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VN Pre-Brief and Post-Simulation Assignment UTI End Stage Renal Disease

Pre-Brief Assignment (completed and submitted prior to simulation) 1. Differentiate the etiology, pathophysiology, and clinical manifestations of upper and lower urinary tract infections. Causative agents of lower respiratory infections are viral or bacterial. Viruses cause most cases of bronchitis and bronchiolitis. In communityacquired pneumonias, the most common bacterial agent is Streptococcus pneumoniae. Organisms enter the distal airway by inhalation, aspiration or by hematogenous seeding. The pathogen multiplies in or on the epithelium, causing inflammation, increased mucus secretion, and impaired mucociliary function; other lung functions may also be affected. Symptoms include cough, fever, chest pain, tachypnea, and sputum production. Patients with pneumonia may also exhibit non-respiratory symptoms such as confusion, headache, myalgia, abdominal pain, nausea, vomiting and diarrhea. 2. Differentiate the different diagnostic modalities available to identify/diagnose UTI. The gold standard for the diagnosis of a urinary tract infection is the detection of the pathogen in the presence of clinical symptoms. The pathogen is detected and identified by urine culture (using midstream urine). 3. Identify measures to implement in the nursing practice to reduce incidence of UTI's. Several practices, often implemented in bundles, appear to reduce UTI or CAUTI in nursing home residents such as improving hand hygiene, reducing, and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions. 4. What is a catheter-associated urinary tract infection (CAUTI) and what are its causes? A catheter-associated urinary tract infection (CAUTI) occurs when germs (usually bacteria) enter the urinary tract through the urinary catheter and cause infection. CAUTIs have been associated with increased morbidity, mortality, healthcare costs, and length of stay. 5. What are some of the measures that hospitals are doing to prevent CAUTIs? The three areas to improve evidence-based clinical care to reduce the rate of CAUTI: the first prevention of inappropriate short-term catheter use, the second nurse-driven timely removal of urinary catheters, and the third urinary catheter care during placement.

Post-Simulation Assignment (completed and submitted after the simulation) 1. Create an SBAR report for the actions that you did in the simulation. The SBAR is a powerful tool that is used to improve the effectiveness of communication between individuals. It is easy to use and can help your staff learn the key components needed to send a complete message! Here are the key components of the SBAR:

VN Pre-Brief and Post-Simulation Assignment UTI End Stage Renal Disease

Situation: Clearly and briefly define the situation. For example, ‘Mr. Jones has multiple prescriptions of Coumadin in his home and he is unclear as to which ones he is supposed to take.’ o Background: Provide clear, relevant background information that relates to the situation. In the example above, you should consider including the patient’s diagnosis, the prescribing physicians, and the dates and dosages of the medications. o Assessment: A statement of your professional conclusion. o Recommendation: What do you need from this individual? For example, ‘Please clarify which is the correct dose of Coumadin for Mr. Jones to take and which physician will be responsible for managing his anticoagulant therapy?

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2. Create documentation with appropriate timestamping for activities and pertinent information from the simulation. 3. Create a nursing care plan (NCP), using the template from your clinical forms packet (see attached template), for this patient. Formulate 2 nursing diagnoses, 3 nursing interventions & 3 rationales for each diagnosis Nursing Care Plan Template and Grading Rubric.docx Create a concept map for the diagnosis of Urinary Tract Infection. (Please see attached template) Nursing Concept Map Template_VBC.docx o o o o o o o o o

Contributing Factors Priority Nursing Diagnosis Pathophysiology Medications Recent Labs Pertinent Physical Examinations Psycho-social / Spiritual issues Patient Teaching References

Please complete medication cards: 1. 2. 3. 4. 5.

AZO (Phenazopyridine HCl) Trimethoprim/Sulfamethoxazole (Bactrim) Nitrofurantoin (Macrodantin) Ampicillin/Sulbactam (Unasyn) Levofloxacin (Levaquin)

Example of the Drug card expected: Ropinirole HCL (Requip)

VN Pre-Brief and Post-Simulation Assignment UTI End Stage Renal Disease

Class: Dopamine Receptor Agonist; Antiparkinson Actions: effectiveness indicated by improvement in idiopathic Parkinson’s disease. Peak: 1-2hr. Half-life: 6hr. Indications: Idiopathic Parkinson’s disease, restless leg syndrome Norm. Dosage, Freq, Route, Range: PO 0.25-4mg Max: 4mg Side Effects: fatigue, viral infection, dizziness, somnolence, sudden sleep attacks, syncope, nausea, vomiting, dyspepsia Nursing Considerations: Lab tests: periodically monitor BUN and creatinine, hepatic function and cardiac status...