UTI in Elderly Patients Essay

Excerpt from Essay :

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…

Sources Used in Document:

References 4

http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NE/A/NE_35_4_2010_04_16_SMITH_200117_SDC1.ppt

Beveridge, L.A., Davey, P.G., Philliops, G. & McMurdo, M.E.T. (2011, June). Optimal management of urinary tract infections in older people. Clinical Interventions of Aging, 6, 173 -- 180. . doi: 10.2147/CIA.S13423. PMCID: PMC3131987

Mellen, C.K., Ford, M., & Rindone, J.P. (2010, July). Effect of high-dose cranberry juice on the pharmacodynamics of warfarin in patients. British Journal of Clinical Pharmacology, 70(1), 139-142. doi: 10.1111/j.1365-2125.2010.03674.x.

Nicolle, L.E. (2000). Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice. Canadian Medical Association Journal (CMAJ),163(3), 285 -- 286.

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