Genitourinary disorder -- HELP please!!!

[sw122500]

I was asked to analyze this scenario but we have not covered any of this in class yet -- and will not for at least another month. I'm lost. Can anyone help me?

Scenario: Patient (M.Z.) is 89 y/o female. 4-day Hx of dysuria, back pain, incontinence, severe mental confusion, and loose stools. Her MD had recently discontinued her HRT (hormone replacement therapy) 1 month ago. Her most current VS are 118/60, 88, 18, 99.4 degrees F. The medical director ordered several lab tests on admission. The results were as follows: WBC 11c/mm, CMP WNL(within normal limits). Postvoiding catheterization yielded 100 mL and UA showed WBC 100+/HPF ( high powered field.), RBC 3-6, bacteria rare. The urinary C&S results were as follows: E.coli > 100,000 colonies, sensitive to ciprofloxacin, trimethoprim/sulfamethoxazole, nitrofurantoin.

1. The medical director makes rounds and writes to start an IV of D5.25NS @ 75mL/h and insert a Foley to bedside drainage. Because M.Z. is unable to take oral meds, the MD ordered ciprofloxacin 200mg bid IVPB (intravenous piggy back). Is the type of fluid and rate appropriate for M.Z.'s age and condition? Explain.

2. As you insert the Foley catheter you note the introitus is red and dry; no lady partsl discharge is noted. You inform the managing physician that M.Z. has atrophic vaginitis and get an order for lady partsl estrogen replacement (Estrace cream). M.Z.'s daughter will need to be instructed how to insert the cream for her mother. Outline your teaching plan

3. You are the nurse assigned to M.Z.'s care. You notice that the nursing assistant emptying the Foley is not wearing personal protection devices. You also observe that the spout is contaminated during the process. What issues need to be considered in protecting M.Z.'s safety? Describe your actions in working with the nursing assistant.

4. The nursing assistant reports that M.Z.'s 8-hour intake is 520mL and the output is 140mL. Is this significant? Generate at least two possible factors that could account for the difference. For each factor, identify which item would be assessed and how?

5. M.Z. has completed her antibiotic therapy, her mental status has cleared, and she is ready for discharge. What instructions should you discuss with her daughter? (multiple answers)

This is waaayyyy beyond anything we have done in class but this was assigned anyway. I really need help with this one. I have some ideas but don't even know where to start. Anything anyone can do for me will be greatly appreciated. THANK YOU!!!! :heartbeat

[netglow, ASN, RN]

Nope you can do this on your own.

You have to go to your pathophys and lab references and look up what you do not know. Then you have to look into what info you need to edu the patient about and do that. Sure this is going to take you some time. Better now than when you are in the hospital. This is what school is for. Nobody will "teach" you this, that is why your instructor gave you this assignment, so you could LEARN BY DOING.

Allnurses is not a place where homework is completed.

[llg, PhD, RN]

Start by looking up on the normal parameters for the lab findings, assessments, etc. Identify what is normal and what is not.

Make a list of nursing diagnoses and rank them by order of priority.

Address them and the specific questions asked by the assignment 1 at a time. Use your textbooks and whatever other resources recommended by your school to start with. Augment with journal articles, etc. as needed.

That's how nursing is learned -- by analyzing the needs of 1 patient at a time. That's how we all did it back when we were in school.

[General E. Speaking, RN, RN]

Seems doable. Once you have some of your ideas/teaching plan in place, you might be able to get a little more feedback from us. You will not learn if we do your homework for you.

Get your books out! Good luck

[sw122500]

Thank you. I'm not trying to get anyone to "do" my homework for me. There are many more aspects to this but these are the points that I'm having a very hard time figuring out.

I've looked through the lab books and diagnostic books. I'm just a tad lost. I was hoping for some help.

[General E. Speaking, RN, RN]

Okay, take a deep breath. I will try and give you some hints in the right direction.

Look up Cipro and see if there are any contraindications to giving it to the elderly, see whether the dose is appropriate for a UTI.

As far as the teaching plan, look up how to administer the lady partsl cream and write it out in layman's terms so the daughter can understand.

As far as the output. What the normal amount of urine output/hr? Usually ?__/hr. She had 140ml/8 hrs. Is it too low? Or high? She had a CMP that was WNL. What does a CMP tell you about kidney function?

As for the tech: you need to explain the need for gloves and not contaminating the catheter bag. The urinary system is considered sterile and infection can creep up the tube so best to try and keep it sterile as possible. She already has a UTI- don't want to make it worse.

As for discharge teaching: she was admitted for UTI. Look up ways to teach how to prevent, recognize symptoms. How does having diarrhea and being incontinent increase the chance for UTI?

[libragirl924]

Just take a deep breath, get up, walk away and do something else for 5 minutes. THEN come back, "solve" one problem at a time, taking deep breaths between them if you need to, then solve another. Remember - you're a student and you're LEARNING.

[traumaRUs, MSN, APRN]

Going to move this to the nursing student assistance forum.

[sw122500]

Thank you so much. You pointed me in the right direction and it was a huge help. :redbeathe