SKINNY Reasoning
Urinary Tract Infection/Urosepsis
, Jean Kelly, 82 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Infection
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Jean Kelly is an 82-year-old woman who has been feeling more fatigued the last three days and has had a fever the last
twenty-four hours. She reports a painful, burning sensation when she urinates as well as frequency of urination the last
week. Her daughter became concerned and brought her to the emergency department (ED) when she did not know what
day it was. She is mentally alert with no history of confusion. While taking her bath today, she was weak and unable to
get out of the tub and used her personal life alert button to call for medical assistance.
Personal/Social History:
Jean lives independently in a senior apartment retirement community. She is widowed and has two daughters who are
active and involved in her life.
What data from the histories are important and RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
, More fatigued for the last 3 days Though a general complaint, when clustered with the other symptoms of
fever this is indicating that there is a likely PROBLEM present.
Fever the last 24 hours Fever reflects the systemic inflammatory response initiated by the
immune system and is there for a reason - to help the body fight off
invading micro-organisms by increasing the production of neutrophils;
the first responders of the immune system that are macrophages. The
elevated temp also makes it less hospitable for bacteria to thrive and
multiply.
These symptoms are classic with a urinary tract infection (UTI).
Painful, burning sensation when she urinates
Suspecting a urinary infection, the nurse needs to know that if a patient
as well as frequency of urination the last
meets the SIRs criteria, they should suspect sepsis.
week
With an infection of any kind, sepsis is identified by having 2 or more
of the following criteria of Systemic Inflammatory Response Syndrome
(SIRS):
• Temp >100.4 or <96.8
• HR >90
• RR >20
• WBC >12,000 or <4000
• Bands >10%
New onset of confusion is always a clinical RED FLAG in the elderly,
Did not know what day it was. She is
and when CLUSTERED with other symptoms is not representing a
mentally alert with no history of confusion
neurologic problem, but is commonly seen with an infection such as a
UTI.
This confirms the weakness and fatigue she has had the past 3 days. It is
While taking her bath today, she was weak severe weakness and a clinical RED FLAG if she is unable to get out of
and unable to get out of the tub and used the the bath tub and needed to call for assistance.
help button to call for medical assistance.
RELEVANT Data from Social History: Clinical Significance:
Jean lives independently in a senior Is functioning at a high level for an 82-year-old woman and is
apartment retirement community. independent at this time. It is important for the nurse to re-evaluate the
functional status anytime there is a hospital admission to ensure safety.
If there is ever a question, consult social services.
She is widowed and has two daughters who Supportive family is a positive influence that will increase her ability to
are active and involved in her life. maintain current autonomy.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 101.8 F/38.8 C (oral) Provoking/Palliative: Nothing/Nothing
P: 110 (regular) Quality: Ache
R: 24 (regular) Region/Radiation: Right flank
BP: 102/50 Severity: 5/10
O2 sat: 98% room air Timing: Continuous
The nurse recognizes the need to validate his/her concern of fluid volume deficit and performs a set of
orthostatic VS and obtains the following:
Position: HR: BP:
Urinary Tract Infection/Urosepsis
, Jean Kelly, 82 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Infection
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Jean Kelly is an 82-year-old woman who has been feeling more fatigued the last three days and has had a fever the last
twenty-four hours. She reports a painful, burning sensation when she urinates as well as frequency of urination the last
week. Her daughter became concerned and brought her to the emergency department (ED) when she did not know what
day it was. She is mentally alert with no history of confusion. While taking her bath today, she was weak and unable to
get out of the tub and used her personal life alert button to call for medical assistance.
Personal/Social History:
Jean lives independently in a senior apartment retirement community. She is widowed and has two daughters who are
active and involved in her life.
What data from the histories are important and RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
, More fatigued for the last 3 days Though a general complaint, when clustered with the other symptoms of
fever this is indicating that there is a likely PROBLEM present.
Fever the last 24 hours Fever reflects the systemic inflammatory response initiated by the
immune system and is there for a reason - to help the body fight off
invading micro-organisms by increasing the production of neutrophils;
the first responders of the immune system that are macrophages. The
elevated temp also makes it less hospitable for bacteria to thrive and
multiply.
These symptoms are classic with a urinary tract infection (UTI).
Painful, burning sensation when she urinates
Suspecting a urinary infection, the nurse needs to know that if a patient
as well as frequency of urination the last
meets the SIRs criteria, they should suspect sepsis.
week
With an infection of any kind, sepsis is identified by having 2 or more
of the following criteria of Systemic Inflammatory Response Syndrome
(SIRS):
• Temp >100.4 or <96.8
• HR >90
• RR >20
• WBC >12,000 or <4000
• Bands >10%
New onset of confusion is always a clinical RED FLAG in the elderly,
Did not know what day it was. She is
and when CLUSTERED with other symptoms is not representing a
mentally alert with no history of confusion
neurologic problem, but is commonly seen with an infection such as a
UTI.
This confirms the weakness and fatigue she has had the past 3 days. It is
While taking her bath today, she was weak severe weakness and a clinical RED FLAG if she is unable to get out of
and unable to get out of the tub and used the the bath tub and needed to call for assistance.
help button to call for medical assistance.
RELEVANT Data from Social History: Clinical Significance:
Jean lives independently in a senior Is functioning at a high level for an 82-year-old woman and is
apartment retirement community. independent at this time. It is important for the nurse to re-evaluate the
functional status anytime there is a hospital admission to ensure safety.
If there is ever a question, consult social services.
She is widowed and has two daughters who Supportive family is a positive influence that will increase her ability to
are active and involved in her life. maintain current autonomy.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 101.8 F/38.8 C (oral) Provoking/Palliative: Nothing/Nothing
P: 110 (regular) Quality: Ache
R: 24 (regular) Region/Radiation: Right flank
BP: 102/50 Severity: 5/10
O2 sat: 98% room air Timing: Continuous
The nurse recognizes the need to validate his/her concern of fluid volume deficit and performs a set of
orthostatic VS and obtains the following:
Position: HR: BP:
