84 year old woman who is been feeling fatigues for last 3 days and has had fever the last 24 hours

84 year old woman who is been feeling fatigues for last 3 days and has had fever the last 24 hours. she reports painful, burning sensation when she urinates as well as frequency of urination the last week. She is brought to the ED by her daughter and daughter states her mother didn't know what day it was. patient is mentally alert with no history of confusion.

Patient have History of: Diabetes type II, hyperlipidemia, hypertension, Gout.

patient medication: allopurinol 100mg BID, Colchicine 0.6 prn, Aspirin 81 mg once a day, simvastatin 20 mg once a day, metoprolol 25 mg two times a day, Lisinopril 10 mg daily.

 

patient Vital signs:  temp: 101.8, RR: 24, BP 128/82, O2: 98%, in room air. patient complains of right flank pain, achy, rated 5/10 and indicates continuous . When obtain orthostatic vital sign, supine BP 103/50, pulse 110. standing 92/42, pulse 132.

 

WBC: 13.2

Hgb:14.4

platelets: 246 u/L

Neutrophils: 93%

sodium: 140

potassium: 3.8

glucose: 184

BUN: 35

creatinine: 1.6

UA: abnormal results, cloudy, specific gravity 1.032, protein 2+, WBC greater than 200, nitrate positive, bacteria large .

 

 

What are clinical finding should be recognize and why?

 

what vitals sign is clinically significant and relevant and why?

 

Based on the data collected, patient will be diagnosed with what condition.

 

provider order:

initiate and maintain PIV

0.9% 1000 mL IV bolus

Acetaminophen  650 po q4 h prn

Ceftriaxone 1g IVPB

Morphine 2 mg IV push q2 h prn

 

what is the relationship between the following orders and the primary problems"

For the 84-year-old woman with fatigue, fever, dysuria, confusion, and abnormal lab results, here's a detailed analysis:Here is a detailed analysis regarding the 84-year-old woman complaint of fatigue, fever, dysuria, confusion and featuring abnormal lab results as follows;

 

 Some of the clinical findings described in this paper will also be explained.

 Fever (Temp: 101.  8°F):

 

 Significance: Goes to possible infection and this is in line with the dull abdominal pain dysuria and flank pain that she presented with. The higher temperature is a deep sign which can be used confirm an infection existing among a number of people.

 Confusion:

 

 Significance: New confusion in geriatric patient may be due to severe infection or sepsis in case other features of systemic inflammation like fever are also present.

 Right Flank Pain:

 

 Significance: Closely related to possible implication of the kidneys, for instance, acute pyelonephritis or acute kidney infection.

 Orthostatic Vital Signs:

 

 Supine BP: Cholesterol has been recorded as 103 for total cholesterol, 50 for LDL cholesterol while, pulse was 110.

 Standing BP: Refer to Core 92/42 and Pulse: 132

 Significance: Orthostatic hypotension is a reduction of bin BP when the individual is in a standing position and this is lower than the usual normal value for the patient and the cause includes both dehydration, sepsis and the two combined. It should be closely observed because it defines volume status or possibility of hypovolemia, sep mis.

 Lab Results:

 

 WBC: 13. 2 (Elevated): May indicate that microbial organisms or irritation of the area involved is present.

 Creatinine: 1. 6 (Elevated): Filters include evidence of kidney harm which may be secondary to infection or lack of volume in the body fluids.

 UA Abnormal Results: Infection presence of bacteriuria, cloudy urine, specific gravity greater than 1015, hematuria, WBC greater than 5 /BPF, nitrites and bacteria suggest in acute pyelonephritis.

 Clinically Significant Vital Signs

 Temperature:

 

 Relevance: If the patient’s temperature is rising the presence of infection is confirmed and may help in the diagnosis of UTI or pyelonephritis.

 Orthostatic Hypotension:

 

 Relevance: May reflect hypovolemia or severe infection as in sepsis The patient’s pulse rate also reflects that, therefore should not be left without attention.

 Elevated Pulse:

 

 Relevance: Tachycardia maybe physiological for several reasons including infection, dehydration or acute pain.

 Diagnosis

 Primary Diagnosis: Pyelonephritis. Therefore, fever, flank pain, dysuria, and chemical analysis assuring that UA is suspicious point at the probable UTI complicated with kidney.

 Overview of Orders by the Provider and as to How They Relate to Significant Issues

 Initiate and Maintain PIV (Peripheral Intravenous Line):IV (Peripherally Inserted Central Catheter) Insertion and and maintenance WHEN LABORING:

 

 Relationship: Very useful for the administration of fluids and medicine together assessing the patinet’s response to the administered treatment.

 0. 9% Normal Saline 1000 mL IV Bolus:9% Normal Saline 1000 mL IV Bolus:

 

 Relationship: For dealing with the possible symptoms of hydration and increasing the blood volume due to her orthostatic hypotension and raised creatinine levels.

 Acetaminophen 650 mg PO q4 h PRN:Acetaminophen 650 mg per os every four hours as needed:

 

 Relationship: In cases where there is fever or other complications which are associated with the fever with an aim of improving the comfort of the patient and in the process trying to reduce on the period of the fever.

 Ceftriaxone 1g IVPB (Intravenous Piggyback):Ceftriaxone 1g IVPB (Intravenous Piggyback):

 

 Relationship: Acute UTI to manage the infection and any renal inflection.

 Morphine 2 mg IV Push q2 h PRN:Morphine 2 mg IVP q 2 h as needed:

 

 Relationship: In order to manage moderate to severe pain particularly for her flank pain that was rated as on the level of 5. Pain management is vital due to patient’s comfort and to maintain health.

 Summary

 Due to recurrent fever, flank pain, dysuria, confusion, and other peculiar changes in urine examination, pyelonephritis can be considered prospectively. These are such orders as infection control orders, rehydration orders, pain management orders and any other orders to improve status of the patient.