Symptom Management: UTI, Delirium, and Advanced Nursing Practice

This report delves into the critical aspects of symptom management within the context of geriatric nursing, specifically addressing the challenges of urinary tract infections (UTIs) and delirium in elderly patients residing in aged care homes. It emphasizes the significance of these conditions, highlighting their prevalence and impact on the quality of life for older adults. The report explores the interventions available for managing UTIs and delirium, including pharmacological treatments, preventive measures, and the role of advanced care nurses in providing comprehensive care. It underscores the importance of nurses in assessing symptoms, administering medications, and educating patients on self-management strategies. Furthermore, the report discusses the need for patient-centered care and the promotion of therapeutic relationships to improve patient outcomes. The study concludes by emphasizing the crucial role of advanced care nurses in managing elderly people with comorbidities like UTI and confusion.

Running head: SYMPTOM MANAGEMENT
SYMPTOM MANAGEMENT
Name of the Student
Name of the University
Author Note

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Symptom cluster and symptom management in advanced nursing practice
Identification and introduction of the symptoms
A symptom can be considered as a subjective experience of some alterations in the bio-
psychosocial functioning, cognition and sensation of an individual. It can only be perceived
by the patient Barsevick A., (2016).
One of the most common hospital acquired infection is the urinary tract infection that
accounts for about 40 % of all the nosocomial infections in Australia, especially in the long
term aged care settings. The management of UTI is challenging due to the barriers in
communication, chronic genitourinary symptoms and comorbidities. Most of the urinary
tract infections are related to urinary catheters that is a common device used in long term
aged care services (Melo et al., 2017). Delirium or confusion is being viewed widely as a
result of urinary tract infection. A UTI normally occurs as the bacteria enters the urinary tract
via urethra travelling to bladder and then to the ureters finally in the kidneys. Once bacteria
enters the kidneys they can enter the bloodstream, carrying the infection to the brain. With
the ageing the blood vessel stiffens over the years, allowing the brain to become susceptible
to infection. The bacteria in the blood stream can cause the blood brain barrier to cause
confusion and other cognitive difficulties. Delirium in adults can cause sudden confusion of
the time and place. They might become incoherent and their level of awareness can fluctuate.
Its relevance and importance to your nursing practice and impacts on the elderly’s
living in nursing home
Delirium and UTI are two common conditions in elderly people residing in aged care
homes. The incidence of both the conditions increases with age. Urinary tract infection
accounts for 25 % of all kinds of infection and delirium is found in almost 30 % of the total
number of elderly people. UTI is caused in older residents staying in the care homes are due

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to the fact, they are often do not receive appropriate care with respect to maintenance of
hydration. Furthermore, most of them don’t have safe swallowing mechanism making them
susceptible to less intake of fluids. Delirium might develop over one of two days (Cheung et
al., 2018) . While delirium can gave more than one aetiologies, but UTI is considered as one
of the predisposing factors. In my placement area, which is the geriatric ward, the presence of
delirium among the UTI patients is quite common. According to Balogun and Philbrick,
(2013), in subjects with Delirium, the UTI rates have ranged from 25.9 % to 32 % in
comparison to 13 % of the subjects that are without delirium.
UTI causes an altered mental status, then in surely affects the quality of life of elderly
people living experiencing this. The elderly people can display certain behaviour changes,
like hallucinating, restlessness, aggressive behaviour, rambling speeches, lethargy and slowed
movements, depression, sense of elated feeling or apathy. Elderly people living aged care are
taught about the self-management of their daily activities of living. Elderly people suffering
from delirium might find it difficult to cope up with their daily activities like grooming,
eating and cleaning. They might require some additional help from the aged care unit. An
extra nurses might have to be appointed, who could have been appointed to somebody having
more serious condition.
Apart from the patients, increased frequency of confusion, among the patients
suffering from dementia, also affects the organisation, due to increased stay, increased use of
the aged care resources including extra medicines and cost of for diagnosis. In case of
complications multidisciplinary teams are often employed to rule out the prevalence of any
neurodevelopment diseases (Rowe & Juthani-Mehta, 2013). Nurses have to invest more time
on elderly people suffering from the delirium, as they are more susceptible to slips, falls and
medication errors. Furthermore, being a nurse, I feel that aged care home is a place where
elderly people come to spend some of their last years of life. They have right to desire for a

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peaceful life with a sense of closure. Helping them with a healthy body and mind is what we
mainly aim for. Hence, any conditions that acts as a barrier to their wellbeing, is worth to be
investigated and cured. This provides the rationale for considering this topic to be a real
problem in aged care settings.
Interventions available
The treatment guidelines for UTI involves nitrofurantoin monohydrate/macrocrystals
100 mg twice daily for about five days, or trimethoprim–sulfamethoxazole 160/800 mg twice
daily for 3 days. Over the counter pain relief can be given. Paracetamol can be given for
giving relief to any kinds of discomfort. In order to prevent the incidence of UTI, adults
should get plenty of hydration (Soukup et al., 2018).
Preventive intervention like reorientation, early and recurrent mobilization,
management of pain, adequate hydration and nutritional assessment, reduction in the sensory
impairments and ensuring proper sleep patterns have been found to be effective for reducing
the incidence of delirium.
Role of an advanced clinician for symptom management
Symptom management can be defined as the administration of the self-care activities
that are prescribed medically or have been developed by individuals aiming at relieving the
clinical manifestations. Normally, symptom management is perceived as an important
element of independent, collaborative and patient centred health care practice and is most
important in health care for the patient (Mustian eat al., 2016).
Nurses play an important role in the diagnosis and the symptom management of UTI
and Delirium. Nurses are responsible for the placing and handling the urinary catheter
system, including cleaning and timely removal of the catheter. Routine care of the catheter
system is delegated to nurses. In adequate placement and care of the catheter can have

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important impact on patient outcomes. Hence, standardisation of education, training and
orientation of the new nursing staffs are necessary.
Timely administration of correct dosage of medication is another important duty of
the advanced care nurses. They should also be educated enough to prevent the occurrence of
medication errors. Nurses also needs to take part in evidence based preventive care services
that can improve health by the identification of the risk factors for the poor health outcomes
among the adults (Twigg et al., 2018). Pain management in UTI patient is one effective
intervention. It is the role of the nurses in assessing the pain intensity by using suitable pain
management scales (Melo et al., 2017). Elderly patients, suffering from delirium and UTI
often have disturbed sleeping patterns. It is necessary for the nurses to identify the sleeping
pattern of the patients, provide comfort by giving backrubs or warm bath, reducing
environmental distractions such as light and noise.
In order to understand the grievances of the patient, it is necessary to practice patient-
centeredness, which suggests that elderly patients should be treated from the biosocial
perspective. Nurses are responsible to practice highly developed communication and
interpersonal skills for enabling and nurturing a therapeutic relationship
Nurses thrive to provide a comprehensive care to the patients. Nurses are responsible
to contribute to meetings with the information about the perception of the older people and
the psychological aspect of care. Hence, as a nurses leaders, I am entitled with the duty of
assessing and document them to produce them in front of the treating physician.
Educating patients about the self-management of chronic condition is another
important accountability of the nurses. Emphasizing on the responsibility of the patient and
self-management is a promising strategy for treating diseases (LeBlanc et al., 2018). Patients
who have recovered from delirium might find it difficult to remember the medications and

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other self-care activities. Nurses can educate the elderly people, about strategies like setting
up of alarm for taking medications, or maintaining a log book. Education about the
precautions that should be taken to prevent further recurrence of the urinary tract infections,
like instructing female clients to wipe the area from front to back and avoiding the use of bath
tubs, to encourage clients in taking fluids, encouraging them to report signs and symptoms of
recurrence or importance of frequent emptying of the bladder.
It should be noted that elderly individuals suffering from delirium are more prone to
slips and falls. Hence, being an advanced care nurse, it is my duty to conduct a fall
assessment of the patients, accompanying them to washrooms and monitoring their
movements. Nurses, as patients advocates can propose the care manager to provide side rails
or wheelchairs for mobilizing those patients (Cameron et al., 2018).
Summary and conclusion
UTI is mainly caused due to the infection caused by the entry of bacteria in to
bloodstream via urinary tract. The bacteria often crosses the blood brain barrier and reaches
brain, often giving rise to symptoms like confusion. It can be stated that the advanced care
nurses play an important role in managing elderly people with comorbidities like UTI and
confusion. The nurses play an important in the self-care management of the conditions. They
are responsible for providing education to the parents. A patient centred care is the ultimate
approach to provide care to these patients.

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