A patient has Human Immunodeficiency Virus infection and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study results?

A) Obtain samples for urine culture and urinalysis:
This is the first priority. The symptoms described—urinary frequency, dysuria (painful urination), and fever—are suggestive of a urinary tract infection (UTI). To confirm the diagnosis and identify the causative organism, it is critical to obtain a urine sample for both a urinalysis and urine culture. The culture will help guide antibiotic therapy once the organism is identified. This is the foundational step before initiating any treatment. The results will also help determine whether the infection is localized or more severe, like a pyelonephritis
or systemic infection.

B) Insert a Foley catheter:
Inserting a Foley catheter may be necessary if the patient is unable to void, but it is not the first intervention in this case. A Foley catheter is generally used for urinary retention or if monitoring of urine output is necessary. In the context of suspected UTI symptoms, a Foley catheter should only be inserted if there is a clear need, not just for the convenience of obtaining a sample. Additionally, inserting a Foley catheter could introduce bacteria if the patient is not already catheterized and should therefore be avoided unless medically indicated.

C) Begin broad-spectrum IV antibiotics:
While starting antibiotics is important in treating a suspected UTI, especially in the presence of fever and potential infection, obtaining a urine sample for culture and urinalysis should be done first. This allows the healthcare team to tailor antibiotic therapy based on the culture results, reducing the risk of unnecessary or incorrect antibiotic use. If the patient is febrile and appears severely ill, broad-spectrum antibiotics may be started after obtaining the urine sample, but the culture and urinalysis must still be prioritized.

D) Prepare the client for a CT scan:
While imaging studies like a CT scan may be helpful in evaluating for complications, they are not the first step in managing the patient’s symptoms. Obtaining the urine sample and identifying whether an infection is present is essential for guiding further management. A CT scan may be ordered later if the clinical suspicion for complications remains high after the initial evaluation and lab results.

A. GERD:
Gastroesophageal reflux disease (GERD) typically presents with symptoms such as heartburn, regurgitation, and chest pain. It is not related to head trauma or the symptoms described, such as severe headache, vomiting, seizure, and unresponsiveness. GERD is not associated with a fall or neurological events, making it an unlikely diagnosis in this scenario.

B. Hemorrhagic stroke:
A hemorrhagic stroke is a strong suspicion in this case, given the client’s recent fall, the report of a severe headache, vomiting, followed by a seizure and loss of consciousness. These are classic symptoms of increased intracranial pressure, which may result from bleeding in the brain, such as from a hemorrhagic stroke. The client’s hypertension (248/120 mmHg) further increases the risk of a hemorrhagic stroke, particularly in someone on long-term Warfarin, which increases the risk of bleeding. The seizure and unresponsiveness are concerning signs of significant brain injury, and a CT scan or MRI would be essential for confirming this diagnosis.
C. Septic shock:
Septic shock presents with hypotension, fever, tachycardia, and signs of infection. While the client’s elevated temperature (99.2 F) and pulse (102/min) are abnormal, they are not out of proportion to what would be expected with a head injury and potential hemorrhage. Septic shock is unlikely without signs of infection or systemic inflammatory response. The presence of a seizure, headache, and vomiting after trauma suggests a neurological emergency, not sepsis.

D. Absence seizure:
Absence seizures are brief, non-convulsive seizures characterized by a sudden interruption of consciousness, often with a blank stare and lack of motor activity. These seizures are typically seen in younger individuals and are not associated with symptoms such as a severe headache, vomiting, or unresponsiveness following head trauma. The client’s seizure, along with other concerning signs (headache, vomiting, high blood pressure), suggests a more serious neurological event like a hemorrhagic stroke rather than a simple seizure disorder.