Mr. M Age: 79 Diagnosis: Urinary Tract

Mr. M Age: 79 Diagnosis: Urinary Tract Infection and Urosepsis VS q4h Ambulate with assistance prn I&O q8h IV Lactated Ringers 100 ml/hr Bathroom privileges with assistance Diet: soft as tolerated Routine meds: Acetamenophen 500 mg tabs i po q4h for temperature greater than 38 degrees celcius; Ceftriaxone 1 g IVPB qAM as ordered Points to consider for Mr M: At 0600 Temp was 38 There is no documentation that Tylenol was given Restlessness Agitated and restless all night – why? What are your thoughts about why this is happening? Sepsis Urinary retention Fever Dehydration What should you be considering? Geriatric patient What should you be assessing? Initiate neuro checks At 0730 Temp was 38.5 Did you give Tylenol? P has gone from 78 to 98 BP has dropped from 146/88 to 120/76 Fine crackles audible Sleepy and lethargic All night was agitated and restless Scant amount of urine What should you be considering as this is an elderly patient? You should be concerned for this patient Notify physician of change in status At 1200 Temp was 39.1 P – 130 R – 28 BP – 90/54 Lethargic, skin warm and flushed Oximetry 88% What is happening? If Tylenol had been given would this situation have developed? Prepare for transfer to ICU Priority Problem: Signs and symptoms of septic shock New action plan: Monitor vital signs and oxygenation; prepare to transfer to intensive care unit Mr. M from the case scenario. Based on what you have learned this week about management of clients with renal and urolgic disorders answer the following questions: What else would you do in this situation with Mr. M? What other options or alternatives would you explore and why for Mr. M? What referrals might you make for Mr. M at this time? Who else on the interprofessional team would you involve in Mr. M’s care?

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