UTI in Elderly Patients

Nursing Informatics

The scenario described herein is in grounded in geriatric medicine, and utilizes the NANDA, NIC, and NOC elements to link the various components in standardized language to the data, information, knowledge, and wisdom associated with this exercise. The key parts of the paper are as follows: 1) Introduction; 2) nursing diagnosis (NANDA), including actual diagnosis, risk diagnosis, and wellness diagnosis; 3) nursing outcomes classification (NOC); 4) nursing interventions classification (NIC); 5) conclusions.

Case Presentation

The patient is an elderly woman with early stage dementia, who reports her age as 87 years. The patient's family brought her to the clinic because she has been complaining of malaise and refuses to receive help with dressing, both of which are unusual for the patient. Vitals were taken and all are within normal range, except that the patient had a temperature just above 37.9C. Examination revealed that the patient was experiencing suprapubic pain and costovertebral angle tenderness. When asked, the patient denied experiencing any urinary frequency or urgency. Her family members report that she wears absorbent pads and that this is a sensitive issue with the patient. The patient was able to void in a container and the sample was sent to the lab. Visual inspection did not indicate gross hematuria or pyuria.

Nursing Diagnosis (NANDA)

Nursing Interventions for Urinary Tract Infection (UTI):

Impaired sense of comfort: pain related to inflammation and infection of the urethra, bladder and other urinary tract structures.

Risk Factors

Given the patient's age and the presence of dementia, the nursing diagnosis is that of an uncomplicated lower urinary tract infection due to significant bateriuria, not due to mechanical obstruction of the bladder or other urinary tract structures (Beveridge, et al., 2011). The UTI is considered uncomplicated since the patient if a post-menopausal female who has not been exposed to urinary catheters and gives no evidence of systemic symptoms (Beveridge, et al., 2011). In elderly patients, it is important to differentiate infections of the lower urinary tract from infections of the upper urinary tract, as commonly prescribed drugs such as nitrofurantoin and fosfomycin only achieve effective concentrations in the lower urinary tract, and should not be prescribed for upper urinary tract infections (Beveridge, et al., 2011). Research indicates that incorrect diagnoses UTIs occur in roughly 40% of older people who are hospitalized (Beveridge, et al., 2011). With the rate of infections from Clostridium difficile and the like increasing in health care facilities, and the rates of antibiotic resistance rising, it is clear that clinicians must endeavor to obtain firm diagnoses and treat patients with appropriate antibiotics, while avoiding the use of broad spectrum antibiotics (Beveridge, et al., 2011).

Actual Diagnosis, Risk Diagnosis, And Wellness Diagnosis

Actual diagnosis.

Lab results showed asymptomatic bacteriuria, and confirmed that the patient had a UTI.

The actual diagnosis was determined following lab result of urine tests, which indicated the presence of a specified number (>105 CFU/mL) of a single species of bacteria in the freshly voided, midstream specimen of urine (Beveridge, et al., 2011). The level of bacteriuria was "considered significant because it is unlikely that it could be explained by contamination of the urine sample with perineal flora (Beveridge, et al., 2011). However, it is important to recognize that level does not indicate clinically significant bacteriuria, which can be asymptomatic and many times does not require treatment. Indeed, lower levels of bacteriuria may be significant (Beveridge, et al., 2011).

Nursing Outcomes Classification (NOC)

The expected results (nursing outcomes) of nursing care include reduction or elimination of pain during and after micturition. No pain when urinating, no pain in the pelvic percussion.

Nursing Interventions Classification (NIC)

The following nursing interventions are recommended when providing care for patients who are experiencing urinary tract infections:

Monitor changes in urine color, monitor the pattern of urination, the input and output every 8 hours and monitor the results of urinalysis repeated.

R /: to identify indications of progress or deviations from expected results

Record the location, the length of the intensity scale (1-10) pain.

R /: to help evaluate the place of obstruction and cause pain

Provide comfort measures, such as massage.

R /: increase relaxation, decrease muscle tension.

Provide perineal care.

R /: to prevent contamination of the urethra

Divert attention on something fun.

R /: relaxation, avoiding too feel the pain.

Collaboration:

Give analgesics according to program requirements and evaluation of its success.

Rationale: analgesics block pain trajectory, thereby reducing pain.

Give antibiotics. Create a wide variety of preparations drink, including fresh water. Giving water to 2400 ml / day.

Rationale: The result of the output of urine facilitate frequent urination and help flush channel urination.

Linkage Between NANDA And NIC

1. Make sure the patient, or the people closest to have written agreements for continued treatment and written instructions for care after the examination.

Rational: Verbal instructions can be easily forgotten.