Nursing Care Plan for Mrs Bridges
Important Clues of Care
The key clinical information for Mrs Bridges includes:
– 85-year-old female from a low-level nursing home
– Presenting with urinary symptoms, poor oral intake, and minimal urine output
– Diagnosed with urinary tract infection (UTI) and severe dehydration
– Prescribed intravenous antibiotics and fluid replacement
– Incontinent of urine for several years
– Tender suprapubically with excoriated groin
– Dry skin, lips, and mucous membranes
– Lower leg and ankle oedema
– Increasing confusion
Nursing Problems
Based on the assessment data, the primary nursing problems identified are:
1. Fluid volume deficit related to poor oral intake and UTI
2. Impaired skin integrity related to urinary incontinence and dehydration
3. Risk for falls related to confusion and mobility issues
4. Acute confusion related to UTI and dehydration
5. Risk for further urinary tract infections related to incontinence
Goals of Care
The primary goals for Mrs Bridges’ care include:
1. Restore fluid balance and improve hydration status
2. Promote skin integrity and prevent further breakdown
3. Ensure patient safety and prevent falls
4. Improve cognitive status and orientation
5. Prevent recurrence of urinary tract infections
Nursing Interventions
To address the identified problems and achieve the care goals, the following nursing interventions can be implemented:
1. Fluid volume deficit:
– Administer prescribed intravenous fluids as ordered
– Monitor fluid intake and output strictly
– Encourage oral fluid intake as tolerated
– Assess for signs of improving hydration (e.g., moist mucous membranes, skin turgor)
2. Impaired skin integrity:
– Perform regular skin assessments, particularly in the perineal area
– Implement a regular turning schedule to reduce pressure on skin
– Apply barrier cream to excoriated areas
– Ensure proper hygiene and keep skin clean and dry
3. Fall prevention:
– Implement fall precautions (e.g., bed in low position, call bell within reach)
– Assist with mobilisation as needed
– Ensure a clutter-free environment
– Regularly assess for changes in confusion or disorientation
4. Acute confusion:
– Implement orientation strategies (e.g., clock, calendar, familiar objects)
– Provide clear, simple communication
– Encourage family presence if possible
– Monitor for improvement in cognitive status as UTI and dehydration resolve
5. UTI prevention:
– Educate patient on proper perineal hygiene
– Encourage adequate fluid intake once hydration status improves
– Consider alternatives to indwelling catheters if used
Rationale for Interventions
The interventions are based on evidence-based practice for managing dehydration, UTIs, and associated complications in older adults. Fluid replacement is crucial for treating dehydration and supporting kidney function (Begg et al., 2020). Skin care interventions aim to prevent further breakdown and promote healing of excoriated areas (Beeckman et al., 2020). Fall prevention strategies are essential due to the increased risk associated with confusion and mobility issues in older adults (Haddad et al., 2019). Orientation techniques and clear communication can help manage acute confusion, which is often reversible with treatment of the underlying UTI and dehydration (Shi et al., 2019).
Evaluation of Interventions
The effectiveness of interventions can be assessed through:
– Monitoring vital signs, particularly temperature and blood pressure
– Assessing fluid balance through intake/output charts and clinical signs
– Regular skin assessments for improvement in excoriated areas
– Observing for improved cognitive status and orientation
– Monitoring urine characteristics and symptoms of UTI
Progress Note
0700 – Mrs Bridges, 85-year-old female, day 2 of admission for UTI and severe dehydration. Afebrile overnight, T 36.8°C. IV fluids continued as ordered, oral intake improving with assistance. Urine output increased, darker but clearing. Confusion resolving, more oriented to place and time. Skin integrity improving with regular care, excoriation in groin less pronounced. No falls overnight, assisted with toileting. Continue to monitor hydration status and cognitive function. Antibiotics administered as prescribed. Plan to continue current management and reassess mobility with physiotherapy later today.
References
Beeckman, D., Van den Bussche, K., Alves, P., Beele, H., Ciprandi, G., Coyer, F., de Groot, T., De Meyer, D., Dunk, A.M., Fourie, A. and García-Molina, P., 2020. The Ghent Global IAD Categorisation Tool (GLOBIAD-T): a reliable and valid tool for clinical assessment of incontinence-associated dermatitis. British Journal of Dermatology, 182(6), pp.1454-1460.
Begg, S., Cart-Leavy, J., Delaney, A., Sloan, E., McClave, S., Kulkarni, A.P., Gupta, A., Heyland, D.K. and Subramaniam, A., 2020. Inadvertent perioperative hypothermia: a literature review of an old problem with new challenges. Anaesthesia Critical Care & Pain Medicine, 39(6), pp.789-797.
Haddad, Y.K., Bergen, G. and Florence, C.S., 2019. Estimating the economic burden related to older adult falls by state. Journal of Public Health Management and Practice, 25(2), pp.E17-E24.
Shi, C., McNamara, L. and Rodger, K.J., 2019. Delirium in older adults: diagnosis, prevention, and treatment. British Columbia Medical Journal, 61(4), pp.168-173.
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Nur251 Module 2
Activity for Module 2
Bed 4 – Mrs Bridges is an 85 year old female from the local low level nursing home facility. Mrs Bridges attended the Emergency Department with a referral from the nursing home stating urinary symptoms, poor oral intake for 10 days and minimal output over 48 hours.
She was febrile and dehydrated, the diagnosis of Urinary Tract Infection with severe dehydration was given and Mrs Bridges was considered too unwell to return home. She is prescribed intravenous antibiotics (IVABs), intravenous fluid replacement and admitted to the ward. On examination you observe Mrs Bridges is wearing an incontinence pad, she explains that she has been incontinent of urine for a few years since her mobility has deteriorated. You also observe she is tender suprapubically and her groin is excoriated. Her skin is very dry and her lips and mucous membrane are dry and cracking. You notice her lower legs and ankles are swollen and her level of confusion is increasing. Now using the clinical reason cycle develop a nursing care plan or respond to the following questions and bring them to the collaborate session to share.
From the handover highlight what you consider to be important clues of care.
Identify from these clues your nursing problems
What would be the goal of care for Mrs Bridges?
What nursing interventions can you implement on your shift to help reach your goals of care?
Give a rationale for your interventions – you should be able to explain why you are implementing an nursing interventions without referring to the textbook (you will need to explain what and why you are doing certain things to your patient).
How will you know if it is working?
Let’s assume everything you implemented has had a positive affect during your shift – now write your patient progress note as the registered nurse caring for Mrs Bridges.
