His past medical history consists of pneumonia
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Running head: NURSING
Case Study
Name of the Student
Name of the University
Author Note
Case Study
Name of the Student
Name of the University
Author Note
1NURSING
Introduction- The case scenario to be discussed in this assignment involves an
octogenarian male X (pseudonym) who had been permanently admitted to the nursing home,
owing to inability of his son to address his increasing care needs and mobility impairment. X
required assistance in mobility and in conducting activities of daily living. He had previously
been admitted seven times in the past 3 months due to confusion, pneumonia, abdominal pain,
falls, disorientation and decreased mobility. His past medical history consists of pneumonia,
hearing impairment, macular degeneration, poor vision in left side, lewy-body dementia,
glaucoma, high cholesterol, atrial fibrillation, anxiety, and depression, osteoarthritis in lumbar
spine, postural hypotension and hernia. He had been subjected to the minimally invasive
procedure of stent implementation in 2001, for the treatment of ischemic heart disease. In
addition, he also reported a history of colorectal cancer, triple aneurysm in abdominal aorta,
colostomy, and prostatectomy that resulted in permanent insertion of a suprapubic catheter. He
had been a smoker 20 to 30 years ago and a social drinker as well.
X had been diagnosed with catheter-associated urinary tract infection (CAUTI).
Considering the fact that the catheter had got stuck, it could not be removed initially. Following
removal of the suprapubic catheter and insertion of a new one after few days, he manifested
signs and symptoms of fever and delirium. Upon conducting inspection of the site it was found
to be infected, protruded with redness, and oozing of blood along with pus. A urine dipstick test
showed positive result for leukocyte and the pathological reports also suggested presence of
infection.
Analysis- CAUTI generally account for around 34-40% healthcare associated infections,
and an estimated 21-54% indwelling catheter are inappropriately used, even when they are not
medically necessary (Miller, 2018). Following a week after admission, the patient was due for a
Introduction- The case scenario to be discussed in this assignment involves an
octogenarian male X (pseudonym) who had been permanently admitted to the nursing home,
owing to inability of his son to address his increasing care needs and mobility impairment. X
required assistance in mobility and in conducting activities of daily living. He had previously
been admitted seven times in the past 3 months due to confusion, pneumonia, abdominal pain,
falls, disorientation and decreased mobility. His past medical history consists of pneumonia,
hearing impairment, macular degeneration, poor vision in left side, lewy-body dementia,
glaucoma, high cholesterol, atrial fibrillation, anxiety, and depression, osteoarthritis in lumbar
spine, postural hypotension and hernia. He had been subjected to the minimally invasive
procedure of stent implementation in 2001, for the treatment of ischemic heart disease. In
addition, he also reported a history of colorectal cancer, triple aneurysm in abdominal aorta,
colostomy, and prostatectomy that resulted in permanent insertion of a suprapubic catheter. He
had been a smoker 20 to 30 years ago and a social drinker as well.
X had been diagnosed with catheter-associated urinary tract infection (CAUTI).
Considering the fact that the catheter had got stuck, it could not be removed initially. Following
removal of the suprapubic catheter and insertion of a new one after few days, he manifested
signs and symptoms of fever and delirium. Upon conducting inspection of the site it was found
to be infected, protruded with redness, and oozing of blood along with pus. A urine dipstick test
showed positive result for leukocyte and the pathological reports also suggested presence of
infection.
Analysis- CAUTI generally account for around 34-40% healthcare associated infections,
and an estimated 21-54% indwelling catheter are inappropriately used, even when they are not
medically necessary (Miller, 2018). Following a week after admission, the patient was due for a
2NURSING
change of the suprapubic catheter. However, it was found that catheter clamping has been
conducted around 30 minutes earlier. Clamping of a catheter typically stimulates the bladder to
urinate, prior to removal of the capacitor, thereby reducing the incidence of any kind of urinary
retention and the necessity for catheter insertion (Gong et al., 2017). However, early clamping
carried the risk of health complications such as, urinary tract injury and prolonging retention of
the catheter. While removing the cathedral it was found to be stuck. The doctor did not arrive
and ignored the due date of the catheter. Risk of being affected with CAUTI is significantly
correlated to the duration and it increases by as much as 5% each day, reaching roughly 100% by
the 30th day (Miller, 2018).
Another significant instance of inappropriate care occurred when the nursing staff
removed the catheter without the doctor’s review. Stuck or retained catheter result in numerous
health complications and their removal without necessary experience even threatens the patient
health by increasing risks of bladder injury, bleeding or urethral rupture (Arnous, Adhya &
Marof, 2019). Despite antibiotic administration, X showed signs of clinical deterioration,
following which the doctor prescribed pain relief medication Endone over the telephone. This
was another incorrect since the patient was not assessed prior to prescribing the medication
(Smith & Sprecher, 2017). The patient was not attended by the doctor who was negligent in not
considering the declining health situation of the patient. Hence, the antecedents in this case were
negligence on the part of the doctor in attending the patient X, prior cathedral clamping, removal
of retained catheter in absence of the doctor, and administration of antibiotics following
telephonic orders.
Since catheter usage increases risk of CAUTI, the retained catheter should have been
carefully removed, under the supervision of the doctor (Eckert et al., 2020). Rather than re-
change of the suprapubic catheter. However, it was found that catheter clamping has been
conducted around 30 minutes earlier. Clamping of a catheter typically stimulates the bladder to
urinate, prior to removal of the capacitor, thereby reducing the incidence of any kind of urinary
retention and the necessity for catheter insertion (Gong et al., 2017). However, early clamping
carried the risk of health complications such as, urinary tract injury and prolonging retention of
the catheter. While removing the cathedral it was found to be stuck. The doctor did not arrive
and ignored the due date of the catheter. Risk of being affected with CAUTI is significantly
correlated to the duration and it increases by as much as 5% each day, reaching roughly 100% by
the 30th day (Miller, 2018).
Another significant instance of inappropriate care occurred when the nursing staff
removed the catheter without the doctor’s review. Stuck or retained catheter result in numerous
health complications and their removal without necessary experience even threatens the patient
health by increasing risks of bladder injury, bleeding or urethral rupture (Arnous, Adhya &
Marof, 2019). Despite antibiotic administration, X showed signs of clinical deterioration,
following which the doctor prescribed pain relief medication Endone over the telephone. This
was another incorrect since the patient was not assessed prior to prescribing the medication
(Smith & Sprecher, 2017). The patient was not attended by the doctor who was negligent in not
considering the declining health situation of the patient. Hence, the antecedents in this case were
negligence on the part of the doctor in attending the patient X, prior cathedral clamping, removal
of retained catheter in absence of the doctor, and administration of antibiotics following
telephonic orders.
Since catheter usage increases risk of CAUTI, the retained catheter should have been
carefully removed, under the supervision of the doctor (Eckert et al., 2020). Rather than re-
3NURSING
inserting the catheter, after forceful removal of the previous one, the alternative measure should
have focused on limiting usage of the indwelling catheter for management of incontinence
(Nicolle, 2017). Alternative efforts like regular toileting should have been used for preventing
further infection. Moreover, the expiration date of the catheter should also have been noted since
although catheters do not break down, the stability gets compromised post the expiration date
(Aydelotte, 2018). In addition, pre-lubricated catheters might also lose the hydration, hence
stability of the lubrication is even not guaranteed following expiration date.
In place of Keflex and Endone antibiotics, the patient must have been prescribed
nitrofurantoin that damages bacterial DNA by getting reduced to an extremely reactive form in
the bacterial cell, by the action of nitrofuran reductase or flavoproteins (Gardiner et al., 2019). It
was necessary to perform a focused physical examination of the patient, in place of giving orders
over telephone, in order to ensure that there were no medical risks that the patient would be
predisposed to, upon administering the prescribed medications. Additionally, the patient should
have been screened using the systemic inflammatory response syndrome (SIRS) criteria, after he
reported fever and delirium (Taniguchi et al., 2017).
The aforementioned conditions created significant consequences on the patient since his
health started deteriorating each day, with signs and symptoms of mottled skin, nausea, shivering
and vomiting, all indicating sepsis. This in turn created a strong impact on the family members
since they observed the critical condition the patient was in, and found the efforts of sending him
to the hospital completely futile. Eventually the patient lasted for a day in the hospital, following
which his family members became shocked at the sudden change in health condition that resulted
in patient death.
inserting the catheter, after forceful removal of the previous one, the alternative measure should
have focused on limiting usage of the indwelling catheter for management of incontinence
(Nicolle, 2017). Alternative efforts like regular toileting should have been used for preventing
further infection. Moreover, the expiration date of the catheter should also have been noted since
although catheters do not break down, the stability gets compromised post the expiration date
(Aydelotte, 2018). In addition, pre-lubricated catheters might also lose the hydration, hence
stability of the lubrication is even not guaranteed following expiration date.
In place of Keflex and Endone antibiotics, the patient must have been prescribed
nitrofurantoin that damages bacterial DNA by getting reduced to an extremely reactive form in
the bacterial cell, by the action of nitrofuran reductase or flavoproteins (Gardiner et al., 2019). It
was necessary to perform a focused physical examination of the patient, in place of giving orders
over telephone, in order to ensure that there were no medical risks that the patient would be
predisposed to, upon administering the prescribed medications. Additionally, the patient should
have been screened using the systemic inflammatory response syndrome (SIRS) criteria, after he
reported fever and delirium (Taniguchi et al., 2017).
The aforementioned conditions created significant consequences on the patient since his
health started deteriorating each day, with signs and symptoms of mottled skin, nausea, shivering
and vomiting, all indicating sepsis. This in turn created a strong impact on the family members
since they observed the critical condition the patient was in, and found the efforts of sending him
to the hospital completely futile. Eventually the patient lasted for a day in the hospital, following
which his family members became shocked at the sudden change in health condition that resulted
in patient death.
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