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Case Study: Urinary Tract Infection
You are working in an extended care facility when M.Z.’s daughter brings her mother in for a week’s stay while she goes on a planned vacation. M.Z. is an 89-year-old widow with a 4-day history of non- localized abdominal pain, incontinence, new-onset mental confusion, and loose stools. Her most current vital signs are 118/60, 88, 18, 98.4° F (37.4° C). The medical director ordered a post void catheterization, which yielded 100mL of cloudy urine that had a strong odor, and several lab tests on admission. Urine culture and sensitivity results are pending; the other results are shown in the chart.
Chart View Laboratory Test Results:
Complete metabolic panel: Within normal limits except for the following results:
BUN 25mg/dL Sodium 131mEq/L
White blood cell count 11,000/mm3
Urinalysis Appearance Cloudy Odor Foul
WBCs 6 per low-power field
What condition do the lab reports point toward?Which assessment findings are typical of an older adult with the condition in Question 1?Considering her history and laboratory results, what other condition is a possibility?
4.The medical director makes rounds and writes orders to start an IV of D5 ½NS at 75mL/hr. and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral medications, the medical director orders ciprofloxacin (Cipro) 400mg q12h IV piggyback (IVPB). Are the type of fluid and rate appropriate for M.Z.’s age and condition? Explain.
5. While the IVPB ciprofloxacin is being administered, which adverse effects might occur?
6. You enter the room to start the IV infusion and insert the Foley catheter and find that the nursing assistive personnel (NAP) has taken M.Z. to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you open the door, you observe her wiping herself from back to front. What do you need to do at this time?
7. Because M.Z. has been having diarrhea, what special instructions should you give the NAP assigned to give basic care to M.Z.?
Case Study Progress:
The next day, you are the nurse assigned to M.Z.’s care. You notice that the NAP emptying the gravity drain is not wearing personal protection devices. You also observe that the drainage port of the drainage bag was contaminated during the process because the NAP allowed it to touch the floor.
8. What issues need to be considered in protecting M.Z.’s safety? Describe your actions in working with the nursing assistant.
9. As you assess M.Z., you notice that her catheter tubing is not secured. Why does the tubing need to be secured, and where is the correct place for the catheter tubing?
10. What changes, if any, will be made to the antibiotic therapy?
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The Institute of Medicine defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. Waiting to obtain an appointment with your MD or sitting for long periods in the Emergency Room can have negative health effects.
You open your social media app and you see a story on your timeline from your local news station that stated the following: Deaths due to long wait times
At Memorial hospital (inpatient and outpatient services), wait times to be seen for the emergency room (ER) and for primary care exceed quality standards. The wait times could range between three to four hours at the ER and an hour or two to be seen at the primary care clinic. Appointments to see a surgeon for surgical procedures are booking out weeks, unfortunately leading to deaths. Because of this, the Center for Medicare & Medicaid Services (CMS) is sending a team to conduct an audit. One possible result of the visit could be a reduction or loss of federal funding. Your job is to write a report that lead to a positive outcome for the hospital.
Examine this report: Measuring Health Care Quality: An Overview of Quality Measures
Implement quality measures at Memorial Hospital
Include the following aspects in the report:
Ø Choose a quality measure for each problem you identify
Ø Consider how you will implement changes to achieve the standards
Ø Outline the financial impact of your changes
Ø What kinds of systems need to be created to track progress?
Ø Please use this template
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Find a business news article that interested that has been published within the last month from one of the business news publications listed below.
•Make sure to also include a link to the article in your submission.
Write 3 paragraphs that are 4-6 sentences each. Each paragraph should answer one of the following questions.
-What’s the story (brief summary)?
-What is your opinion or analysis of the story?
-How does the story relate to what we have learned in class (make sure to bold 4-5 key terms/concepts from the class in your answer)?
Choose an article from one of the following business news publications
The Wall Street Journal
Harvard Business Review
Fast Company (連結到外部網站。)
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Describe and analyze steps toward increased self-esteem or Explain how to find employment after college graduation.