NRNP 6552-week 5 case study: Case Study #3: Vivian
NRNP 6552-week 5 case study: Case Study #3: Vivian
Instructions: NRNP 6552-week 5 case study: Case Study #3: Case Study #3
Case 3: Vivian
Vivian is an 88year old female who presents with various complaints including; dark cloudy foul smell, hallucinations at night and new confusion. She has a history of Urinary Tract Infection (UTI), Urinary symptoms and disturbed sleep. Her medical history includes chronic kidney disease stage 2, hypertension, osteoporosis, vesicovaginal fistula, a previous femur fracture and diverticular disease. Upon examining her she appears restress though oriented. She has leukocytosis and an abnormal urine dip. Her differential diagnosis include Urinary tract infection, Delirium and side effects caused by medication.
RUBRIC
| Outline Subjective data. Identify data provided in your chosen case and any additional data needed. The subjective data included dark cloudy foul smell, hallucinations at night and new confusion. Besides, it included a history of Urinary Tract Infection (UTI), Urinary symptoms and disturbed sleep. The additional data needed could include the symptoms and severity of her symptoms. Any recent change in her medication and more information on her recent behaviors and activities. | Outline Objective findings. Identify findings provided in your chosen case and any additional data needed. The objective findings noted after the physical exam include 3+ leukocytes, urine dip results with PH6.0 and positive nitrites. The vital signs obtained were noted to be within the normal limit and there were no more significant abnormalities noted . More data that could be needed include a cognitive assessment score, her electrolyte levels, a urine culture results. | Identify diagnostic tests, procedures, laboratory work indicated. Describe the rationale for each test or intervention with supporting references. Diagnostic tests include; Urine culture to confirm or eliminate Urinary tract infection (UTI). Cognitive assessment to confirm Delirium. Electrolyte test to evaluate metabolic abnormalities. | Distinguish at least three differential diagnoses. Describe the rationales for your choice of each diagnosis with supporting references. The three differential diagnoses include; Urinary Tract Infection- The symptoms presented by Vivian including cloudy urine, dysuria, and abnormal urine dip results makes UTI a major consideration (kaiser, 2022). Delirium– The patient has a new confusion, is restless and has hallucinations raising delirium concerns which may also be caused by the patient being an old adult (Bhat, 2019). Acute Kidney Injury– the current symptoms including lower abdominal pains, dark cloudy urine raises concerns for Acute Kidney Injury (Piracha, 2023). | Identify appropriate medications, treatments or other interventions associated with each differential diagnosis. Describe rationales and supporting references for each. Urinary Tract Infection (UTI): Antibiotics such as Nitrofurantoin for possible urinary tract infections (Wolterink et al., 2020). Phenazopyridine 100 mg two times a day to relieve urinary discomfort and dysuria (Hamza et al., 2022) Delirium Administer Deliriogenic Medication such as Anticholinergic drugs (Sura et al., 2019). Encourage Incorporate modification of the patient environment including ensuring the patient stays in a quiet familiar environment. Encourage regular sleeping cycles and proper lighting to manage delirium symptoms Acute Kidney Injury Administer intravenous fluids to the patient to restore proper renal function. Correct electrolyte abnormalities through metabolic acidosis. | Explain key Social Determinants of Heath (SDoH) for your chosen case. The social determinant of health for Vivian based on the information provided in her case include her current living situation where she lives under care givers full time. Besides, she recently lost her husband and has had a history of falling which resulted to femur fracture. Such factors maybe impacting her health | Describe collaborative care referrals and patient education needs for your chosen case. Describe rationales and supporting references for each. The collaborative care referrals involves referring Vivian to geriatric psychiatry to further evaluate her cognitive symptoms (Baune, 2021). She may also need physical therapy to prevent falls ,further social and rehabilitation support in her home. The patient education to Vivian should include improving her hygiene and hydration to prevent UTIs (Nicolson et al., 2020). Beside she should be educated on the importance of adherence to medication and being able to recognize when her symptoms worsen. |
References
References
Baune, B. T. (2021). Psychological interventions for cognitive dysfunction in MDD. Cognitive Dimensions of Major Depressive Disorder, 65-78. https://doi.org/10.1093/med/9780198835554.003.0008
Bhat, R. (2019). Psychotic symptoms in delirium. Psychosis in the Elderly. https://doi.org/10.4324/9780203336984_chapter_11
Hamza, A., Nasrullah, A., Singh, R., & DiSilvio, B. (2022). Phenazopyridine-induced methaemoglobinaemia – The aftermath of dysuria treatment. European Journal of Case Reports in Internal Medicine. https://doi.org/10.12890/2022_003191
Kaiser, G. L. (2022). Urinary tract infection. Symptoms and Signs in Pediatric Surgery, 459-488. https://doi.org/10.1007/978-3-642-31161-1_27
Nicolson, A., Aiyegbusi, O., & Baggott, A. (2020). Improving antibiotic prescribing for UTIs in renal impairment. Access Microbiology, 2(2). https://doi.org/10.1099/acmi.fis2019.po0100
Piracha, K. (2023). Acute kidney injury: An algorithmic approach. Acute Kidney Injury. https://doi.org/10.1007/978-3-031-49924-1_1
Sura, S. D., Carnahan, R. M., Chen, H., & Aparasu, R. R. (2019). Prevalence and determinants of anticholinergic medication use in elderly dementia patients. Drugs & Aging, 30(10), 837-844. https://doi.org/10.1007/s40266-013-0104-x
Wolterink, I., Verheij, T., Platteel, T., Van den Bruel, A., Stam, A., & Van de Pol, A. (2020). Nitrofurantoin failure in elderly men: A retrospective observational study. Antibiotics, 9(5), 211. https://doi.org/10.3390/antibiotics9050211
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