Urinary Tract Infection/Urosepsis
Jean Kelly, 82 years old
Primary Concept
Infection
Interrelated Concepts (In order of emphasis)
1. Perfusion
2. Fluid and Electrolyte Balance
3. Thermoregulation
4. Clinical Judgment
5. Patient Education
6. Communication
UNFOLDING Reasoning Case Study: STUDENT Sepsis
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
© 2016 Keith Rischer/www.KeithRN.com
, 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:
Increasingly worsening fatigue, Confusion is a common sign of UTI, and a change in mental
painful, burning, and frequent status should be evaluated.
urination Significant signs and symptoms of UTI prompting request
fever for 24 hours for UA
weakness
confusion
RELEVANT Data from Social History: Clinical Significance:
Lives independently in a retirement The life alert button offers security and assistance to her in
community, wears a life alert button, case of an emergency when she is alone at home. She has
widowed and 2 daughters who active a strong support system from her daughters and can return
and involved in her life. to a safe environment after discharge
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes type 2 1. Allopurinol 100 mg PO 1. Antipruritic 1. Lowering of serum
Hyperlipidemia bid and antigout agents uric acid levels.
Hypertension (HTN) 2. ASA 81 mg PO daily 2. Salicylates 2. Reduce platelet
Gout 3. Pioglitazone 15 mg PO
daily 3. Antidiabetic/ aggregation
4. Simvastatin 20 mg PO thiazolidinediones 3. Decrease insulin
daily 4. Lipid -lowering resistance
5. Metoprolol 25 mg PO bid agents 4. Decrease
6. Lisinopril 10 mg PO daily 5. Beta blockers cholesterol/lipid levels
7. Furosemide 20 mg PO 6. ACE inhibitors 5. Decrease BP
daily 7. Loop diuretics 6. Decrease BP
8. Potassium chloride 20
mEq PO daily
8. Mineral & Electrolyte 7. Diuresis/Decrease
replacements/suppl. BP
8. Prevention/
Correction of K
depletion
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in
their life?
Circle what PMH problem started FIRST
Underline what PMH problem(s) FOLLOWED as dominoes
© 2016 Keith Rischer/www.KeithRN.com
Jean Kelly, 82 years old
Primary Concept
Infection
Interrelated Concepts (In order of emphasis)
1. Perfusion
2. Fluid and Electrolyte Balance
3. Thermoregulation
4. Clinical Judgment
5. Patient Education
6. Communication
UNFOLDING Reasoning Case Study: STUDENT Sepsis
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
© 2016 Keith Rischer/www.KeithRN.com
, 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:
Increasingly worsening fatigue, Confusion is a common sign of UTI, and a change in mental
painful, burning, and frequent status should be evaluated.
urination Significant signs and symptoms of UTI prompting request
fever for 24 hours for UA
weakness
confusion
RELEVANT Data from Social History: Clinical Significance:
Lives independently in a retirement The life alert button offers security and assistance to her in
community, wears a life alert button, case of an emergency when she is alone at home. She has
widowed and 2 daughters who active a strong support system from her daughters and can return
and involved in her life. to a safe environment after discharge
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes type 2 1. Allopurinol 100 mg PO 1. Antipruritic 1. Lowering of serum
Hyperlipidemia bid and antigout agents uric acid levels.
Hypertension (HTN) 2. ASA 81 mg PO daily 2. Salicylates 2. Reduce platelet
Gout 3. Pioglitazone 15 mg PO
daily 3. Antidiabetic/ aggregation
4. Simvastatin 20 mg PO thiazolidinediones 3. Decrease insulin
daily 4. Lipid -lowering resistance
5. Metoprolol 25 mg PO bid agents 4. Decrease
6. Lisinopril 10 mg PO daily 5. Beta blockers cholesterol/lipid levels
7. Furosemide 20 mg PO 6. ACE inhibitors 5. Decrease BP
daily 7. Loop diuretics 6. Decrease BP
8. Potassium chloride 20
mEq PO daily
8. Mineral & Electrolyte 7. Diuresis/Decrease
replacements/suppl. BP
8. Prevention/
Correction of K
depletion
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in
their life?
Circle what PMH problem started FIRST
Underline what PMH problem(s) FOLLOWED as dominoes
© 2016 Keith Rischer/www.KeithRN.com
