A patient with acute pyelonephritis is admitted to the hospital. Despite initial treatment, her condition worsens, with increased abdominal pain, fever, and decreased urine output. Which nursing intervention is the most critical to prioritize for this patient to prevent further complications?

A) Administering intravenous fluids as ordered to address dehydration.

B) Monitoring vital signs every 4 hours to track changes in her condition.

C) Administering antiemetics to control nausea and prevent vomiting.

D) Preparing the patient for a possible switch to a broader-spectrum antibiotic.

A patient with a worsening urinary tract infection is suspected of having acute pyelonephritis, as indicated by increased lower abdominal pain radiating to the right flank, persistent fever, and elevated heart rate. Which intervention should the nurse prioritize to prevent further deterioration of the patient's condition?

A) Administer prescribed intravenous fluids to manage dehydration and improve kidney perfusion.

B) Encourage the patient to increase oral fluid intake to promote kidney function.

C) Monitor the patient's temperature every four hours to track fever progression.

D) Educate the patient on the importance of completing the entire course of antibiotics.

A patient with confirmed bacteremia secondary to Escherichia coli infection is experiencing fluctuations in temperature, increased heart rate, and respiratory rate, with a recent drop in oxygen saturation to 92%. What is the most appropriate immediate nursing intervention to prioritize in this clinical scenario?

A) Increase the rate of intravenous fluids to manage potential septic shock.

B) Administer antipyretics to reduce the patient's fever.

C) Monitor the patient's blood glucose levels closely.

D) Elevate the head of the bed to improve respiratory status.

A nurse is caring for a patient diagnosed with bacteremia caused by Escherichia coli, which is resistant to ciprofloxacin. The patient is currently on intravenous meropenem. The patient's lactate level is elevated, and there is a concern for sepsis. Which nursing intervention is the most critical to implement at this time to prevent further complications?

B) Initiating aggressive fluid resuscitation to maintain tissue perfusion

A) Administering antipyretics to manage the patient's fever

B) Initiating aggressive fluid resuscitation to maintain tissue perfusion

C) Monitoring blood glucose levels to detect hyperglycemia

D) Positioning the patient in a high Fowler's position to optimize breathing

A patient with sepsis is experiencing hypotension despite aggressive fluid resuscitation and is now on a norepinephrine infusion. Her oxygen saturation has decreased to 89% and serum lactate levels have increased. What is the priority nursing action in managing this patient’s condition?

B) Apply a non-rebreather mask to improve oxygen saturation.

A) Increase the rate of norepinephrine infusion to stabilize blood pressure.

B) Apply a non-rebreather mask to improve oxygen saturation.

C) Initiate continuous renal replacement therapy to manage kidney injury.

D) Reassess the need for additional fluid boluses to improve perfusion.

A patient with sepsis is experiencing hypotension and hypoxia despite ongoing treatment. Which of the following interventions should the nurse prioritize to address the patient's respiratory compromise?

B) Transition from a non-rebreather mask to mechanical ventilation support.

A) Increase the rate of norepinephrine infusion to stabilize blood pressure.

B) Transition from a non-rebreather mask to mechanical ventilation support.

C) Administer additional fluid boluses to improve tissue perfusion.

D) Initiate continuous renal replacement therapy to manage acute kidney injury.

A patient with suspected acute respiratory distress syndrome (ARDS) is being considered for mechanical ventilation. Which of the following interventions should the nurse prioritize to minimize further lung injury in this patient?

B) Implement low tidal volume ventilation strategy.

A) Increase tidal volume to improve ventilation.

B) Implement low tidal volume ventilation strategy.

C) Administer high concentrations of oxygen to maintain SpO2 above 95%.

D) Use high levels of positive end-expiratory pressure (PEEP) without monitoring for barotrauma.

A patient with suspected acute respiratory distress syndrome (ARDS) is experiencing persistent hypotension and compensatory tachycardia despite norepinephrine infusion. Her oxygen saturation remains low with bilateral crackles on auscultation. Which of the following interventions should the nurse prioritize to address her current respiratory condition?

B) Prepare for intubation and mechanical ventilation using lung-protective strategies.

A) Increase the flow rate of the non-rebreather mask to improve oxygenation.

B) Prepare for intubation and mechanical ventilation using lung-protective strategies.

C) Administer an additional dose of norepinephrine to stabilize blood pressure.

A patient with a persistent urinary tract infection has elevated C-reactive protein and procalcitonin levels, indicating a systemic inflammatory response. Despite broad-spectrum antibiotics, blood cultures remain positive for Escherichia coli. The patient also shows signs of worsening acute kidney injury with decreased urine output and increased serum creatinine. Which nursing intervention should be prioritized to address the patient's current clinical condition?

A) Increase the frequency of vital signs monitoring to detect early signs of septic shock.

B) Encourage oral fluid intake to improve renal perfusion.

C) Administer a diuretic to manage fluid overload and improve urine output.

D) Prepare the patient for intermittent hemodialysis as ordered by the nephrology team.

A patient with sepsis and acute kidney injury is not responding to broad-spectrum antibiotics with persistent positive blood cultures for Escherichia coli. The patient's renal function continues to deteriorate despite adjustments to continuous renal replacement therapy (CRRT). Which nursing intervention is most important to prioritize in this situation?

B) Collaborate with the healthcare provider to review and possibly adjust the antibiotic regimen.

A) Initiate a fluid bolus to improve renal perfusion.

B) Collaborate with the healthcare provider to review and possibly adjust the antibiotic regimen.

C) Increase the frequency of vital sign monitoring to every 15 minutes.

D) Educate the patient and family about the importance of completing the antibiotic course.

UTI - Nursing Case Study

Pathophysiology

• Primary mechanism: Uropathogenic bacteria, primarily Escherichia coli, ascend through the urethra into the bladder, adhering to the uroepithelium using fimbriae, which facilitates colonization and infection.

• Secondary mechanism: The host immune response is activated, resulting in inflammation and release of cytokines, leading to symptoms such as dysuria, increased frequency, and urgency. This inflammatory response can cause bladder irritation and contribute to the clinical manifestations of a UTI.

• Key complication: If untreated, the infection can ascend to the kidneys, causing pyelonephritis, characterized by fever, flank pain, and potential renal damage, increasing the risk of sepsis and systemic involvement, especially in vulnerable populations.

Patient Profile

Demographics:

35-year-old female, office manager

History:

• Key past medical history: Recurrent urinary tract infections, history of kidney stones

• Current medications: Ciprofloxacin, Ibuprofen as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased urinary frequency and burning sensation

• Key symptoms: Lower abdominal pain, fever, chills, cloudy urine with a strong odor

• Vital signs: Temperature: 101.3°F, Heart Rate: 110 bpm, Blood Pressure: 135/85 mmHg, Respiratory Rate: 22 breaths per minute

Section 1

Change in Patient Status:

Over the next 24 hours, the patient's condition begins to worsen despite initial antibiotic therapy with Ciprofloxacin. She reports an increase in the intensity of her lower abdominal pain, which now radiates to her right flank, suggestive of possible renal involvement. Her fever persists, climbing to 102.5°F, and she experiences episodes of nausea and vomiting, further complicating her hydration status. Upon reassessment, her heart rate has increased to 120 bpm, and her respiratory rate is elevated at 24 breaths per minute. Her blood pressure remains stable at 130/80 mmHg, but there is a noted decrease in urine output, with her urine appearing darker and more concentrated.

A repeat urinalysis shows a significant increase in white blood cells and the presence of white blood cell casts, indicating possible pyelonephritis. The complete blood count reveals leukocytosis with a white blood cell count of 15,000/mm³, and a blood chemistry panel shows elevated creatinine levels at 1.5 mg/dL, suggesting impaired renal function. These findings, coupled with her clinical presentation, indicate that the infection may have ascended to the kidneys, leading to a diagnosis of acute pyelonephritis. The patient is at an increased risk for the development of sepsis, given her elevated heart rate and fever, necessitating prompt escalation of care.

In response to these concerning developments, the healthcare team decides to admit the patient to the hospital for intravenous antibiotic therapy and further monitoring. The possibility of switching to a broader-spectrum antibiotic, considering her penicillin allergy, is discussed. Additionally, supportive care measures, including intravenous fluids for rehydration and antiemetics for nausea, are initiated to stabilize her condition. The team closely monitors her kidney function and vital signs to catch any signs of further deterioration early, aiming to prevent progression to more severe systemic complications.

Section 2

Over the next 12 hours, the patient’s condition continues to evolve despite the initiation of intravenous antibiotic therapy and supportive measures. Her fever persists, fluctuating between 101°F and 103°F, and she remains tachycardic with a heart rate consistently around 118-122 bpm. Her respiratory rate has increased slightly to 26 breaths per minute, indicating possible respiratory compensation for metabolic changes. Although her blood pressure remains stable, her oxygen saturation drops to 92% on room air, prompting the healthcare team to administer supplemental oxygen via nasal cannula to maintain adequate oxygenation.

New laboratory results raise further concerns. The patient’s blood cultures, drawn upon hospital admission, return positive for Escherichia coli, confirming bacteremia. The sensitivity report indicates resistance to ciprofloxacin, which explains the lack of improvement with initial therapy. Consequently, the team transitions her to intravenous meropenem, a broad-spectrum carbapenem antibiotic suitable for her penicillin allergy. Additionally, her serum lactate levels are noted to be elevated at 2.8 mmol/L, suggesting a heightened risk of sepsis.

In light of these developments, the healthcare team prioritizes vigilant monitoring for signs of septic shock, such as hypotension or further organ dysfunction. They also consider the need for consultation with a nephrologist due to her impaired renal function, as indicated by an increasing creatinine level now at 1.8 mg/dL. The focus shifts to ensuring adequate tissue perfusion and preventing further complications, with a comprehensive plan that includes aggressive fluid resuscitation, continued evaluation of her response to the new antibiotic regimen, and frequent reassessment of her vital signs and laboratory parameters. This proactive approach aims to stabilize her condition and prevent the progression to severe sepsis or multi-organ failure.

Section 3

Over the following hours, the patient exhibits a notable change in her clinical status, prompting further evaluation by the healthcare team. Her blood pressure begins to trend downward, with readings dropping to 98/60 mmHg, despite aggressive fluid resuscitation efforts. This hypotensive episode indicates potential progression towards septic shock, warranting immediate intervention. The team initiates a norepinephrine infusion to maintain adequate perfusion and prevent further hypotension. Concurrently, her respiratory status deteriorates as her oxygen saturation decreases to 89% on the nasal cannula, necessitating an escalation to a non-rebreather mask to ensure adequate oxygen delivery.

New diagnostic results reveal a further increase in serum lactate levels to 3.5 mmol/L, underscoring the urgency of the situation and suggesting worsening tissue hypoperfusion. Her renal function continues to decline, with creatinine rising to 2.2 mg/dL, indicating acute kidney injury likely exacerbated by sepsis. Given these developments, the healthcare team expands their focus to include potential complications such as acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), necessitating interdisciplinary collaboration with pulmonary and nephrology specialists.

In response to these complications, the patient's care plan is adjusted to include continuous renal replacement therapy (CRRT) to manage her renal failure while avoiding fluid overload. Additionally, close hemodynamic monitoring and frequent reassessment of her respiratory status are prioritized to prevent further deterioration. The patient’s critical status highlights the need for ongoing, dynamic clinical reasoning and vigilance to stabilize her condition and mitigate the risk of multi-organ failure. This proactive, multidisciplinary approach aims to optimize her chances for recovery as the team continues to navigate the complexities of her evolving condition.

Section 4

As the healthcare team continues to manage the patient’s condition, there is a notable change in her status over the next several hours. Despite the norepinephrine infusion, her blood pressure remains labile, occasionally dropping to 92/58 mmHg, indicating persistent vasopressor dependency. Her heart rate has increased to 118 beats per minute, suggesting compensatory tachycardia in response to her hypotensive state. Clinicians are concerned about the risk of further hemodynamic instability and the potential progression to septic shock, which necessitates a reevaluation of her current treatment regimen.

Additionally, the patient's respiratory status continues to be a significant concern. Even with the non-rebreather mask, her oxygen saturation fluctuates between 88% and 90%. Auscultation reveals bilateral crackles, raising suspicion for developing acute respiratory distress syndrome (ARDS). A chest X-ray is ordered and demonstrates diffuse bilateral infiltrates consistent with ARDS. To optimize oxygenation and reduce the risk of ventilatory failure, the team considers transitioning her to mechanical ventilation with a focus on lung-protective strategies, such as low tidal volume ventilation, to minimize further lung injury.

In response to these new complications, the healthcare team intensifies their collaborative efforts, involving both pulmonary and critical care specialists to refine her respiratory management plan. They initiate corticosteroid therapy to address the inflammatory response associated with ARDS. Concurrently, nephrology continues to monitor her renal status closely, adjusting the CRRT parameters to support her renal function while maintaining fluid balance. The team remains vigilant, frequently reassessing her clinical status and laboratory parameters, to adapt her treatment plan dynamically and mitigate the risk of further organ dysfunction. This comprehensive approach underscores the importance of interdisciplinary collaboration and proactive clinical reasoning in navigating the complex challenges of her evolving condition.

Section 5

As the healthcare team closely monitors the patient's response to the intensified treatment regimen, new diagnostic results provide further insights into her condition. Laboratory tests reveal a significant elevation in inflammatory markers, including a C-reactive protein (CRP) level of 23 mg/L and a procalcitonin level of 15 ng/mL, suggestive of a pronounced systemic inflammatory response. Blood cultures remain positive for Escherichia coli, confirming the persistence of the underlying urinary tract infection as the source of sepsis. Despite broad-spectrum antibiotic therapy, these results indicate the need for reassessment of the antimicrobial strategy, possibly considering the addition of an aminoglycoside to enhance bacterial clearance.

In parallel, the patient's renal function shows signs of further deterioration. Her serum creatinine has increased to 3.2 mg/dL, and the urine output has decreased to 15 mL/hour, despite adjustments to the continuous renal replacement therapy (CRRT) settings. These findings suggest a worsening acute kidney injury, likely exacerbated by ongoing hemodynamic instability and sepsis-related renal insult. The nephrology team debates the potential benefits of initiating intermittent hemodialysis to more aggressively manage fluid overload and remove inflammatory mediators, which could potentially alleviate some of the stress on her compromised renal system.

These evolving clinical challenges necessitate a reassessment of the patient's overall management plan. The team considers the possibility of septic shock progression and recognizes the need for a multi-faceted approach to stabilize her condition. This involves not only optimizing antibiotic therapy but also ensuring meticulous hemodynamic monitoring and support, addressing respiratory insufficiency, and preventing further renal compromise. The collaboration among the interdisciplinary team remains crucial, as they continue to navigate the complexities of the patient's condition, aiming to achieve stabilization and ultimately, recovery.