Summary SKINNY Reasoning Urinary Tract Infection/Urosepsis ALL ANSWERS 100% CORRECT SPRING FALL- 2022 SOLUTION GUARANTEE GRADDE A+

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 Category/Subcategory Covered in 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 Fever the last 24 hours Though a general complaint, when clustered with the other symptoms of fever this is indicating that there is a likely PROBLEM present. 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 as well as frequency of urination the last week Suspecting a urinary infection, the nurse needs to know that if a patient meets the SIRs criteria, they should suspect sepsis. 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% Did not know what day it was. She is mentally alert with no history of confusion New onset of confusion is always a clinical RED FLAG in the elderly, and when CLUSTERED with other symptoms is not representing a 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 severe weakness and a clinical RED FLAG if she is unable to get out of While taking her bath today, she was weak the bath tub and needed to call for assistance. and unable to get out of the tub and used the 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 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. Supportive family is a positive influence that will increase her ability to maintain current autonomy. apartment retirement community. She is widowed and has two daughters who are active and involved in her life. 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: