Patient Name: Gwen Harrison
Visit #: 6
Scenario: UTI Parkinson’s
SLS: Not in EHR
Allergies: LATEX, SULFA
BSN Course Objectives (COs): By the end of the course, the student should be able to:
1. Identify competent nursing care for clients with chronic conditions, utilizing evidence-based
practice guidelines (SLO 1,2,5).
2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2,3,5).
3. Acknowledge legal and ethical issues in healthcare (SLO 3).
4. Prioritize nursing care for patients with chronic alterations in health (SLO 1.2.4.5).
5. Develop an individualized teaching plan for the client with the goal of improving and
maintaining personal health (SLO 1,2,3,4).
6. Correctly calculate medication doses appropriate for the population (SLO 1,5).
THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and upload 24 hours
BEFORE SIMULATION TIME (48
hours preferable). Incomplete tickets will be returned for redo, and must be in before next
simulation at discretion of instructor.
**ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year,
page).
1. “Sacred Cow”: Everyone “knows” that confusion in the elderly indicates an
underlying UTI. What are some pathophysiology theories about how the
correlation?
Because the body’s immune system change’s with age, it responds differently
to an infection. Instead of pain symptoms, seniors with a UTI may show
increased signs of confusion, agitation or withdrawal and for the elderly who
have dementia these behavioral changes may come across as part of that
condition or signs of advanced aging. If the underlying UTI goes unrecognized
and untreated for too long, it can spread to the bloodstream and become life
threatening.
Opinion based on research: What do you think?
It’s hard to say without scientific evidence showing the exact correlation,
however I can see why the theory exists. My thoughts veer towards the
simplicity regarding the body’s reaction to overuse of antibiotics that change
the chemistry within the body’s cells and if the cells are not provided with
nutrition like ATP, glucose and all the other mechanisms that are on the
microscopic level then yes the person along with having dementia,
Parkinson’s, and Alzheimer’s will experience these symptoms because the
brain isn’t getting what it needs.
,2. Opinion based on research: How might Parkinson’s Disease increase the risk
of UTI? Parkinson’s disease patients are prone to urinary tract infections.
When the bladder is full, it alerts the brain through nerve cells, and the brain
uses additional nerve cells to tell the muscles to relax and allow the urine to
excrete. On the other hand, the patient may be able to urinate but does not have
enough muscle control to empty all urine from the bladder completely. Thus,
Parkinson’s disease patients have a hard time emptying their bladder, creating
a breeding ground for bacteria.
, 3. What labs should be followed for Mrs. Harrison’s
medications? BMP
CBC
w/diff
UA
4. Discuss the difference between normal urine output (per hour) and minimal.
What does each indicate?
Normal urine output is 1-2 ml/kg/hr. To determine the urine output of your
patient, you need to know their weight, the amount of urine produced, and the
amount of time it took them to produce that urine. Minimal urine output is
considered oliguria which is an urinary output of less than 400 milliliters.
Opinion based on research: If a patient’s urine output decreases each hour,
60-55-50-45-40- 35-30 (mL/h), when should the provider be notified?
Notify the provider when urine output is <30 mL/hr.
5. See Marchant, J. (2018). When Antibiotics turn Toxic. Nature. Retrieved from
https://www.nature.com/articles/d41586-018-03267-5 Discuss fluroquinolone
adverse effects and toxicity.
Adverse effects include tendonitis, pain in extremities, gait disturbance,
neuropathies associated with paraesthesia, depression, fatigue, memory
impairment, sleep disorders, and impaired hearing, vision, taste and smell.
Although fluoroquinolones are valuable antibiotics, and safe for most people,
they are widely prescribed that their side effects affect a large population in
America especially with the elderly. In regards to Fluoroquinolone toxicity
they don’t just harm microbes they can severely damage human cells, too.
Recently some investigations have been done to look into the side effects of
antibiotics and how they disrupt the human microbiome.
What is your opinion on its use in UTI and in the elderly?
After witnessing my hundred year old grandmother who is diagnosed with
Dementia almost die from an infection she acquired from a flu virus a few
years ago, my sister Liz and I made the decision to have antibiotics
administered to prolong her life. I think with the elderly population it’s a hit or
miss situation because as much as I want her to die naturally and to stay living
as long as possible, we chose the antibiotics. Was that the right thing to do? I
don’t know. Well, she hasn’t been sick since. To add, she doesn’t know who
we are, although she lives in a pretty nice, they take great care of her facility but
she can’t walk or bath herself, etc., and with that thinking would she want this if
she could tell us? Now we have a DNR for her. It’s still hard for me to be in
those shoes to make a choice for someone when they can’t. For now, she keeps
on living loving cookies and coffee.
6. How does the nurse’s communication pattern differ between delirium and
dementia? Communicating with a person who has both dementia and
delirium tends to be more challenging. The person's ability to understand
Visit #: 6
Scenario: UTI Parkinson’s
SLS: Not in EHR
Allergies: LATEX, SULFA
BSN Course Objectives (COs): By the end of the course, the student should be able to:
1. Identify competent nursing care for clients with chronic conditions, utilizing evidence-based
practice guidelines (SLO 1,2,5).
2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2,3,5).
3. Acknowledge legal and ethical issues in healthcare (SLO 3).
4. Prioritize nursing care for patients with chronic alterations in health (SLO 1.2.4.5).
5. Develop an individualized teaching plan for the client with the goal of improving and
maintaining personal health (SLO 1,2,3,4).
6. Correctly calculate medication doses appropriate for the population (SLO 1,5).
THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and upload 24 hours
BEFORE SIMULATION TIME (48
hours preferable). Incomplete tickets will be returned for redo, and must be in before next
simulation at discretion of instructor.
**ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year,
page).
1. “Sacred Cow”: Everyone “knows” that confusion in the elderly indicates an
underlying UTI. What are some pathophysiology theories about how the
correlation?
Because the body’s immune system change’s with age, it responds differently
to an infection. Instead of pain symptoms, seniors with a UTI may show
increased signs of confusion, agitation or withdrawal and for the elderly who
have dementia these behavioral changes may come across as part of that
condition or signs of advanced aging. If the underlying UTI goes unrecognized
and untreated for too long, it can spread to the bloodstream and become life
threatening.
Opinion based on research: What do you think?
It’s hard to say without scientific evidence showing the exact correlation,
however I can see why the theory exists. My thoughts veer towards the
simplicity regarding the body’s reaction to overuse of antibiotics that change
the chemistry within the body’s cells and if the cells are not provided with
nutrition like ATP, glucose and all the other mechanisms that are on the
microscopic level then yes the person along with having dementia,
Parkinson’s, and Alzheimer’s will experience these symptoms because the
brain isn’t getting what it needs.
,2. Opinion based on research: How might Parkinson’s Disease increase the risk
of UTI? Parkinson’s disease patients are prone to urinary tract infections.
When the bladder is full, it alerts the brain through nerve cells, and the brain
uses additional nerve cells to tell the muscles to relax and allow the urine to
excrete. On the other hand, the patient may be able to urinate but does not have
enough muscle control to empty all urine from the bladder completely. Thus,
Parkinson’s disease patients have a hard time emptying their bladder, creating
a breeding ground for bacteria.
, 3. What labs should be followed for Mrs. Harrison’s
medications? BMP
CBC
w/diff
UA
4. Discuss the difference between normal urine output (per hour) and minimal.
What does each indicate?
Normal urine output is 1-2 ml/kg/hr. To determine the urine output of your
patient, you need to know their weight, the amount of urine produced, and the
amount of time it took them to produce that urine. Minimal urine output is
considered oliguria which is an urinary output of less than 400 milliliters.
Opinion based on research: If a patient’s urine output decreases each hour,
60-55-50-45-40- 35-30 (mL/h), when should the provider be notified?
Notify the provider when urine output is <30 mL/hr.
5. See Marchant, J. (2018). When Antibiotics turn Toxic. Nature. Retrieved from
https://www.nature.com/articles/d41586-018-03267-5 Discuss fluroquinolone
adverse effects and toxicity.
Adverse effects include tendonitis, pain in extremities, gait disturbance,
neuropathies associated with paraesthesia, depression, fatigue, memory
impairment, sleep disorders, and impaired hearing, vision, taste and smell.
Although fluoroquinolones are valuable antibiotics, and safe for most people,
they are widely prescribed that their side effects affect a large population in
America especially with the elderly. In regards to Fluoroquinolone toxicity
they don’t just harm microbes they can severely damage human cells, too.
Recently some investigations have been done to look into the side effects of
antibiotics and how they disrupt the human microbiome.
What is your opinion on its use in UTI and in the elderly?
After witnessing my hundred year old grandmother who is diagnosed with
Dementia almost die from an infection she acquired from a flu virus a few
years ago, my sister Liz and I made the decision to have antibiotics
administered to prolong her life. I think with the elderly population it’s a hit or
miss situation because as much as I want her to die naturally and to stay living
as long as possible, we chose the antibiotics. Was that the right thing to do? I
don’t know. Well, she hasn’t been sick since. To add, she doesn’t know who
we are, although she lives in a pretty nice, they take great care of her facility but
she can’t walk or bath herself, etc., and with that thinking would she want this if
she could tell us? Now we have a DNR for her. It’s still hard for me to be in
those shoes to make a choice for someone when they can’t. For now, she keeps
on living loving cookies and coffee.
6. How does the nurse’s communication pattern differ between delirium and
dementia? Communicating with a person who has both dementia and
delirium tends to be more challenging. The person's ability to understand
