You are working in an extended care facility when M.Z.’s daughter brings her mother in for a week’s stay while she goes on a planned vacation. M.Z. is an 89-year-old widow with a 4-day history of non- localized abdominal pain, incontinence, new-onset mental confusion, and loose stools. Her most current vital signs are 118/60, 88, 18, 98.4° F (37.4° C). The medical director ordered a post void catheterization, which yielded 100mL of cloudy urine that had a strong odor, and several lab tests on admission. Urine culture and sensitivity results are pending; the other results are shown in the chart. Complete metabolic panel: Within normal limits except for the following results: BUN 25mg/dL Sodium 131mEq/L Potassium 3.2mEq/L White blood cell count 11,000/mm3 Urinalysis Appearance Cloudy Odor Foul pH 6.9 Protein Negative Nitrites Positive Crystals Negative WBCs 6 per low-power field RBCs 3 4.The medical director makes rounds and writes orders to start an IV of D5 ½NS at 75mL/hr. and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral medications, the medical director orders ciprofloxacin (Cipro) 400mg q12h IV piggyback (IVPB). Are the type of fluid and rate appropriate for M.Z.’s age and condition? Explain. The next day, you are the nurse assigned to M.Z.’s care. You notice that the NAP emptying the gravity drain is not wearing personal protection devices. You also observe that the drainage port of the drainage bag was contaminated during the process because the NAP allowed it to touch the floor.

The type of fluid and rate prescribed for M.Z.’s age and condition appears to be appropriate. M.Z. is experiencing symptoms of abdominal pain, incontinence, mental confusion, and loose stools, which could indicate a urinary tract infection (UTI) or another underlying medical condition. The results of the lab tests suggest an abnormality in her urinary system. The presence of cloudy urine with a strong odor, positive nitrites, and elevated white blood cell count in the urine analysis could be indicative of a UTI. The urine culture and sensitivity results are pending, which will help confirm the diagnosis.

Given M.Z.’s age and symptoms, starting an intravenous (IV) fluid is a prudent approach. The medical director has ordered D5 ½NS, which stands for 5% dextrose in 0.45% normal saline. This type of fluid provides both hydration and a source of energy in the form of dextrose. The addition of dextrose helps prevent hypoglycemia, especially in elderly patients who may have compromised nutritional intake. Additionally, the use of a balanced solution like 0.45% normal saline helps maintain electrolyte balance and prevent fluid overload.

The rate of 75mL/hr. for the IV fluid appears appropriate as well. The exact fluid requirement may vary based on M.Z.’s weight and underlying medical conditions, but 75mL/hr. is within the typical range for maintenance fluid therapy in elderly patients. This rate helps maintain hydration without overloading the patient’s cardiovascular system. However, it is important to reassess M.Z.’s fluid status regularly and adjust the fluid rate if necessary based on changes in her vital signs, urine output, and overall clinical condition.

In addition to the IV fluid, the medical director has ordered ciprofloxacin (Cipro) 400mg q12h intravenous piggyback (IVPB) for M.Z. Ciprofloxacin is a commonly used antibiotic that is effective against many bacterial pathogens, including those commonly causing UTIs. The IV route is appropriate for M.Z. since she is unable to take oral medications.

It is important to note that the final determination of the appropriateness of the fluid type and rate for M.Z. should be made by the attending physician based on a comprehensive assessment of her clinical condition, including any underlying medical conditions and laboratory findings.

Moving on to the next day when you, the nurse, are assigned to M.Z.’s care. You observe that the Nursing Assistant Practitioner (NAP) emptying the gravity drain is not wearing personal protective devices, and you notice that the drainage port of the drainage bag was contaminated during the process by touching the floor. This is a concern as it violates basic infection control practices.

Maintaining strict infection control measures is crucial in preventing the spread of infections, especially in healthcare settings. The NAP should be aware of and comply with the established protocols for wearing personal protective equipment (PPE), such as gloves and gowns, when handling bodily fluids or contaminated materials. By not wearing PPE, the NAP increases the risk of cross-contamination and the potential transmission of infections to both themselves and M.Z.

Additionally, the contamination of the drainage bag’s port by allowing it to touch the floor is another breach of infection control practices. The floor is known to harbor bacteria and other pathogens, which can easily transfer to the drainage port and potentially infect the patient if not properly cleaned and disinfected.

As the nurse assigned to M.Z.’s care, you should immediately address these concerns. You should educate the NAP on the importance of following infection control procedures to protect both themselves and the patients. Additionally, proper cleaning and disinfection of the drainage bag’s port should be performed to minimize the risk of infection.