El Camino College
December 12, 2013
Pediatric Urinary Tract Infection Identifying Information: Patient BY, 30 day old male of African-American and Hispanic ethnicity. Admitting diagnosis: Urinary tract infection. Date of admission: 1 December, 2013. History of presenting illness: Patient’s mother states that on the 30th of November, the patient began a pattern of irritability and inconsolable crying. After failed attempts of consoling the child and suspected fever, the mother finally brought the patient to the emergency room. Upon examination, the patient was initially diagnosed with 103.6 fever and suspected infection. Following urinalysis and urine culture, the patient was found to have an E. coli count of 7,100,000 CFU/mL, which is significantly high, and enough to confirm a diagnosis of febrile urinary tract infection (UTI). The patient was initially prescribed ampicillin and cefotaxime, with the ampicillin being discontinued on the 4th of December. Currently, BY is now being treated with 185 mg of cefotaxime, to be given via intravenous (IV) infusion every 6 hours. The patient is also receiving continuous IV fluid, D5NS1/4 with 10 mEq KCl, infusing at 12 mL/hr.
What are you on alert for today?
Today I am on alert for signs and symptoms of infection. Because BY has already been diagnosed with a UTI, it is important to monitor this patient closely to make sure the symptoms are gradually fading and not increasing in intensity. I must assess that the treatment is effective, because the patient’s illness could easily progress to a more advanced stage if not addressed. I also must be on alert for any complications related to the patient’s IV infusion that may put the patient’s health and safety at risk.
What are the important assessments to make today?
Important assessments to make today include monitoring vital signs and assessing the infant for any other signs and symptoms of infection. It is very important to assess frequently, because failure to intervene could lead to serious consequences. It is also important to monitor the patient’s IV infusion. The IV site should be checked regularly for patency, to prevent infiltration and risk of IV burn. The medication orders should be double checked for safe dosage and infusion rate, along with contraindications, and the infusion pump should be assessed throughout infusion time to ensure that no malfunction takes place.
What complications may occur?
Failure to monitor the patient for signs and symptoms of infection could result in long-term damaging effects. For example, a steadily increasing internal temperature could result in febrile seizures, which would put the patient’s health at risk. If the urinary tract infection continues to progress, the patient is at risk for kidney infection, renal scarring, and sepsis. Other complications related to IV infusion includes fluid overload, infiltration, and IV burn.
What interventions will prevent complications?
Complications regarding the infant’s infection could be prevented by continuously monitoring the patient’s temperature, and intervening with anti-pyretic medications as necessary. Other interventions, such as monitoring the patient’s urine output and notifying the physician of any blood in urine or increased abnormalities, could prevent further complications related to the infection. Calculating the medication’s safe dosage and comparing to the doctor’s order will also prevent complications and protect the patient. Finally, proper IV pump and IV site assessment will prevent further complications regarding the patient’s IV infusions.
What assumptions did you make about the patient’s care based on the admitting diagnosis, information from the chart review and/or shift report?
Based on the diagnosis and chart review, I decided that my main focus would be on the safety and well-being of