CASE STUDY 60

Group 3
Estrella, Jenico
Jimenez, Chona
Monis, Biana
Opolinto, John Michael

GENTIOURINARY DISORDERS
SCENARIO
N.H. an 89 years old widow, recently experienced a left
sided cerebrovascular accident (CVCA). She has right
sided weakness and expressive aphasia with minimal
swallowing difficulty. N.H. has a past medical history of
left-sided CVA 2 yrs ago, chronic atrial flutter, and
hypertension. She has lived with her daughters family in a
rural town since her previous stroke. Since admission to an
cute care facility 5 days ago. N.H. has gained some
strength, has become oriented to person and place, and is
anxious to begin her rehabilitation program. She is
transferred for rehabilitation to your skilled nursing facility
with the following orders :

ADMISSION ORDERS

Hydrochlorotiazid (hydro DIURIL) 25 MG/DAY PO

Digoxin (Lanoxin) 0.125 mg/day PO
Aspirin (enteric coated) 81 mg/day PO
Warfarin (Coumadin) 5 mg/day PO
Acetaminophen (Tylenol) 325mg q6h PO prn for pain
Zolpidem (Ambien) 5mg PO at bedtime prn for sleep
Diet : mechnical soft, low sodium with ground meat
Foley catheter to gravity drainage, and then begin
bladder training
Referrals for speech therapy, OT, PT to evaluate and
treat swallowing, communication, and functional
abilities.

1. What lab orders would you

anticipate as a result of this specific
list of orders? (With each response,
describe
your
rationale)

HCTZ CBC (can cause agranulucytosis,

thrombocytopenia, aplastic anemia) blood glucose(one of
SE is hyperglycemia)
DIGOXIN serum digoxin, potassium, magnesium,
calcium levels(these will be affected when using digoxin)
ASA PT and IRN with concurrent anticoagulant
therapy(to determine effect in prothyombintione and will
normalized ratio)
WARAFARIN for maintenance, PT/INR (to determine
prothrombin), Urinalysis (to check for blood), liver
function test (warfarin affects hepatic synthesis)
ACETAMINOPHEN no lab orders needed

A
week
later
,
at
the
interdisciplinary
care
conferences, you report that
bladder training is progressing
and recommend removing the
catheter if N.H.s mobility and
communication
abilities
have
progressed sufficiently. The group
of N.H. agree that she is ready for
foley catheter to removed.

2. Identify three problems that N.H. is at risk for

developing following catheter removal, and describe
specific interventions for each problem.

Difficulty in urination after removal provide instructions on how to do bladder

training.
Pain provide analgesics as ordered or
for pain.
Scarring of urethra that could cause
urethral stricture urethral dilation or
open urethral reconstruction.

Two days after the Foley is removed, you

observed that N.H.s urine is cloudy, is
concntrated, and has a strong odor .
3. What are your immediate actions?
- Notify the physician
- Assess for other signs of UTI
- Obtain order for clean-catch specimen for
urinalysis
- Encourage client to drink fluids
- Expect an order for antibiotics if UTI is
indicated.

N.H. is started sulfamethoxazole

800 mg/trimethoprim 160mg 1
tab PO bid x 10 dys. However ,
2 days later, N.H. is in the
bathroom, and she is very
upset. She has just voided;
there is blood on the toilet, and
the water is bright red with
blood. You help the NAP clean
N.H. and help her into bed.

4. Describe your
assessment steps.
Assess if there is other potential
source of blood other than the source
of urine.
Assess for vital signs and encourage
to verbalize feelings.
Refer to the physician immediately.

5. Using SBAR, what information

would your provide to the
physician when you call
SITUATION hello I am nurse ___ , I am calling
about N.H. The problem I am calling about is her
urine has bright red blood.
BACKGROUND state the diagnosis / date of
admission / surgery date.
ASSESSMENT Provide recent VS, O2 saturation,
ECG (if any), SAO2 and input/output. Provide
information on change from prior assessments
such as mental status, lab results, etc.
RECOMMENDATION State when you would like to
see done(changes in current treatment, etc)

6. Identify at least two potential

causes for N.Hs Hematuria.
URINARY TRACT INFECTION

7. What specific issues must be

considered in the teaching and
discharge planning to prevent a
recurrence of infection
Increase oral fluid intake
Avoid irritating feminine hygiene
products
Wipe from front to back
Empty bladder at least every 4 hours

8. You talk with N.H.s

daughter
about
her
understanding of caregiving
responsibilities
for
her
mother.
What
kind
of
questions do you ask to
assess whether she is
capable of taking on this
additional burden?

 Are you really capable of taking care of your mom all

by yourself? Do you need to hire outside help or
consider assisted living?
Do you have the social support and resources youre
going to need?
Will you be able to make time for yourself?
How will caregiving affect your physical & mental
health?
Will you be able to allow yourself to accept health and
take breaks?
Are you financially prepared for the extra costs of
caregiving?
Will you be able to cut back on work responsibilities
during those times when you need for care for your
parent?
If she has an aggressive behavior , will you be able to
cope and potentially hurtful words or actions?