The nurse is providing care for older adult clients in an extended care facility. Which patient should be monitored for signs of urosepsis?

The patient who has an indwelling catheter for a urinary tract infection (UTI)

The patient who is unable to obtain fluids independently

The patient who has surgery for placement of an ileostomy

The patient with continuous urinary incontinence

Answer and Explanation

The Correct Answer is A

Choice a reason: The patient who has an indwelling catheter for a urinary tract infection (UTI) is at the highest risk of developing urosepsis. Indwelling catheters provide a direct pathway for bacteria to enter the urinary tract, leading to infections that can escalate to sepsis. Monitoring this patient closely for signs of urosepsis, such as fever, chills, altered mental status, and increased heart rate, is crucial to ensure early detection and intervention.
Choice b reason: While the patient who is unable to obtain fluids independently is at risk for dehydration, which can lead to urinary tract infections, the immediate risk of urosepsis is lower compared to a patient with an indwelling catheter. Ensuring adequate fluid intake is important, but this condition does not present the same direct risk of bacterial entry into the urinary system as an indwelling catheter does.
Choice c reason: The patient who has undergone surgery for placement of an ileostomy does not have a direct connection to the urinary system that would increase the risk of urosepsis. While this patient might require monitoring for postoperative complications and hydration status, the focus is not specifically on urosepsis.
Choice d reason: The patient with continuous urinary incontinence is at risk for skin breakdown and potential urinary tract infections due to constant moisture and bacteria in contact with the skin. However, the risk of urosepsis is not as immediate or direct as it is with an indwelling catheter. Regular skin care and monitoring for signs of infection are necessary, but the focus on urosepsis is less urgent than for a patient with a catheter.

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Correct Answer is C

Explanation

Choice a reason: Maintaining IV fluids and encouraging oral fluids is important for patients with renal colic to ensure hydration and facilitate the passage of kidney stones. However, it is not the most immediate action to take for managing the patient's current condition, which includes severe pain and hematuria.
Choice b reason: Promoting assisted ambulation as tolerated can help in the movement and passage of kidney stones. Nevertheless, it is not the priority action to take initially when the patient is experiencing severe pain and there is a need to identify the cause of the hematuria.
Choice c reason: Straining urinary output and observing for stones is the most appropriate initial action. This allows the nurse to collect any stones that pass, which can then be analyzed to determine their composition. Understanding the type of stone can help in planning further treatment and preventive measures. Identifying and collecting the stones is crucial for proper diagnosis and management of renal colic.
Choice d reason: Administering prescribed narcotic medication is essential for managing severe pain associated with renal colic. Pain management is a critical component of care. However, while it is necessary, it should be accompanied by straining the urine to detect any stones and understand the underlying cause of the symptoms.

A. Laboratory results indicating a high level of an aminoglycoside B. A tumor obstruction diagnosed as being present in the right ureter C. A family history of polycystic kidney disease (PKD) D. Impaired blood flow to the kidneys

Correct Answer is D

Explanation

Choice a reason: Laboratory results indicating a high level of an aminoglycoside can point to nephrotoxicity, which is a type of intrinsic renal injury. Aminoglycosides are antibiotics that can be toxic to the kidneys, causing damage to renal tissues. This condition is different from prerenal injury, which is related to reduced blood flow to the kidneys, not direct damage from toxins.
Choice b reason: A tumor obstruction in the right ureter is indicative of postrenal injury, which occurs due to obstruction of urine flow anywhere along the urinary tract. This kind of injury does not fall under the category of prerenal injury, which is due to factors causing reduced perfusion to the kidneys.
Choice c reason: A family history of polycystic kidney disease (PKD) suggests a genetic predisposition to intrinsic renal disease. PKD is a hereditary condition that leads to the formation of cysts in the kidneys, eventually impairing their function. This type of injury is not prerenal, as it results from structural abnormalities within the kidney itself.
Choice d reason: Impaired blood flow to the kidneys is the hallmark of prerenal injury. Prerenal injuries are caused by conditions that reduce renal perfusion, such as dehydration, heart failure, or shock. When the kidneys receive insufficient blood flow, they cannot function properly, leading to symptoms of renal insufficiency. Addressing the underlying cause to restore adequate blood flow is crucial in managing prerenal injury.

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The nurse is providing care for older adult clients in an extended care facility. Which patient should be monitored for signs of urosepsis?

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