Urosepsis Jean Kelly age 82 Name: Christina Hammack
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
painful, burning, and frequent urination.
Sudden onset of confusion (change in mental
status) with no prior history
Clinically significant symptoms of urinary tract infection prompting
request for an order for a urinalysis.
Confusion is a common presentation of UTI in the elderly, and change
in mental status from baseline should always be fully investigated.
RELEVANT Data from Social History: Clinical Significance:
Lives in a senior retirement community with
daughters who are actively involved in her
life and wears a life alert button
Jean has a strong support system and a safe place to return to after
discharge that will provide support. Her life alert button provides the
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
- Antiplatelet/salicylate
- Thiazolidinedione/anti
diabetic - Antihyperlipidemic
- Beta blocker
- Ace inhibitor
- Loop diuretic
- K supplement
- Decreased production
of uric acid to reduce gout
flares - Reduce platelet
aggregation and clumping
to prevent clotting - Reduces and controls
blood glucose levels - Reduces cholesterol/
blood lipid levels - Reduces blood pressure
- Reduces blood pressure
- Reduces BP through
diuresis - Replaces K in the body
lost through diuresis
Hyperlipidemia bid
Hypertension (HTN) 2. ASA 81 mg PO daily
Gout 3. Pioglitazone 15 mg PO
daily - Simvastatin 20 mg PO
daily - Metoprolol 25 mg PO bid
- Lisinopril 10 mg PO daily
- Furosemide 20 mg PO
daily - Potassium chloride 20
mEq PO daily
Urosepsis Jean Kelly age 82 Name: Christina Hammack
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
Pulse of 110
Respirations of 24
BP 102/50
Orthostatic BP changes
Indicative of fever, systemic sign of infection
Tachycardia, heart is beating faster – could be sign of anxiety or
compensation of some sort
Tachypnea could also be a sign of anxiety or compensation
In combination with tachycardia, probably indicative of fluid volume
deficit in which heart beats faster to maintain pressure with the
decreased blood volume
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: