UTI Hesi 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? "The client sleeps at night so there is no need for fluids." "Fluids are encouraged in the evenings to stay hydrated." "There is an increase in IV fluid amount on the day shift due to the antibiotic given." "The numbers change every day for each shift."

"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.

The pharmacy dispenses an IV mini-bag labeled NS 100 mL with 94 mg of levofloxacin. What rate should the nurse set the infusion pump to infuse the prescribed medication over one hour? (Enter numerical value only. If rounding is necessary, round to the whole number.)

100ML/HR

Based on the I&O chart in the EMR, what is the client's total intake for the 24-hour period? (1oz = 30mL. Enter numerical value only. If rounding is necessary, round to the tenth.)

1525.6

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

39.4 20.8 lbs/2.2 kg = 9.459.45 X 100 mL/kg/day = 945 mL/day945 mL/day/24 hours = 39.37 mL/hour39.37 mL/hour rounded to the tenth is 39.4

What would be appropriate nursing diagnoses for this client? (SATA) Alteration in hydration status related to history of fever, vomiting, and diarrhea over the last 48 hours. Readiness for learning related to change in health status, as evidenced by requiring admission to the hospital. Parental anxiety related to change in child's health, as evidenced by appearing anxious and questioning why the client is not better. At risk for alteration in skin integrity related to increase frequency of stools and diaper use.

Alteration in hydration status related to history of fever, vomiting, and diarrhea over the last 48hours. Parental anxiety related to change in child's health, as evidenced by appearing anxious and questioning why the client is not better. At risk for alteration in skin integrity related to increase frequency of stools and diaper use.

Meet the patient

An 18-month-old toddler is brought to the urgent care clinic by their parent who reported the client had a 48-hour history of fever, diarrhea, and vomiting. The client was last seen by their pediatrician two days ago and was diagnosed with gastroenteritis and sent home with the recommendation to follow a bland diet and consume Pedialyte as tolerated. The parent states the client's highest temperature was 101.8 °F (38.8 °C) which was relieved by acetaminophen. The last dose of acetaminophen was given approximately four hours ago. The client appears lethargic and the parent appears anxious about their child's condition. The parent continually asks the healthcare provider (HCP) "Why isn't my child getting better? We saw the pediatrician two days ago and it was just gastroenteritis!" The parent also indicates they ran out of Pedialyte the night prior and substituted a sports drink for hydration. The child was fussy and irritable the prior evening and the parent felt uncomfortable leaving the child to go to the store to buy more Pedialyte. The parent reports that the family traveled out of town and returned four days prior to the onset of the illness.

Which is the most appropriate intervention for the nurse? Contact the HCP to increase the medication. Tell the parent not to worry because the fever will go down soon. Apply cool compresses to the client's forehead and axilla and reduce the temperature in the room. Instruct the UAP to teach the parent ways to keep the child cool.

Apply cool compresses to the client'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.

The nurse conducts an admission interview with the parent. What additional questions should the nurse ask the parent about the client? (SATA) Are the client's immunizations up to date? Has the client been exposed to anyone else who has been sick? Does the parent have a copy of the client's insurance card? Does the client attend daycare? Does the parent consider the haphazard cleanliness of their home as a contributing factor to her child's illness? Where did the family travel for their vacation?

Are the client's immunizations up to date? Has the client been exposed to anyone else who has been sick? Does the client attend daycare? Where did the family travel for their vacation? Rationale: This is an opportunity to follow up on the client's immunization status. 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. It is important to determine the possibility of increased risk of exposure to other individuals. It is important to establish whether the client and family 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? (SATA)

Bacteria. Leukocyte. WBC.

Based on the client's history, physical exam, and presenting signs and symptoms, which diagnostic tests would the nurse anticipate the HCP will prescribe? (SATA) Liver Panel. Abdominal x-ray. CBC with differential. Basic metabolic panel. Stool culture.

CBC with differential. Basic metabolic panel. Stool culture. Rationale: The CBC with differential reveals anemia, hydration status and the presence of infection caused by a virus, bacteria, or parasite. Because of the episodes of vomiting and diarrhea, this test indicates abnormal electrolytes that might require intervention. 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 and blood.

The healthcare provider (HCP) recommends the client return to a regular diet once rehydrated. Which foods should the parents be instructed to avoid giving the client? (SATA) Full-strength cow milk products. Carbonated drinks. Lean meats. Sports drinks. Vegetables, raw or cooked.

Carbonated drinks. Sports drinks. Rationale: Avoid carbonated soft drinks as they have an excessive amount of sugar, which can worsen diarrhea. Avoid sports drinks as they have excessive sugar and inappropriate levels of electrolytes.

The health care provider prescribes IV fluids of dextrose 5% and sodium choloride 0.45% at 39.4 mL/hr and IV levofloxacin 200 mg every 24 hours to infuse over 60 minutes. The client is to be placed on strict intake and output.Levofloxacin Pediatric dose: < 50 kg: 10 mg/kg/dose every 24 hours; max: 500 mg/dose 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? Anemia. Thrombocytopenia. Dehydration. Inflammation. Submit

Dehydration. Plasma, hemoglobin, and hematocrit are parts of whole blood. When a client is dehydrated, the volume of the plasma decreases, causing the hemoglobin and hematocrit to become more concentrated, therefore having a higher ratio proportion as compared to 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 naturally lives in the intestines as normal flora. If E.coli gets into the urethra, it can develop into a urinary tract infection. Because the client 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? Use wrist restraints and have a parent hold the infant down on the table. Sedate the toddler for the venipuncture. Have the toddler sit in the parent's lap while the parent hugs the child. Tightly swaddle the toddler in a blanket, leaving one extremity exposed to obtain serum sample.

Have the toddler sit in the parent's lap while the parent hugs the child. Rationale: To reassure and comfort the child, the parent or (unlicenced assistive personnel) 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)? The appearance and odor of the urine collected. A C&S can only be prescribed on clients catheterized for a urine sample. The test is to determine the causative organism. If antibiotics are needed, the sensitivities are available.

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

Which interventions are important for the nurse to provide during the client's hospitalization to ensure the best outcome for the client and parent? (SATA) Involve the parent in all aspects of the client's care throughout hospitalization. During hospitalization, teach the parent the proper way to clean/wipe the client's perineum area after a bowel movement and observe the parent performing the task with a diaper change prior to discharge. Arrange for a social service consult to improve family dynamics. Encourage the parent to leave the room for a break when the nurse and/or UAP are in the room caring for the client. Arrange time for play therapy for the client with the appropriate practitioners.

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

Which statements are true about urine culture and sensitivity tests? (SATA) Isolation of organisms takes at least 48 hours to be identified. Antibiotics are not initiated until the urine specimen is collected and sent to the lab for analysis. A urine sample collected upon rising in the morning yields the most organisms' concentration. The final results of a urine C & S take no longer than 7 days. A C&S can be performed on all urine specimens regardless of the collection.

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

Which statements are true about gastroenteritis? (SATA) Most people can recover on their own at home. Young children and older adults are more susceptible to dehydration from gastroenteritis. Dehydration and constipation are the most common symptoms. It is spread through the fecal oral route. Thoroughly washing raw food is the best prevention against gastroenteritis.

Most people can recover on their own at home. Young children and older adults are more susceptible to dehydration from gastroenteritis. Rationale: 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. The intestinal walls become inflamed. The viral form is the second most common illness in the U.S. The norovirus is the main cause of viral gastroenteritis. Note: Dehydration from vomiting and diarrhea is the main complication due to the gastroenteritis. It happens more often to infants, young children, older adults, and those who are immunocompromised. Gastroenteritis can occur from various sources such as raw food that is not washed properly, drinking water from contaminated sources, placing hands in the mouth after touching surfaces contaminated with the norovirus, and contact with contaminated individuals and/or sharing foods with them. Vigorous hand washing using water and soap, especially after using the bathroom, changing diapers, and before meals is the best way to prevent the spread of infection.

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. Instruct the parent on how to obtain a mid-stream catch urine sample with a urinalysis cup. Collect a urine specimen with a straight catheter. Place the toddler on a commode with a collection device and wait for her to urinate.

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. Inspect the insertion site every 2 hours for patency and/or infiltration. Tape the arm with the IV securely to an IV board. Hang a 500 mL bag of dextrose 5% in sodium chloride 0.45% to infuse through an infusion pump.

Set the infusion pump for no more than a two hour supply of IV fluids. The IV infusion 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 IV fluids placed in the device to prevent accidental over-hydration of the client.

As the client's condition improves and they tolerate oral hydration, which prescription does the nurse anticipate from the HCP? Progress to a full liquid diet. Convert IV to saline lock. Discontinue strict intake and output. Titrate the IV fluid rate based on the oral fluids tolerated.

Titrate 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. Submit Previous Section

The client's urine is noted to have an odor, have a slightly cloudy appearance, and have an amber color. The urine dipstick results reveal a specific gravity of 1.025 with a trace of nitrates and protein. Based on the dipstick results and the presenting symptoms, which diagnosis does the nurse anticipate? Urolithiasis. Sepsis. Hepatitis A. Urinary tract infection.

Urinary tract infection. Rationale: Based on the presence nitrates and protein, odor and color of the urine, along with the history of fever, the nurse anticipates the HCP to diagnose the client has a urinary tract infection.

Safe and Effective Care The client continues to have diarrhea and the urine bag placed for the urine sample continues to fall off and become contaminated by fecal matter. A urinalysis is obtained via a straight catheterization using a 6 French catheter. The nurse notifies the HCP that the urine appears cloudy and dark and it has an odor. The HCP adds a urine culture and sensitivity to be sent to the lab with the urinalysis. The HCP also prescribes a urine dipstick to be administered on the unit to obtain a preliminary reading while waiting for the lab results. Which steps ensure the integrity of the lab specimen and results? (SATA) Label the specimens after leaving the room and reviewing the medical record to verify the prescriptions. Verify the specimen labels with the client's identification bracelet. Place the specimen in a sealed container on the counter to be sent to the lab after the client's admission

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. Rationale: 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 lab values from the client's WBC with differential results would be indicative of a viral or bacterial infection?

WBC

Which method will the nurse use to measure urine and stool output in a toddler who wears diapers? Weigh the soiled diaper on a scale. Place the client on a bedpan or commode every 2 hours and encourage voiding. Insert an indwelling catheter for urine collection. Instruct the parent to place a bedpan under the client each time the need to void is felt.

Weigh the soiled diaper on a scale. The nurse weighs a dry diaper to determine the diaper's weight then weighs the wet/dirty diaper. The nurse subtracts the dry diaper weight from the soiled diaper weight to determine the weight of the contents. 1 g of wet diaper = 1 mL of urine. The nurse document if the diaper is urine only or urine with stool.