Posted: April 4th, 2019

An 82-year-old man recently returned to the long-term care facility

D4
Case 4
________________________________________
An 82-year-old man recently returned to the long-term care facility after hospitalization for open reduction internal fixation of the right hip. He has been divorced for over 50 years and has two adult children who visit him frequently in the nursing home. He has a 5-year history of mild to moderate dementia and known urinary tract infections. His last recorded mini mental state examination (MMSE) registered 18, which was 3 months ago. While in the hospital, he did have an indwelling catheter for 4 days. He has been incontinent since his return to the hospital but the staff their attributes this to the catheter and his deconditioned state following hospitalization. His medications include donepezil, memantine, and acetaminophen for pain and fever as needed. He has no other known medical problems except a history of multiple urinary tract infections throughout his lifetime that, according to his son, have required extensive antibiotic treatment. He enjoys drinking regular coffee throughout the day, says it is a habit he has had since his days in the service years ago. His family members and the nursing staff report that he has been very restless and has been unable to use the urinal on time the past couple of days.
Vital signs: T 99°F, HR 80, RR 18, BP 128/78, BMI 22.
Chief Complaint: Foul smelling urine, incontinence, restless
Discuss the following:
1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
2) What additional objective data will you be assessing for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What radiological examinations or additional diagnostic studies would you order?
6) What treatment and specific information about the prescription that you will give this patient?
7) What are the potential complications from the treatment ordered?
8) What additional laboratory tests might you consider ordering?
9) What additional patient teaching may be needed?
10) Will you be looking for a consult?

Submission Instructions:
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• Please post your initial response by 11:59 PM ET Thursday

Can I See Writer Credentials?

You can view anonymized writer profiles, highlighting their degrees and expertise, to feel confident in who’s handling your paper. Each profile gives you a clear picture of their background, so you know they’re qualified for the job. Our team ensures every writer meets high academic standards. This transparency helps students make informed choices and find the best academic writing help online.

Grading Rubric – grade miners score
________________________________________
Your assignment will be graded according to the grading rubric.
Discussion Rubric – grade miners score
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts Distinguished – 5 points
Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts. Excellent – 4 points
Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts. Fair – 2 points
Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts. Poor – 1 point
Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts. 5 points
Use of Citations, Writing Mechanics and APA Format – Best Help Writing My 99 Papers—owl Essay Samplesting Human Written Academic Papers – Guidelines Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors. Excellent – 2 points
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors. Fair – 1 point
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail. Poor – 0 points
Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. 3 points

D4 Case 4

Subjective Data

Chief Complaint: Foul smelling urine, incontinence, restless
Past Medical History: Mild to moderate dementia, multiple urinary tract infections, hip fracture
Social History: Divorced, two adult children
Family History: Unknown
Medications: Donepezil, memantine, acetaminophen
Allergies: None known
Objective Data

What If I Need Last-Minute Changes?

No problem! Request revisions anytime within 7 days, and we’ll tweak your paper quickly to meet your needs, free of charge. Our flexible process keeps your paper on track. Just update your order details in your account. Fast and responsive revision services are key for students managing tight deadlines.

Vital signs: T 99°F, HR 80, RR 18, BP 128/78, BMI 22
Physical Exam: Genitourinary: Incontinent, foul smelling urine
Differential Diagnoses

Urinary tract infection
Bladder cancer
Prostate cancer
Renal calculi
Interstitial cystitis
Urethral stricture
Dehydration
Dementia
Delirium
Laboratory Tests

Urinalysis: Urine culture and sensitivity
Complete blood count (CBC)
Blood urea nitrogen (BUN) and creatinine
Electrolytes
Liver function tests
Radiological Examinations

Kidney, ureter, and bladder (KUB) X-ray
Renal ultrasound
Treatment

Can I Request Revisions to My Completed Essay?

Absolutely, our essay writing service offers free, unlimited revisions within 14 or 30 days, depending on your order, to meet your expectations. Simply contact your writer or our 24/7 support team to request adjustments, ensuring your paper aligns perfectly with your needs. We’re dedicated to your satisfaction, refining your essay until it’s just right. Trust us for exceptional, customizable academic assistance! Students often rely on our revision policy to achieve polished and professional academic results.

Antibiotics for urinary tract infection
Pain medication for pain
Fluid management for dehydration
Behavioral interventions for dementia
Environmental modifications for delirium
Potential Complications

Ascending infection
Pyelonephritis
Septicemia
Renal failure
Death
Additional Laboratory Tests

If the patient does not respond to antibiotics, additional laboratory tests may be ordered to rule out other causes of the infection, such as a kidney stone or prostatitis.
Additional Patient Teaching

The patient should be taught about the importance of drinking plenty of fluids, voiding regularly, and wiping from front to back after urination.
The patient should also be taught about the signs and symptoms of a urinary tract infection, such as foul smelling urine, pain or burning during urination, and frequent urination.
Consult

If the patient does not respond to treatment or has any complications, a consult with a urologist may be necessary.
References

How Do You Define Originality?

Originality means crafting every paper from scratch, with unique content and proper citations, verified by plagiarism checks for 95%+ uniqueness. You’ll receive a free originality report with every order. We guarantee your paper is one-of-a-kind. Academic integrity is our priority, ensuring your work is plagiarism-free and trustworthy.

Beers, M. H., Porter, R. S., Jones, T. V., & Kaplan, J. S. (2022). The Merck manual of diagnosis and therapy (19th ed.). Elsevier.
Fauci, A. S., Braunwald, E., Kasper, D. L., Hauser, S. L., Longo, D. L., Jameson, J. L., … & Fauci, A. S. (2022). Harrison’s principles of internal medicine (21st ed.). McGraw-Hill Education.

Order|Paper Discounts