NUR 611 Discussion 4 Case 4
University:
St. Thomas University
NUR 611 Discussion 4 Case 4
Paper Instructions
An 82-year-old man recently returned to the long-term care facility after hospitalization for open reduction internal fixation of the right hip. He has been divorced for over 50 years and has two adult children who visit him frequently in the nursing home. He has a 5-year history of mild to moderate dementia and known urinary tract infections. His last recorded mini mental state examination (MMSE) registered 18, which was 3 months ago. While in the hospital, he did have an indwelling catheter for 4 days.
He has been incontinent since his return to the hospital but the staff their attributes this to the catheter and his deconditioned state following hospitalization. His medications include donepezil, memantine, and acetaminophen for pain and fever as needed. He has no other known medical problems except a history of multiple urinary tract infections throughout his lifetime that, according to his son, have required extensive antibiotic treatment.
He enjoys drinking regular coffee throughout the day, says it is a habit he has had since his days in the service years ago. His family members and the nursing staff report that he has been very restless and has been unable to use the urinal on time the past couple of days.
Vital signs
- T 99°F
- HR 80
- RR 18
- BP 128/78
- BMI 22
Chief Complaint
- Foul smelling urine, incontinence, restless
Discuss the following:
- What additional subjective data are you seeking to include past medical history, social, and relevant family history?
- What additional objective data will you be assessing for?
- What are the differential diagnoses that you are considering?
- What laboratory tests will help you rule out some of the differential diagnoses?
- What radiological examinations or additional diagnostic studies would you order?
- What treatment and specific information about the prescription that you will give this patient?
- What are the potential complications from the treatment ordered?
- What additional laboratory tests might you consider ordering?
- What additional patient teaching may be needed?
- Will you be looking for a consult?
Submission Instructions
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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Sample Answer
An 82-year-old man was recently returned to the long-term care facility after hospitalization for an open reduction internal fixation of the right hip, currently has foul-smelling urine, incontinence, and restlessness. His vital signs include T 99°F, HR 80, RR 18, BP 128/78, and BMI 22.
From the patient’s data, it is crucial to inquire whether there is a family history of Alzheimer’s disease, the kind of care the patient has been receiving in the long-term care facility, and the current prognosis of the disease (Breijyeh et al., 2020). I would also inquire whether the cause of the urinary tract infections has been identified, the number of repeated attacks he has had, and prior detailed management plans.
While examining the patient, it would be crucial to examine the abdomen to check for any flank pain and suprapubic fullness and tenderness and perform a digital rectal examination. I would also look for signs of dehydration and bilateral pedal edema. In addition, I would do another mini-mental state examination and a detailed central nervous system examination. My differential diagnosis for the patient would be urinary tract obstruction secondary to benign prostatic hyperplasia and a urinary tract infection (Choi et al., 2021).
As a result, I would perform the following laboratory tests a urinalysis, complete blood counts, and prostatic specific antigen (PSA). In addition, I would perform an ultrasound for the kidney, ureters, and bladder (KUB) and one for the prostrate. In addition, I would also request for computed tomography (CT)-KUB and cystoscopy (Xie et al., 2020). The laboratory and imaging tests are both helpful in determining the cause of the foul-smelling urine and incontinence.
I would prescribe Prazosin 2 mg and Ciprofloxacin 500 mg PO q12hr. Both medications are associated with nausea and vomiting, and concomitant use of dairy products with ciprofloxacin should be avoided (Miernik et al., 2020). Both drugs are associated with abnormal liver function, hence the need to perform regular liver function tests. I would encourage the patient to be compliant with his medication and inform him that benign prostatic hyperplasia is common among older men and has a good prognosis. I would also recommend a urologist, nephrologist, and psychiatric consult for the patient.
References
- Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease Causes and Treatment. Molecules, 25(24). https //doi.org/10.3390/molecules25245789
- Choi, J. B., & Min, S. K. (2021). Complicated urinary tract infection in patients with benign prostatic hyperplasia. Journal of Infection and Chemotherapy Official Journal Of The Japan Society Of Chemotherapy, 27(9), 1284–1287. https //doi.org/10.1016/j.jiac.2021.06.006
- Miernik, A., & Gratzke, C. (2020). Current Treatment for Benign Prostatic Hyperplasia. Deutsches ÄRzteblatt International, 117(49), 843-854. https //doi.org/10.3238/arztebl.2020.0843
- Xie, R., Li, X., Li, G., & Fu, R. (2022). Diagnostic value of different urine tests for urinary tract infection A systematic review and meta-analysis. Translational Andrology and Urology, 11(3), 325-335. https //doi.org/10.21037/tau-22-65
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