Urosepsis Jean Kelly age 82 Name:
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:
Progressively worsening fatigue, fever, and Clinically significant symptoms of urinary tract infection prompting
painful, burning, and frequent urination. request for an order for a urinalysis.
Sudden onset of confusion (change in mental Confusion is a common presentation of UTI in the elderly, and change
status) with no prior history in mental status from baseline should always be fully investigated.
RELEVANT Data from Social History: Clinical Significance:
Lives in a senior retirement community with Jean has a strong support system and a safe place to return to after
daughters who are actively involved in her discharge that will provide support. Her life alert button provides the
life and wears a life alert button security she needs in the event of an emergency since she lives alone.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions-indicate with numbers or some form that I can identify
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes type 2 1. Allopurinol 100 mg PO 1. Antigout agent 1. Decreased production
Hyperlipidemia bid of uric acid to reduce gout
Hypertension (HTN) 2. ASA 81 mg PO daily flares
Gout 3. Pioglitazone 15 mg PO 2. Antiplatelet/salicylate 2. Reduce platelet
daily aggregation and clumping
4. Simvastatin 20 mg PO to prevent clotting
daily 3. Reduces and controls
5. Metoprolol 25 mg PO bid 3. Thiazolidinedione/anti blood glucose levels
6. Lisinopril 10 mg PO daily diabetic 4. Reduces cholesterol/
7. Furosemide 20 mg PO 4. Antihyperlipidemic blood lipid levels
daily 5. Reduces blood pressure
5. Beta blocker
8. Potassium chloride 20 6. Reduces blood pressure
mEq PO daily 7. Reduces BP through
6. Ace inhibitor
diuresis
8. Replaces K in the body
7. Loop diuretic
lost through diuresis
8. K supplement
, Urosepsis Jean Kelly age 82 Name:
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
• DMII
● Underline what PMH problem(s) FOLLOWED as dominoes
• HTN, HLD (probably coexisted), Gout
• Wasn’t exactly sure when Gout could have happened as it not necessarily linked to her other
comorbidities
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:
Supine 110 102/50
Standing 132 92/42
What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
Temp of 101.8F Indicative of fever, systemic sign of infection
Pulse of 110 Tachycardia, heart is beating faster - could be sign of anxiety or
compensation of some sort
Respirations of 24 Tachypnea could also be a sign of anxiety or compensation
BP 102/50 In combination with tachycardia, probably indicative of fluid volume
deficit in which heart beats faster to maintain pressure with the
decreased blood volume
Orthostatic BP changes Orthostatic hypotension defined as a systolic change of at least 20
between supine and standing which she demonstrates. Indicative of many
things but given her vitals and s/s, this is consistent with fluid volume
deficit
Current Assessment:
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:
Progressively worsening fatigue, fever, and Clinically significant symptoms of urinary tract infection prompting
painful, burning, and frequent urination. request for an order for a urinalysis.
Sudden onset of confusion (change in mental Confusion is a common presentation of UTI in the elderly, and change
status) with no prior history in mental status from baseline should always be fully investigated.
RELEVANT Data from Social History: Clinical Significance:
Lives in a senior retirement community with Jean has a strong support system and a safe place to return to after
daughters who are actively involved in her discharge that will provide support. Her life alert button provides the
life and wears a life alert button security she needs in the event of an emergency since she lives alone.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions-indicate with numbers or some form that I can identify
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Diabetes type 2 1. Allopurinol 100 mg PO 1. Antigout agent 1. Decreased production
Hyperlipidemia bid of uric acid to reduce gout
Hypertension (HTN) 2. ASA 81 mg PO daily flares
Gout 3. Pioglitazone 15 mg PO 2. Antiplatelet/salicylate 2. Reduce platelet
daily aggregation and clumping
4. Simvastatin 20 mg PO to prevent clotting
daily 3. Reduces and controls
5. Metoprolol 25 mg PO bid 3. Thiazolidinedione/anti blood glucose levels
6. Lisinopril 10 mg PO daily diabetic 4. Reduces cholesterol/
7. Furosemide 20 mg PO 4. Antihyperlipidemic blood lipid levels
daily 5. Reduces blood pressure
5. Beta blocker
8. Potassium chloride 20 6. Reduces blood pressure
mEq PO daily 7. Reduces BP through
6. Ace inhibitor
diuresis
8. Replaces K in the body
7. Loop diuretic
lost through diuresis
8. K supplement
, Urosepsis Jean Kelly age 82 Name:
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
• DMII
● Underline what PMH problem(s) FOLLOWED as dominoes
• HTN, HLD (probably coexisted), Gout
• Wasn’t exactly sure when Gout could have happened as it not necessarily linked to her other
comorbidities
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:
Supine 110 102/50
Standing 132 92/42
What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
Temp of 101.8F Indicative of fever, systemic sign of infection
Pulse of 110 Tachycardia, heart is beating faster - could be sign of anxiety or
compensation of some sort
Respirations of 24 Tachypnea could also be a sign of anxiety or compensation
BP 102/50 In combination with tachycardia, probably indicative of fluid volume
deficit in which heart beats faster to maintain pressure with the
decreased blood volume
Orthostatic BP changes Orthostatic hypotension defined as a systolic change of at least 20
between supine and standing which she demonstrates. Indicative of many
things but given her vitals and s/s, this is consistent with fluid volume
deficit
Current Assessment:
