Case Study
Mrs. Davis is a 62 year old woman who was involved in a motor vehicle crash. She has just been admitted to your unit with several fractures and is awaiting surgery. She has a dislocated shoulder and broken forearm to her left upper extremity, a broken femur and foot to her right lower extremity, and deep bruising to her chest from her seatbelt. She has a history of hypothyroidism, hypertension, hyperlipidemia and prediabetes. Prior to the crash, she was independent with her ADLs.
Her orders are as follows:
Bedrest
Keep right leg immobilized
NPO
Place foley catheter
IV fluids- LR at 75ml/hr
Morphine (narcotic) 1-2mg q 4hr prn pain
VS q 4hr
Her Vitals signs on admit were
T-97.9 F , P 108, R 22, BP 148/92, O2 sats 95%
What vital signs are abnormal? What do you think is causing this?
An order has been written to place a foley. Is this an appropriate indication for this patient? Using the chart in the link provided, explain why it would or would not be appropriate. AHRQ CAUTI Reduction
Give at least 5 examples of ways you can prevent a Catheter-associated urinary tract infection through any of the stages of insertion and/or maintenance.
You have been caring for Mrs. Davis for 3 days now. She is still in significant pain, though tolerable with the pain medication. She is having some difficulty with eating in drinking because of the pain and ability to use both arms. She is complaining that her pelvic area is hurting and a burning sensation around the catheter site. She seems a little more confused than her normal.
Her vital signs are T-100.2 F, P 104, R 22, BP 138/86
What labs would you anticipate the physician to order (Identify at least 3)?
You get some results back from the urine:
Results of Dipstick Urinalysis : Urine collection type-foley
Analyte Result Normal Range
Glucose Negative Negative
Ketones Negative Negative
Specific Gravity 1.035 (1.000-1.030)
Blood Trace Negative
pH 6.5 (5.0-8.0)
Protein Negative Negative
Leukocytes Moderate Negative
Appearance Cloudy Clear
Color Amber Pale to dark yellow
What do the abnormal values tell you?
Next you receive the C&S back. It is positive for MRSA and the following susceptibilities:
Which antibiotics are NOT going to be effective?
What type of isolation do you need to put Mrs. Davis in?
What PPE must be used when providing care to Mrs. Davis?
Mrs. Davis is treated with antibiotics and seems to be doing better from her infection. Pain continues to be an issue and she has not participated in physical therapy even though she is allowed to move now that surgery has been completed. She has not had a BM since she was admitted. She has tried a stool softener, a laxative, diet changes, suppository and prune juice. The physician orders a soap suds enema.
Is this type of enema hypertonic, hypotonic or isotonic? _________________________
What are some complications that can arise from giving this type of enema?
You put the enema tube in place, have the temperature at 105 F exactly, hold the bag approximately 15 inches above the anus and unclamp it. Mrs. Davis complains of cramping. What should you do?
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The enema was not successful. There is a large fecal impaction in the rectum. You have next given a small volume glycerin enema to soften the stool. The physician ordered to digitally disimpact the stool. As you start to perform the procedure, Mrs. Davis’s heart rate drops to 48. Why did this happen?
Mrs. Davis is finally able to have a BM on her own that evening. She is thankful for all your help. She asks you what she can do to prevent getting so constipated again. What do you tell her?
You have done a great job taking care of Mrs. Davis for the past 3 days. It is time to say goodnight and go home for a much needed rest!!! Then after the rest-go back to some of the ATI modules that maybe didn’t get done in the first month of class like Vital Signs and Health Assessment.
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