in rate per hour? (Enter numerical value only. If rounding is required, round to the tenth.)

39.4 20.8lbs/ 2.2kg= 9.45 9.45 x 100mL/kg/day= 945mL/day 945 mL/day/24hr= 39.37 mL/hr 39.37 mL/hr rounded to the tenth is 39.4

Impaired skin integrity as related to: 1. decreased hydration status as evidence by cool skin extremities, mottled skin, and delayed capillary refill. 2. gastrointestinal losses as evidence by frequent episodes of vomiting and watery stools 3. Frequent loose, watery stools 4. Frequent loose, watery stools as evidence by excoriated skin on buttocks

4. Frequent loose, watery stools as evidence by excoriated skin on buttocks

Which is the most appropriate intervention for the nurse?

Apply cool compresses to Yon's forehead and axilla and reduce the temperature in the room. The cool compress will help decrease the fever slowly. It usually takes up to 45 minutes to help bring the fever down along with the medication.

Which nursing intervention is a priority for administration of this IV antibiotic with this client?

Contact the HCP regarding the levofloxacin prescription. (The HCP prescribes a dose that is inconsistent with the recommended dose)

The nurse notes that the hemoglobin and hematocrit levels are elevated. This elevation is most likely result of which condition?

Dehydration (Plasma, hemoglobin, and hematocrit are parts of whole blood. When a client is dehydrated, the volume of the plasma decreased, causing the hemoglobin and hematocrit to become more concentrated, therefore having a higher ratio proportion as compare the the plasma volume)

The urine culture results are reported 48 hours later and are positive for E.coli in urine, which confirms the causative organism for the urinary tract infection. What is the causative factor for the urinary tract infection?

Frequent diarrhea in diapers. (E.coli primarily lives in the intestines as normal flora. If E.coli gets into urethra, it can develop into a UTI. Because Yon wears diapers and is experiencing frequent diarrhea episodes, she is at an increased risk of the E.coli traveling up the urethra)

Which technique is appropriate to use to draw a blood sample in a toddler?

Have the toddler sit in the parent's lap while the parent hugs the child. (To reassure and comfort the child, the parent or UAP should have the child sit on the parent's or UAP's lap)

For which purpose does the HCP prescribe an additional urine culture and sensitivity (C&S)?

If antibiotics are needed, the sensitivities are available. (The purpose of sensitivities is to determine whether a specific organism is resistant or sensitive to to a specific medication)

Which action does the nurse take to obtain a urine sample in a toddler?

Place a clear plastic, self-adhering bag (urine bag) to the genitalia area. (These bags are used for infants and toddlers who are not toilet trained)

Which nursing intervention is necessary regarding IV fluid administration with this client?

Set the infusion pump for no more than a two hour supply of IV fluids. The IV pump should be set up with an infusion pump and an infusion tubing set with a buretrol or infusion pump. There should be no more than a two hour supply of the IV fluids place in the device to prevent accidental over-hydration of the client.

As Yon's condition improves and she tolerates oral hydration, which prescription does the nurse anticipate from the HCP?

Titrating the IV fluid rate based on the oral fluids tolerated. Based on the PO fluid tolerated, the HCP will begin to titrate the IV fluid rate.

Based on the dipstick results and the presenting symptoms, which diagnosis does the nurse anticipate?

UTI (Based of the presence of protein and nitrates, odor and color of the urine, along with the history of fever, the nurse anticipates the HCP to diagnose the client with a UTI)

Which lab values from Yon's WBC with differential results would be indicative of a viral or bacterial infection?

WBC (An elevated level of WBC's indicates an infection or inflammation process)

Which method will the nurse use to measure urine and stool output in a toddler who wears diapers?

Weight the soiled diaper on a scale. (1g of a wet diaper = 1mL of urine)