Harrison Ticket.
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.
, Harrison Ticket.
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 what you are saying and his or her ability to
make you understand can be inconsistent. Here are a few communication techniques I
found researching this topic:
Gain the person's attention prior to providing verbal instructions.
Provide instructions in a clear calm voice with a slower cadence.
Try not to give more than 1 instruction at a time.
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.
, Harrison Ticket.
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 what you are saying and his or her ability to
make you understand can be inconsistent. Here are a few communication techniques I
found researching this topic:
Gain the person's attention prior to providing verbal instructions.
Provide instructions in a clear calm voice with a slower cadence.
Try not to give more than 1 instruction at a time.
