NR 601 Standardized Procedure Worksheet Paper

NR 601 Standardized Procedure Worksheet Paper

NR 601 Standardized Procedure Worksheet Paper

NR 601 Standardized Procedure Worksheet Sample

Carefully read the assignment guidelines and rubric and complete each section of the worksheet below.

1. Definition
2. Disease or condition

Urinary Tract Infections (UTIs) in older individuals living in the community are bacterial infections that affect the urinary tract, including the bladder, urethra, ureters, and kidneys.

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1. Pathophysiology

Urinary tract infections (UTIs) commonly arise when bacteria, particularly Escherichia coli (E. coli), invade the urinary tract. Various reasons, such as compromised immune systems, urine retention, or urinary incontinence, can cause UTIs in older persons. These characteristics enhance the vulnerability to bacterial colonization and infection in the urinary system.

1. Incidence and prevalence

UTIs are relatively common among older adults, both in terms of incidence and prevalence. UTIs are highly prevalent among individuals in this population. The prevalence of UTIs rises with advancing age, with an estimated occurrence rate above 50% among adult females throughout their lifespan (Medina & Castillo-Pino, 2019). UTIs pose a notable issue among those residing in nursing homes (Latour et al., 2022).

2. Assessment
3. Symptoms

Common subjective findings or symptoms of UTIs in older adults include frequent urination, urgency, burning during urination, cloudy or bloody urine, and lower abdominal discomfort. In elderly patients, symptoms can be atypical and include confusion or agitation (Dutta et al., 2022).

1. Physical Exam

Physical examination may reveal suprapubic tenderness, costovertebral angle tenderness, and potentially altered mental status in elderly patients (Sabih & Leslie, 2023).

3. Diagnostic tests
4. Testing

Diagnostic tests for UTIs may include urinalysis, urine culture, and imaging (e.g., ultrasound) to assess for complications.

1. Expected results

Atypical findings indicative of urinary tract infections (UTIs) may encompass the existence of bacteria, white blood cells, and nitrites in the urine. A positive urine culture with a significant number of colonies of a pathogenic organism is indicative of a UTI. Imaging can reveal indications of a kidney infection or obstruction.

4. Management
5. First-line medications

Trimethoprim/Sulfamethoxazole (TMP/SMX):

Trade Names: Bactrim, Septra

Generic Names: Trimethoprim/Sulfamethoxazole

Typical Dose: The usual dose is one double-strength tablet (800 mg sulfamethoxazole and 160 mg trimethoprim) every 12 hours for 3 days.

Contraindications: Allergy to sulfonamides, folate deficiency, severe hepatic or renal impairment.

Major Drug-Drug Interactions: May interact with certain anticoagulants, oral hypoglycemics, and other drugs (Kemnic & Coleman, 2022).

Nitrofurantoin:

Trade Names: Macrobid, Macrodantin

Generic Name: Nitrofurantoin

Typical Dose: Commonly prescribed as 100 mg twice daily for 5 to 7 days.

Contraindications: Allergy to nitrofurantoin, renal impairment, G6PD deficiency (Squadrito & Del Portal, 2022).

Major Drug-Drug Interactions: Limited drug interactions.

Ciprofloxacin:

Trade Name: Cipro

Generic Name: Ciprofloxacin

Typical Dose: Often prescribed as 250-500 mg every 12 hours for 3 days.

Contraindications: Allergy to ciprofloxacin, tendon disorders, and certain medical conditions.

Major Drug-Drug Interactions: Interactions with various medications, including antacids and some anticoagulants (Thai et al., 2023).

1. Second-line medications

Fosfomycin:

Trade Name: Monurol

Generic Name: Fosfomycin tromethamine

Typical Dose: The typical dose for uncomplicated UTIs is one sachet (3 grams) of fosfomycin mixed with water as a single-dose treatment.

Contraindications: Known hypersensitivity to fosfomycin or its components.

Major Drug-Drug Interactions: Limited drug interactions (Falagas et al., 2016).

1. Other treatments

Hydration, pain management, and addressing contributing factors like urinary retention may be necessary.

1. Follow-up

Patients should be instructed to adhere to the entire duration of antibiotic treatment. Follow-up may involve conducting more urine cultures to verify the resolution of the infection.

1. Referral

Referral to a specialist or urologist may be necessary in cases of recurrent or complicated UTIs.

References

Dutta, C., Pasha, K., Paul, S., Abbas, M. S., Nassar, S. T., Tasha, T., Desai, A., Bajgain, A., Ali, A., & Mohammed, L. (2022). Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review. Cureus, 14(12), e32321. https://doi.org/10.7759/cureus.32321

Falagas, M. E., Vouloumanou, E. K., Samonis, G., & Vardakas, K. Z. (2016). Fosfomycin. Clinical Microbiology Reviews, 29(2), 321–347. https://doi.org/10.1128/cmr.00068-15

Kemnic, T. R., & Coleman, M. (2022). Trimethoprim Sulfamethoxazole. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513232/#:~:text=Trimethoprim%2Fsulfamethoxazole%2C%20also%20known%20as

Latour, K., De Lepeleire, J., Catry, B., & Buntinx, F. (2022). Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study. BMC Geriatrics, 22(1). https://doi.org/10.1186/s12877-022-02866-2

Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary tract infections. Therapeutic Advances in Urology, 11(1), 175628721983217. https://doi.org/10.1177/1756287219832172

Sabih, A., & Leslie, S. W. (2023, January 18). Complicated Urinary Tract Infections. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK436013/

Squadrito, F. J., & Del Portal, D. (2022). Nitrofurantoin. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470526/

Thai, T., Zito, P. M., & Salisbury, B. H. (2023). Ciprofloxacin. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535454

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Preparing the Assignment

Nurse practitioners provide high-quality, comprehensive care to clients in various healthcare settings. Standardized procedures may be used to help guide care. Boards of Nursing, such as California link  https://www.rn.ca.gov/pdfs/regulations/npr-i-19.pdf   provide resources to ensure that NPs provide quality care while functioning within their scope of practice.

TOPIC: urinary tract infections in community-dwelling older adults

Use the standardized procedure template

Links to an external site. to complete the assignment.

1. Disorder or condition
   1. Identify the selected disorder or condition.
   2. Provide a basic description of the pathophysiology of the selected disorder or condition.
   3. Provide a summary of the incidence and prevalence of the selected disorder or condition in the United States.
   4. Provide a scholarly source.
2. Assessment
   1. Identify common subjective findings (symptoms) consistent with the selected diagnosis.
   2. Identify pertinent physical examination components and the expected exam findings consistent with the selected disorder or condition.
   3. Identify your intended state of practice and whether physician collaboration is required, as it is in California. If collaboration is required, describe the circumstances that would require physician consultation.
   4. Provide a scholarly source.
3. Diagnostic tests
   1. List diagnostic tests appropriate for the selected disorder or condition.
   2. List expected abnormal results consistent with the selected disorder or condition.
   3. Provide a scholarly source.
4. Management: Present an evidence-based management plan for the selected disorder or condition.
   1. Describe in detail first-line prescribed medications recommended for the selected disorder or condition.
   2. Describe in detail second-line medication that should be prescribed IF the client had an allergy to first-line line treatment for the selected disorder or condition.
   3. Identify medication details including
      1. Trade and generic names for each medication
      2. Typical dose for each medication
      3.  Major contraindications for use
      4. Major drug-drug interactions
   4. Identify other recommended treatments, if any, for the selected disorder or condition.
   5. Discuss expected client follow-up. If the client called in with persistent or recurrent symptoms after initial treatment, describe the appropriate next action.
   6. Describe indications for referral.
   7. Use current clinical practice guidelines or relevant, scholarly resources appropriate for advanced practice as defined by to support the management plan.