INFECTION JUNE 2024.docx

**INFECTION** **OBJECTIVES** 1\. Identify factors contributing to upper and lower urinary tract infections (UTIs) 2\. Describe the clinical manifestations, nursing management, complications, and prevention of upper or lower urinary tract infection. 3\. Explain the medical management for patien...

**INFECTION** **OBJECTIVES** 1\. Identify factors contributing to upper and lower urinary tract infections (UTIs) 2\. Describe the clinical manifestations, nursing management, complications, and prevention of upper or lower urinary tract infection. 3\. Explain the medical management for patients with upper or lower urinary tract infections 4\. Describe the risk factors, clinical manifestations, nursing management, complications, and prevention of COVID. 5\. Explain components of the medical management for patients with COVID 6\. Define sepsis and explain its underlying pathology. 7\. Identify patients at risk for sepsis. 8\. Describe the early clinical manifestations to indicate a patient may be developing sepsis including the use of the Q sofa screening tool 9\. Identify the components of the Hour 1 Sepsis Bundle and explain the rationale for each component. 10\. Identify additional interventions in the plan of care for patients with Sepsis. **CH.8 pg 188 Increased Susceptibility to Infection** - loss of physiologic reserve and chronic illnesses also contribute to increased susceptibility. - Pneumonia, UTIs, GI infections, and skin infections are some of the common infections in older adults. - Because of a weakened immune response, the effects of influenza and pneumococcal infections on older adults are significant. Vaccination can help prevent both infections. Influenza and pneumococcal vaccinations lower the risks of hospitalization and death in older adults - Influenza should be given early Autum - The response to pain in older adults may be lessened because of reduced acuity of touch, alterations in neural pathways, and diminished processing of sensory data. - The baseline body temperature for older adults is about 1°F lower than it is for younger people - A temperature of 37.8°C (100°F) in combination with systemic symptoms may signal infection. A temperature of 38.3°C (101°F) almost certainly indicates a serious infection that needs prompt attention - Older adults admitted to the hospital are at high risk for disorientation, confusion, change in level of consciousness, and other symptoms of delirium, as well as anxiety and fear. - Older adults may be unable to respond effectively to an acute illness or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. **CH.49 pg 1604-1611 UTI** - A UTI is the second most common infection in the body - UTI most common infection in older adults - UTI happens more frequently in women - Lower UTI more common than upper UTI (bladder & urethra) - Upper UTI most common for urosepsis (kidney & ureters) - Fifty percent of all hospital-acquired infections are UTIs, and in the majority of cases these are catheter-associated urinary tract infections (CAUTI)= ongoing monitoring is a UTI that occurs while the patient had an indwelling urinary catheter in place for more than 2 calendar days on the day that the infection was detected. - CAUTI- Patients with UTIs are at increased risk for gram-negative sepsis. For each day a - urinary catheter is in place, the risk of developing CAUTI increases by 3% to 7% per day of catheterization. The Centers for Medicare and Medicaid Services has classified a CAUTI as a "never event" which means no reimbursement to pay for the cost of treatment will be covered by CMS - Lower UTIs include bacterial [cystitis] (inflammation of the urinary bladder), [bacterial prostatitis] (inflammation of the prostate gland), and [bacterial urethritis] (inflammation of the urethra). - UTI RISK FACTORS- Female gender. Diabetes, Pregnancy. Neurologic disorders, Gout, Altered states caused by incomplete emptying of the bladder and urinary stasis, Decreased natural host defenses or immunosuppression, Inability or failure to empty the bladder completely, Inflammation or abrasion of the urethral mucosa, Instrumentation of the urinary tract (e.g., catheterization, cystoscopic procedures), - RISK FACTORS Obstructed urinary flow caused by: Congenital abnormalities, Urethral strictures, Contracture of the bladder neck, Bladder tumors, Calculi (stones) in the ureters or kidneys, and Compression of the ureters - An obstruction to free-flowing urine is a condition known as urethrovesical reflux, which is the reflux (backward flow) of urine from the urethra into the bladder. With coughing, sneezing, or straining, the bladder pressure increases, which may force urine from the bladder into the urethra. - Ureterovesical or vesicoureteral reflux refers to the backward flow of urine from the bladder into one or both ureters - **Bacteria enter the urinary tract in three ways**: by the t[ransurethral] route (ascending infection), through the [bloodstream] (hematogenous spread), or by means of a [fistula] from the intestine (direct extension). - **The most common route of infection is transurethral**, - Signs and symptoms of an uncomplicated lower UTI include burning on urination, urinary frequency (voiding more than every 3 hours), urgency, nocturia (awakening at night to urinate), incontinence, and suprapubic or pelvic pain. Hematuria and back pain may also be present. These symptoms are less common in older adults - any patient with a catheter who suddenly develops signs and symptoms of septic shock should be evaluated for urosepsis (the spread of infection from the urinary tract to the bloodstream that results in a systemic infection). - UTI infection most common infection in older adults and more frequently in women because of a shorter urethra and penile vaginal intercourse - Neurogenic bladder- no control or sensation to void. Pt has to self cath - The use of catheterization or cystoscopy in evaluation or treatment for prostatic hyperplasia or carcinoma, strictures of the urethra, and neuropathic bladder may contribute to the higher incidence of UTIs in men. The most common cause of recurrent UTIs in older males is chronic bacterial prostatitis. - Factors That Contribute to Urinary Tract Infection in Older Adults- cognitive impairments, immunocompromised, immobility, incomplete bladder emptying, low fluid intake, excessive fluid loss, obstruction of flow, poor hygiene, multiple chronic conditions, frequent use of antimicrobial agents. The organisms responsible for UTIs in older adults residing in institutions may differ from those found in patients residing in the community; this is thought to result in part from the frequent use of antibiotic agents by patients in long-term care facilities - [Escherichia coli is the most common organism seen in older patients in the community or hospital]. However, patients with [indwelling catheters are more likely to be infected with organisms such as Proteus, Klebsiella, Pseudomonas, or Staphylococcus]. Patients who have been [previously treated with antibiotics may be infected with Enterococcus] species. - S/S - Early symptoms of UTI postmenopausal women and older adults include malaise, nocturia, urinary incontinence, or a complaint of foul-smelling urine. Additional early symptoms include burning, urgency, and fever. Some patients develop incontinence and delirium with the onset of a UTI. - TREATMENT/ GOALS/INTERVENTIONS- antibiotics, increased fluids, i&O, monitor kidney function, Antispasmodic agents may also be useful in relieving bladder irritability and pain, Analgesic agents and the application of heat to the perineum help relieve pain and spasm. Prevent pain, analgesics, cranberry juice or capsules, fluids, [The goal of treatment is to prevent infection from progressing and causing permanent kidney damage and injury, Major goals for the patient may include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications.] - DIAGNOSTICS- [culture, urine sample, bacterial colony counts.] UTI is diagnosed by bacteria in the urine culture. A colony count greater than 100,000 CFU/mL of urine on a clean-catch midstream or catheterized specimen indicates infection. Microscopic [hematuria] is present in about half of patients with an acute UTI, [Pyuria] (white blood cells \[WBCs\] in the urine) occurs in all patients with UTI; [dipstick, STD test], A [CT scan] may detect pyelonephritis or abscesses. [Ultrasonography] and kidney scans are extremely sensitive for detecting obstruction, abscesses, tumors, and cysts - MANAGEMENT- [antibiotics table 49.1 pg 1607]. uncomplicated lower UTIs in women: single-dose administration, short-course (3-day) regimens, or 7-day regimens, most cases are cured after 3 days of treatment, occasional hospitalization IV , daily intake of cranberry=1 glass a day, especially in the form of capsules, Periodic monitoring of renal function - ASSESSMENT- changes in urine, pain, frequency, contraceptives, hygiene, pt knowledge, potential complications- urosepsis, Early recognition of UTI and prompt treatment, labs, v/s, alert, LOC, kidneys, - EDUCATION- Urinary tract irritants (e.g., coffee, tea, citrus, spices, colas, alcohol) should be avoided. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely, because doing so can lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. recognize early signs and symptoms, The patient is instructed to notify the primary provider if fatigue, nausea, vomiting, fever, or pruritus occurs. Table 49.3 pg 1609 =hygiene wipe front to back, shower rather than bathe, 1 glass a day cranberry juice, take meds as prescribed, reoccurring= long term antimicrobial therapy, void after sex, f/u with provider - The micturition (voiding or urination) process involves several highly coordinated neurologic responses that mediate bladder function **CH.11 pg 273-285, 290-296** - sepsis: [life-threatening] organ dysfunction caused by a dysregulated host response to infection. [Systemic inflammation due to an infection]. - Severe sepsis- [organs stop working] - septic shock: [when BP drops, heart rate is up.] a subset of sepsis in which underlying circulatory and cellular metabolic abnormalities are profound enough to substantially increase mortality. Septic shock, the most common type of distributive shock, is caused by widespread infection or sepsis. - If shock is not effectively treated, multiple organ dysfunction syndrome (MODS) which is the presence of altered function of two or more organs in an acutely ill patient such that interventions are necessary to support continued organ function may ensue, often resulting in patient death. [MODS may be a complication of any form of shock but is most commonly seen in patients with sepsis]. - Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These [physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response. ] - The pathophysiology of shock involves cellular changes, vascular responses, and changes in blood pressure. In shock, the cells lack an adequate blood supply and are deprived of oxygen and nutrients; - PATHOPHYSIOLOGY Sepsis results when the response to infection becomes generalized and involves normal tissues remote from the site of injury or infection. Severe sepsis is defined by dysfunction of one of the major organ systems or unexplained metabolic acidosis. - STAGES OF SHOCK: compensatory (stage 1), progressive (stage 2), and irreversible (stage 3). The earlier that interventions are initiated along this continuum, the greater the patient's chance of survival. 1. STAGE 1 SHOCK 2. STAGE 2 SHOCK 3. STAGE 3 SHOCK - RISK FACTORS SEPTIC SHOCK- Immunosuppression, Extremes of age (\65 y), over 65 more likely, very young, very old, chronic conditions, Malnourishment, Chronic illness (diabetes, hepatitis, kidney disease, immune defiency), Invasive procedures, Emergent and/or multiple surgeries, increased use of invasive procedures and indwelling medical devices, the increased number of antibiotic-resistant microorganisms, and the aging population, healthy, cancer, liver disease - Older adult patients are at particular risk for sepsis because of decreased physiologic reserves, an aging immune system, comorbid conditions and often nonspecific presentation of infection - S/S- Sepsis is an evolving process that may result in septic shock and life-threatening organ dysfunction if not recognized and treated early. In the [early stage of septic shock], 1. BP may remain within normal limits, or the patient may be hypotensive but responsive to fluids. 2. The heart rate increases, progressing to tachycardia. 3. Hyperthermia and [fever, chills, feeling cold], with warm, [pale, flushed skin] and 4. bounding pulses, are present. 5. The respiratory rate is elevated. [SOB] 6. Urinary output may remain at normal levels or decrease. 7. GI status may be compromised, as evidenced by nausea, vomiting, diarrhea, or decreased gastric motility. 8. Hepatic dysfunction is evidenced by rising bilirubin levels and worsening coagulopathies (e.g., decreasing platelet counts). 9. Signs of hypermetabolism include increased serum glucose and insulin resistance. 10. Subtle changes in mental status, such as confusion or agitation, may be present. 11. The lactate level is elevated because of the maldistribution of blood. Inflammatory markers such as WBC counts, plasma C-reactive protein (CRP), and procalcitonin levels are also elevated 12. [Extreme pain or discomfort ] 13. [Sleepy or difficult to arouse ] 14. ["I feel like im dying"] - Video warning signs 1. Problems breathing 2. Fast heart rate, high temp, fever, chills 3. Dizzy or lightheaded 4. Changes in LOC (confusion or difficult to aurose) 5. Survivor's-disabilities, amputations, memory, calculations, PTSD, problems with thinking - As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the patient begins to show signs of organ dysfunction. - SEPSIS PROGRESS TO SHOCK- As sepsis progresses, [tissues become less perfused] and [acidotic], compensation begins to fail, and the patient [begins to show signs of organ dysfunction]. The [cardiovascular system also begins to fail], the BP does not respond to fluid resuscitation and vasoactive agents, and [signs of end-organ damage are evident] (e.g., AKI, pulmonary dysfunction, hepatic dysfunction, confusion progressing to nonresponsiveness). As sepsis progresses to septic shock, the [BP drops] and the [skin becomes cool, pale, and mottled.] [Temperature may be normal or below normal]. [Heart and respiratory rates remain] [rapid. Urine production ceases], and multiple organ dysfunction [progressing to death] occurs. - TREATMENTS & INTERVENTIONS 1. [rapid identification] and elimination of the cause of infection. goals are to identify and initiate treatment for patients in early sepsis within 1 hour to optimize patient outcomes. Specimens of blood, sputum, urine, wound drainage, and tips of invasive catheters are collected for culture using aseptic technique. 2. [Fluid replacement.] An initial fluid challenge, which includes an IV infusion of at least 30 mL/kg of crystalloids over 30 minutes, may be required to aggressively treat sepsis-induced tissue hypoperfusion. In addition to monitoring BP, patient mentation, respiratory rate, fluid responsiveness after PLR, urine output, and serum lactate levels are monitored to assess effectiveness of fluid resuscitation. 3. If the infecting organism is unknown, [broad-spectrum] [antibiotic] agents are started until culture and sensitivity reports are received ( google= clindamycin, aminoglycosides, cephlaosporins, pennicillins, daptomycin, azithromycin, pipercillin) 4. [Vasopressors], inotropic agents, [packed red blood cells], Neuromuscular blockade agents and sedation agents, ([DVT) prophylaxis] with low-dose unfractionated heparin or low-molecular-weight heparin, in combination with mechanical prophylaxis[, ulcer prophylaxis] 5. Temperature 6. Oxygen 7. Insulin 8. Pain meds 9. Aggressive nutritional supplementation should be initiated within 24 to 48 hours of ICU admission to address the hypermetabolic state present with septic shock - 1 HOUR SEPSIS BUNDLE- Recognize s/s of sepsis or septic shock 1. [Measure lactate] levels (remeasure if greater than 2 mmol) 2. [Blood cultures] before giving antibiotics 3. [Broad spectrum antibiotics] (once culture identifies bacteria give specific ATB) 4. 30ml/kg [Rapid IV crystalloid fluids] (0.9% NaCL for hypotension or give lactated ringers greater than 4 mmol) 5. [Vasopressors] if hypotensive during or after fluid resuscitation to maintain arterial pressure greater than or = to 65 mm Hg (vasopressors= 1^st^ line defense norepinephrine, dopamine, epinephrine) - Q-SOFA SCREENING TOOL- pg 294, table 11.4 1. Qsofa= non ICU patient 2. Sofa= ICU patient 3. Greater than or =2 greater risk for a poor outcome, altered mental status, tachypnea greater than 22, systolic less than 100 4. GLASCOW SCALE- lower the score, lower level, of consciousness. 15 best responses. 8 or less comatose. 3 totally unresponsive (table 38.2) **CH.66 pg 2144-2163,** **CH.66 2171-2173 COVID** - COVID RISK FACTORS- - COVID S/S- fever, chills. Sob, fatigue, loss of smell or taste, sore throat, congestion, runny nose, headache, muscle aches, n,v,d - COVID COMPLICATIONS - COVID MANAGEMENT- oxygen, cardiorespiratory monitoring, endotracheal intubation, oral or nasal intubation, mechanical ventilation = deep sedation, ecmo, suctionng - Diagnostics- PCR TEST- PCR means polymerase chain reaction. It\'s a test to detect genetic material from a specific organism, such as a virus. The test detects the presence of a virus if you have the virus at the time of the test. The test could also detect fragments of the virus even after you are no longer infected. Nasopharynx, blood, bronchoscopy- last resort - Treatment- medications= Remdesivir, Corticosteroids, Bamlanivimab, clinical trials, **1 MINUTE NURSE** Which are interprofessional goals of treating sepsis? Select all that apply. Interprofessional goals for treating sepsis are to prevent and treat infection, maintain tissue oxygenation, provide nutritional and metabolic support, support failing organs, and to keep the MAP above 65 mm Hg Which statement is true regarding drawing blood cultures? The nurse should always draw both sets of blood cultures before administering antibiotics to ensure that the best unaltered sample is obtained. **[Which is not]** a potential source of an infection that could cause sepsis[? Atherosclerosis does not cause sepsis.] Central venous access devices, COVID-19, and a wound like a stage 4 pressure injury are all potential sources of infections that lead to sepsis. Which patient is at the highest risk for developing sepsis? People who are immunocompromised, older adults, have chronic illnesses, or have undergone invasive procedures and emergent and/or multiple surgeries are at the highest risk for developing sepsis. In this group, the patient admitted for end-stage kidney disease is at a higher risk than the patient with nephrolithiasis, the patient giving birth, or the patient who is awaiting a procedure Which description best characterizes sepsis? Sepsis is the body\'s extreme response to infection. It affects the full body and is not localized. It affects more than the skin and lymph nodes and while it can develop postoperatively, it can also develop due to other reasons. **RANDOM PREP-U** **The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client?** Coffee in the morning **LECTURE NOTES** - UTI ATB= Cipro, amoxicillin, Levaquin - 2L water/fluids a day- uti - [Pyridium (phenazopyridine) turs urine reddish orange], used for pain and discomfort - Positive for Nitrates in urine - \#1 cause of death in hospital= sepsis - Sepsis- low urine output, cbc (wbc), cmp/bmp= electrolytes & kidney function, d dimer for clot formation, cactive proteien for inflammation, protein= bacteria - Vasopressors= dopamine p295, norepinephrine, and 1. if MAP is inadequate despite low-to-moderate norepinephrine \> add vasopressin 2. if cardiac dysfunction with persistent hypoperfusion is present despite adequate volume status and blood pressure \> add dubatamine or epinepherine - Qsofa no longer recommended - MEWS- modified early warning score evaluates the patients physiological state based on heart rate, bp, respiratory, core body temp, menyal status, and urine output. Sepsis identity cues to recognize. 1. Resp rate 2. Heart rate 3. Systolic pressure 4. Conscious level 5. Temp 6. Hourly urine for 2h - Organ failure- intubated, pronate, unresponsive, - Leonox, heaparin, aspirin - PCR TEST FOR COVID- only 1 test question? **NCSPN- WEBISTE FOR STUDYING CASE STUDIES FOR NCLEX** **PRECONCEPT QUIZ** 1. A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? DIABETES 2. The most common route of lower UTIs is \_\_\_\_\_\_\_\_\_\_, a process whereby bacteria (often from fecal contamination) colonize the periurethral area and enter the bladder. TRANSURETHRAL 3. Which objective symptom of a UTI is most common in older adults, especially those with dementia? CHANGE IN COGNITIVE FUNCTION 4. Factors that contribute to urinary tract infections (UTIs) include bacterial invasion of the urinary tract, urethrovesical reflux, and shorter urethra in women. TRUE 5. Which medication may be ordered to relieve discomfort associated with a UTI? Phenazopyridine 6. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine? After painful urination is relieved, stop taking phenazopyridine. 7. Which term refers to inflammation of the renal pelvis? Pyelonephritis 8. Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? Costovertebral angle tenderness and chills 9. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? Drink 8 to 10 eight-oz glasses of water daily. 10. What is sepsis? body\'s toxic response to an infection in the blood 11. Sepsis can develop from? TATOO, MOSQUITO BITE, UTI, CUT ON FINGER 12. The spread of infection from the urinary tract to the bloodstream that results in a systemic infection known as? UROSEPSIS 13. All of the following are signs of sepsis **[EXCEPT?]** SLOW HEART RATE ISNT A SIGN OF SEPSIS 14. What can the nurse include in the plan of care to ensure early intervention along the continuum of shock to improve the client\'s prognosis? Select all that apply. Assess risk for shock, Administer intravenous fluids, Monitor for changes in vital signs. 15. The nurse is aware that fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis? Lactated Ringer\'s 16. How is COVID-19 PRIMARILY spread to others? DROPLET 17. What are the signs and symptoms of COVID-19? COUGH, FEVER, SOB, FATIGUE, SORE THROAT 18. A person with COVID-19 can transmit the virus even though they are asymptomatic. True 19. The nurse is teaching 20. Members of the community preventive measures on how to prevent acquiring COVID-19. Which of the following statements demonstrates a need for further teaching? I should keep a distance of 2 feet apart from others.\" 21. Which lab test is most indicative of sepsis? LACTATE **INFECTION PREP U QUIZ** 1. A client is experiencing issues related to immune function after having COVID 19. Which test(s) should the nurse review that would indicate the functioning of the client\'s cellular immune system? Select all that apply- Delayed hypersensitivity skin test, Total lymphocyte count 2. The nurse is caring for a client after a severe COVID 19 infection. Which occurs as a result of the release of cytokines experienced with this illness? Select all that apply. The production of antibodies or a cell-mediated response, Initiation of the inflammatory response process 3. The nurse is educating a group of nursing students about COVID-19 and risk for cerebrovascular disorders. The nurse educator notes that COVID-19 has shown to increase which condition? Ischemic stroke- Blood clotting abnormalities have been found to occur in COVID-19 afflicted clients. With the clotting abnormalities, there is an increased risk for ischemic stroke. There is no evidence that COVID-19 causes any of the other conditions. 4. A client with a critical illness has a temperature of 38.5°C (101.3°F). Which parameters will the nurse use to determine if the client is developing sepsis? [Urine output, bilirubin, platelet, respiratory, BP.] Clients with a critical illness who are demonstrating signs of an infection should be monitored for the developing of sepsis using the Sepsis-Related Organ Failure Assessment Score. The parameters monitored through this score include urine output, bilirubin level, platelet count, blood pressure, and respiratory rate in addition to mean arterial pressure, serum creatinine, and Glasgow Coma Scale score. 5. A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? PNEUMONIA, SEPSIS, SKIN BREAKDOWN, DELIRIUM. Complications in clients with hip fractures are often related to the client\'s age. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia can develop as a result of the anesthesia. Thromboemboli are possible, as is sepsis. Elderly clients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly client with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus. 6. The intensive care unit nurse is caring for a client with sepsis whose tissue perfusion is declining. What sign would indicate to the nurse that end-organ damage may be occurring? Heart and respiratory rates are elevated. As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the client begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., acute kidney injury, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs. 7. A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is on large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies? Bone marrow suppression 8. A nurse has admitted a client who has been diagnosed with urosepsis. Which immune response predominates in sepsis? Humoral. 9. The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? New diagnosis of urosepsis 10. A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Temperature of 102F, Heart rate of 120 beats/minute, Respiratory rate of 24 breaths/minute 11. A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? Preventing infection 12. A client with infective endocarditis is admitted to the hospital. While obtaining a history, what should the nurse ask the client about? Renal dialysis, Intravenous (IV) drug use, Nasal piercing, Prosthetic cardiac valves, Recent urinary tract infection 13. An older adult client who is postmenopausal informs the nurse that she believes she has developed another urinary tract infection (UTI). What risk factors do female clients in this age group have? Residual urine, estrogen deficiency, urinary incontinence 14. An older client with foul-smelling urine has a temperature of 100.4°F (38°C). Which assessment findings will the nurse use to determine if the client has a urinary tract infection? Confusion, warm flushed skin, hr 102 bpm, resp rate 26. 15. A client with a spinal cord injury says he has difficulty recognizing the symptoms of urinary tract infection (UTI). Which symptom is an early sign of UTI in a client with a spinal cord injury? Fever and change in urine clarity. Fever and change in urine clarity as early signs of UTI in a client with a spinal cord injury. Lower back pain is a late sign. A client with a spinal cord injury may not experience a burning sensation or urinary frequency. 16. The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? UTI 17. The nurse recognizes that test results that most likely indicate a urinary tract infection include: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring. 18. The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client? The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and counted toward the daily fluid total. 19. A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? INFECTION. Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome. 20. A female client has been prescribed a course of antibiotics for the treatment of a urinary tract infection (UTI). When providing health education for the client, the nurse should address what topic? The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy. Yeast vaginitis occurs in as many as 25% of clients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI.