CTSE 5: Altered Illness Responses

Case Scenario:
     As a hospice care nurse taking care of client Z, 80 years old, female, with late-stage Alzheimer's
disease, your daily assessment normally finds her to be medically stable, with a pleasant but
confused affect. When you assess her today, her vital signs are stable. However, she angrily yells at
you when you speak to her, she is notably agitated, and she cries with pain as she attempts to void.
She complains about how many times she would go to the toilet for voiding. She does not want to
drink water and blamingly asks you if you are putting something in her glass of water to make her
urge to void.

Questions:

1. How would you respond to client Z's query? What would be your appropriate response-
statement?

It can take time and effort to communicate with elderly who has Alzheimer's disease in its
late stages. I will respond to Clint Z in a calm way as a hospice nurse. She needs to know why
she needs to go to the bathroom so frequently because her late Alzheimer's disease is
causing her to lose control over her bladder. The client will then have my assurances that
drinking water is safe because it will lessen the concentration of her urine and help wash
away bacteria that might cause infections and irritate the bladder.

2. What possible acute condition would you consider based on client Z's complaints and
objective cues?

A urinary tract infection could be present given Client Z's acute dysuria, which is pain while
urinating. The client is crying because she experiences discomfort or pain when she defecates.
She also bemoaned how frequently she used the restroom due to polyuria, which is another sign
of infection.

3. What nursing diagnosis should you rule out and include in client Z's plan of care? Give
at least 3.

o Deficient fluid volume related to active fluid loss from frequent urination
o Impaired Thought processes related to late-stage Alzheimer's disease as evidenced by
periods of agitation

o Disturbed sleep pattern related to physiological interruptions such dysuria

4. Based on your understanding of the altered response to acute infection in the elderly,
what assessment parameters would you evaluate further?

As a hospice nurse, I will first evaluate the baseline data for client z, which includes her
medical history, physical examination, and results of clinical and diagnostic tests. I will also
check the baseline information for client z's doctor. Asking her to rate the level of discomfort
 she had while trying to urinate on a pain scale from 1 to 10 is the second assessment I need
to make. The third assessment is to check the skin turgor of the client because poor skin
turgor is one of the symptoms of dehydration.

5. What plan of action would you initiate?

She won't be allowed to consume any alcohol or caffeine, which might make UTI symptoms
worse. Instead, I will tell her to drink a lot of water, even if she is not thirsty, as this helps to
flush the bacteria away. I will enable her to take the medication the doctor recommended.
And I'll tell client Z to wipe her genitalia from front to back after using the toilet because
doing so prevents bacteria from getting in contact with the urethra.