Chronic Urinary Tract Infections Treatment Case Nursing Essay

Chronic Urinary Tract Infections Treatment Case Nursing Essay RP, a 72-year-old Caucasian female, was brought to the emergency room (E.R) from Hillcrest Adult Foster Care via ambulance. Preadmission report to F-300 stated that she came to E.R confused, lethargic and weak, complaining of acute pain upon urination. She also urinated small amounts ( Upon arrival to F-300 RPs labs revealed significantly lowered thyroid stimulation hormone (TSH), a lowered red blood cell (RBC) count, along with decreased hemoglobin and hematocrit (HH). Her white blood (WBC) count was elevated, as expected with a urinary tract infection (UTI). Primary Diagnosis and Priority Secondary diagnosis The primary medical diagnosis was chronic urinary tract infections, with a secondary diagnosis of hypothyroidism. Patient History RP has a history of chronic UTIs, hypothyroidism, chronic kidney disease (stage III), and chronic anemia. She has several admissions the past few months related mainly to UTIs and dehydration. PATHOPHYSIOLOGY/ETILOGY OF THE PRIMARY DIAGNOSIS AND PRIORITY SECONDARY DIAGNOSIS UTIs are the results of infection, mainly from bacteria, fungi, viruses, or parasites. This leads to a condition referred to as cystitis (inflammation of the bladder). Most common of the UTIs are from infection known as infectious cystitis. A bacterium, the most common cause of infectious cystitis, is from the external urethra, this spreads inwards to the bladder (distal to proximal). Once a bacterium migrates to the bladder and starts the process of growing, it can migrate to other parts of the body (Ignatavicius Workman, 2006). UTIs present with symptoms that include frequency, urgency, retention, burning, foul odor, and incontinence. According to Wikipedia, four stages must be met in order for bacteria to grow. These include an infectious agent, one that must be able to grow, multiply and enter the body. Once we have the agent, the bacteria must find a portal of entry, (how it enters the body). Once in the body it needs an adequate reservoir, a place where organisms can thrive and multiply and the susceptibility of host, how bacteria affects the body after entry. Determents include age, overall health and other co-morbidities of the host and the susceptibility to pathogens. Most UTIs first grow in the perineal area due to irritation; in RPs case this may have been caused by lack of personal hygiene due to being overly fatigued, brought on by her hypothyroidism. Minton (2009) stated, Thyroid is the most important hormone in the body. Because it stimulates the production of cellular energy, production of all other hormones will be negatively impacted when thyroid hormone levels are less than optimal. Every aspect of health is affected by low thyroid function. Hypothyroidism is signaled by fatigue and loss of energy. According to textbook, hypothyroidism is the result of decreased metabolism from low levels of thyroid hormones (THs). Low levels of THs may be a result of several different reasons: thyroid cells may fail to produce sufficient amounts, or the cells themselves are damaged. The patient may not be ingesting enough of the substances needed to make THs, especially iodide and tyrosine. Low levels of THs affect most tissue and organs causing decreased cellular energy. The patient could become confused, lethargic, and have slowing of intellectual functions. ACTUAL OR POTENTIAL IMPACT OF RELEVANT MEDICAL HISTORY ON THE PRIMARY DIAGNOSIS AND PRIORITY SECONDARY DIAGNOSIS RP has a history of chronic UTIs that has caused numerous admits to the hospital over the last few months. UTIs that are left untreated may and can cause damage to the kidneys and start the process of renal failure. Chronic infection of the kidneys causes scar tissue, which decreases the function of the renal system. With renal failure, the body cannot rid itself of certain toxins that may contribute to UTIs. Chronic UTIs may lead to chronic pyelonephritis, repeated upper tract infection of bacteria that migrates from the bladder superior (toward the kidney) to the kidneys. RPs diagnosis of chronic renal failure may be heightened by the chronic UTIs. Hypothyroidism and anemia, that cause fatigue and loss of energy, will discourage you from providing adequate hygiene. This encourages bacterial growth, which may start the chain of events leading up to a UTI. RP resides at an extended care facility that may not have adequate staff to assure that she receives the necessary amounts of iodide and tyrosine needed stimulate TH production. She is also very confused which would decrease her understanding of the importance of proper nutritional intake. MEDICAL MANAGEMENT: CHRONIC URINARY TRACT INFECTIONS And Hypothyroidism A urine sample must be obtained either by a clean catch method or if client unable, by straight catheter method. A catheter method was used on RP, due to her confusion and retention. Urinalysis testing for leukocyte esterase (n=negative) and nitrate (n=none), along with a WBC (n= 0-4) are specifically for diagnosis of a UTIs (Mosbys 2006). Normal urine should appear clear with a yellow tint present (Mosbys 2006). A noticeable smell should not be present in uninfected urine; RPs urine had a pungent odor noted. RPs leukocyte esterase was 3+ and her nitrate was positive. WBCs were to numerous to count. These results determined that RP did have a UTI. Blood work was noted that RPs thyroid stimulating hormone (TSH) was 0.05 (n=2-10). This confirmed the diagnosis of hypothyroidism. NURSING MANAGEMENT: URINARY TRACT INFECTION Recommended textbook intervention is to monitor for signs of UTIs. This includes, but not limited to: frequency, urgency, dysuria, incontinence, pyuria. In some older adults the only sign may be an increase in mental confusion or frequent, unexplained falls. RP was on Q-4 hour vital sign assessment, paying close attention to any increase in temperature and/or heart rate. The patient remained afebrile throughout admission. Heart rate remained between 80-90 beats per minute. Respiratory rate remained between 16-20 breaths per minute. Due to her confusion, bed alarms and padded side rails were used. She had a high fall risk assessment; therefore fall risk precautions were implemented upon admission. She was placed on strict intake and output (IO), and her fluids were monitored. She was instructed to drink required amount of fluid per day (1500ml). Staff member offered bedside commode every two hours to encouraging voiding. She and family members were informed as to the importance of RP to remain dry. This will limit the environmental factors needed for bacterial growth. RN (preceptor) communicated with adult foster care on the needs of the client after discharge. Lab results were also monitored closely for any change that would indicate worsening infection. PHARMACOLOGICAL MANAGEMENT: URINARY TRACT INFECTION AND HYPOTHYROIDISM Textbook recommends medications that treat bacteria and the promotion of client comfort. Cure is dependent on the antibiotic level achieved in the urine. Long-term antibiotic therapy is recommended for chronic UTIs (Ignatavicius Workman, 2006). RP received, via intravenous therapy (IV), Azactam (antibiotic) per Dr. order, to treat her infection. Paroxetine mesylate (antianxiety agent, antidepressant) 30 mg by mouth daily, used to decrease anxiety. Also given Levothyroxine (hormone) as a thyroid supplement. PROVIDER AND MANAGER ROLE: NURSING CARE PLAN Priority Nursing Diagnosis P Impaired urinary elimination R Incontinence due to urinary tract infection C Acute lower tract pain 7/10 upon urination, Priority Patient Goal The patient will be able to state absence of pain or excessive urination by discharge AEB: Pain upon urination 0/10, Decreased urge to void, Empting bladder completely Three Priority Nursing Interventions The nurse will monitor patient for incomplete emptying of bladder by using bladder scan post void. The nurse will encourage patient to drink water at each meal. The nurse will instruct patient on the signs and symptoms of a urinary tract infection. Evaluation of Progress toward Patient Goal The patient was able to recite some signs of UTIs to nurse. She recognized pain on urination and foul odor as signs of an infection. The patient was reluctant to drink water at any one time. She continued to have incontinent periods, but this was less frequent on day of discharge. The patient partially met the goals put forth for her. PROVIDER AND MANAGER ROLE Member of the discipline and the Role of the Multi-Disciplinary Team As a member of the discipline I was inclined to have verbal interactions with the ER staff before RP had arrived to F-300. Consulted with housekeeping to assure the RPs room was cleaned and ready for admission. Ward clerk assured that tests were ordered. Dietician was consulted to help with nutritional needs. Discharged planner made transportation arrangement to return patient to long care facility. Social worker discussed local community resources of support with the family. Provider of Care Role As provider of care for this patient, I kept this patient cleaned and dry when incontinent. I utilized the fall risk precautions to provided safety. Implemented steps to encourage patient to accept and understand a bladder training routine. Monitored patient labs and reported abnormal results to the doctor. Manager of Care Role As manager of care I evaluated the client for her fall risk and implemented fall risk precautions. Delegated the placement of bed alarms and tabs to the LPN assigned to us. My preceptor and I discussed the possible ways to teach client prevention of developing UTIs. Collaborated with nursing home staff on ways to improve clients care at extended care facility. Growth in the Manager of Care Role In completing these tasks I was able to see the complete picture of the patient. I was educated on the disease process and the effect other co-morbidities had on providing an environment that encourages an infection. In caring for RP I was able to developed and strengthen my delegating skills, learning to rely on others and not solely on myself.

Deviancy in Society Essay -- essays research papers fc

There are many different kinds of deviancy in today’s society. In this essay I will tell you the meaning of deviance, the different kinds of deviancy, the biological, social, and psychological factors on deviant behavior, and how they differ from each other. According to James M. Henslin, Editor of Down to Earth Sociology, â€Å"For society to exist, people must be able to know what to expect of others.† â€Å"People develop norms to provide regularity to social life.† â€Å"Deviancy is the violation of these rules and expectations.† So according to Mr. Henslin, we all have deviant tendencies in us at some point in our lives. We all violate rules and expectations others have created whether it is a minor or large-scale offense. In today’s society, the word deviant is used very commonly and its meaning becomes distorted. People might associate the word deviant with being twisted, nasty, or perverted. â€Å"Deviance is not a term for negative judgment.† It just means anyone to violate the expectations of others. The norms that we create cover three basic aspects of human behavior: our appearance, manner, and conduct. The rules of appearance and manner, if broken, are usually called civil disobedience and conduct is usually called criminal disobedience. The first major type of deviance that will be mentioned is against the appearance norm. The expectations of appearance concerns clothing, make-up, hairstyle, and other â€Å"social extensions of a person.† There are even certain expectations on things...

Segmentation, Targeting & Positioning

University of Zimbabwe Graduate School of Management *Marketing Ma*nagement Question: Kotler (1988) has stated that: â€Å"The heart of modern strategic marketing can be described as STP – segmenting, targeting and positioning. ’’ Discuss this statement using appropriate examples. Introduction Market segmentation By definition market segmentation is the division of a market into different groups of customers with similar needs. Or to express it in another way, market segmentation is the division of a mass market into identifiable and distinct groups or segments, and each has common characteristics and needs and displays similar response to marketing actions. ‘’In essence it is the process of dividing a varied and differing group of buyers or potential buyers into smaller groups, within which broadly similar patterns of buyers exist. ’’ (Wilson and Gilligan, 2007, p. 318). There are several ways in which companies can segment their markets. Just as you can divide an orange up into segments you can divide the population as a whole into different groups of people or segments that have something in common. Marketers therefore look for variables they can use to divide up the population. According to Kotler (1997) the commonly used variables are: Geographic segmentation, demographic segmentation, psychographic segmentation and behavioural segmentation. Products can be aimed at a lifestyle. People are grouped according to the way they lead their lives and the attitudes they share. For example, young professionals may drive a sports car because of the image they want to portray. Married parents might want the same things, but have to provide for their children, which is a large extra cost. They will need a family car to suit their lifestyle. Thus you will find a couple that has just married and have no children, will go for a Mazda 3, while older couples with three or so children will go for a Mazda BT-50 because it is bigger and can accommodate the whole family. However the range and variety of marketing decisions suggest that any attempt to use a single basis for segmentation may result in incorrect marketing decisions as well as a waste of resources. Thus increasingly today you will find marketing strategies combining two or more basis for segmentation of their market. TARGETING Once the firm is satisfied that the segments warrants attention there are various ways in which a firm can then target a market. The first is a single product offering. In other words, the marketer targets a single product offering at a single segment in a market with many segments. For example, British Airway’s Concorde is a high value product aimed specifically at business people and tourists willing to pay more for speed. Identifying marketing targets enables organisations to find opportunities and tap into them. It gives firms the information needed to focus on the buyers that are interested in what they have to offer. This saves both time and money in an ever-changing society. However if you pursue one segment of your target market and the demand for your product decreases, so will your financial strength. In essence, you are putting all your eggs in one basket. When your firm becomes well established in a particular market segment, it may be difficult for you to move to another segment. This may occur due to your market reputation or popularity. For example, if Lorimark HR Consultants becomes known for helping college graduates find jobs, unemployed professionals may perceive them as only having the expertise to serve that market. Another downside of target marketing may that a large segment of the population may be left out in the cold. Though demographics and segmentation might give an overall view of the intended market, consumer spending habits change greatly, depending on trends and economic factors. With society taking on more of a unisex lifestyle businesses should be careful when using for example gender to target market. An example of a product that was traditionally targeted at women and is now being targeted with variations in strategy at men is hair colouring. Men now pay particular attention to their hair in much the same way as woman. Thus target marketing should be done with extra care taking into account all factors that may have an effect on the organization’s profitability and the perception or position it wants to create in the market. POSITIONING Thus positioning is all about perception and is inextricably linked to segmentation. It cannot be defined until the market has been divided into unique segments, and target segments have been selected. As perception differs from person to person, so do the results of the positioning map. Positioning reflects the â€Å"place† a product occupies in a market or segment. A successful position has characteristics that are both differentiating and important to consumers and the characteristic may or may not reflect reality. A position is effectively built by communicating a consistent message to consumers about the product and where it fits into the market in terms of the features, performance, quality, conformance, durability, reliability, style and design — through advertising, brand name, and packaging and all the other elements of marketing mix. Kotler, 1997, p. 301) For years OK Zimbabwe has constantly and consistently bombarded the minds of consumers’ with the message ‘†¦. where your money buys you more. ’ Thereby creating in the mind of the consumer that OK has the best prices and your dollar with OK can take you a long way. Another example w ill be that of Colgate and Surf by Unilever, these products are stuck in the minds of consumers (positioned), such that if someone is buying any other toothpaste or washing powder, not necessarily Colgate or surf, they will still refer to the product as Colgate or surf respectively. It is ‘the’ product in mind of the consumers. That is positioning. What is our current position? What does the space look like – what are the most important dimensions in the category? What are the other products in that space and where are they? What are the gaps, unfilled positions or ‘holes’ in the category? Which dimensions are most important? How do these attitudes differ by market segment? What position do we want to have? Some of the positioning opportunities for a product include: Finding an unmet consumer needs – or at least one that is not being adequately met now by completion? Identifying product strength that is both unique and important. Determining how to correct a product weakness and thereby enhance a product’s appeal. For example Ponds â€Å"new and improved†. Changing consumer usage patterns to include different or additional uses for the product. Identifying market segments, which represent the best targets for a product. How do we create a new positioning? Physical product differences. Communications- finding a memorable and meaningful way to describe the Positioning is not what you do to a product; ‘positioning is what you do to the mind of the prospect’. (www. s-m-a-r-t. com/Exp_brandpros. ) Accessed 3 September 2009. Other questions that the marketer should contend with in terms of positioning are: whom do I have to defeat to own the position, do I have the resources to do it, can I persist until I get there and are my tactics supporting the positioning objectives I have set. The positioning map below will show how the motor industry positions their products in the market. Positioning map: +High (price) From the above positioning map it can be concluded that products tend to bunch in the high price/low economy (fast) sector and also in the low price/high economy sector. There is an opportunity in the low price/low economy (fast) sector. Maybe Hyundai or Kia can consider introducing a low cost sport saloon. However it is all down to the perception of the market about the product. Conclusion Undertaking a Segmentation, Targeting and Positioning process is probably one of the most important processes management should undertake both at the onset of a new offer creation as well as part of a periodic revision of the portfolio of offers and strategies used by organization. A market research is always the starting point in the STP process; otherwise the organizations resources will be misdirected. References: Aaker A. David, (1995). Strategic Market Management, 4th Edition, John Wiley & Sons, Inc. Armstrong J. Scott, (2006). Strategic Marketing Management – A Business Process Approach. Brand pros available at http/www. s-m-a-r-t. com/Exp_brandpros. Accessed 3 September 2009. Grahame Dowling, (2004). Creating Corporate Reputation. Identity, Image and performance. Oxford University Press Inc. Kotler P, (1997). Marketing Management, Analysis, Planning, Implementation and Control, 9TH Edition, Prentice Hall. Malcolm H. B. McDonald, (1996) Marketing Plans, How to prepare them how use them, 3rd Edition, Butterworth-Heinemann. Wilson and Gilligan

Prohibition and Organized Crime essays

Prohibition and Organized Crime essays In October 1919, congress voted and approved the ratification of the Eighteenth Amendment by thirty-six states and turned it into law as the National Prohibition Act of 1920 just one year later. This amendment prohibited the manufacture, sale, transport, import or export of alcoholic beverages. The Eighteenth Amendment is comprised of three main sections: 1. After one year from the ratification of this article the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States and all territory subject to the jurisdiction thereof for beverage purposes is hereby prohibited 2. The Congress and the several states shall have concurrent power to enforce this article by appropriate legislation. 3. This article shall be inoperative unless it shall have been ratified as an amendment to the Constitution by the legislatures of the several states, as provided in the Constitution, within seven years from the date of the submission hereof to the states by the Congress. So how did it happen? How did a liberty loving people decide to give up a private right that had been used by millions all over the country since the first settlers arrived? Why would they solicit the extinction of the fifth largest industry in the nation? Interestingly enough, why would the new Eighteenth Amendment be the first to restrict citizens when the first seventeen limited government? Now there were two exceptions to the great Amendments: you couldnt buy alcohol and you couldnt own slaves. 2. Prohibition changed the way people lived and in the end redefined the role of government and how it began to dictate the lives of its constituents. Big Brother is not a recent phenomenon but one that began almost one hundred years ago during the time of Prohibition. George Washington himself was quoted as saying The benefits arising from moderate ...

Almost Famous essays

Almost Famous essays Directed and written by Cameron Crowe Starring Patrick Fugit, Kate Hudson, Billy Crudup, Jason Lee and Frances McDormand Cameron Crowe views his life and experiences of his mid teen years as a rock critic for Rolling Stone Magazine, whom he shows through the eyes of his alter-ego, William Miller (who is played by Patrick Fugit), in the critically acclaimed film, "Almost Famous." William follows around a "mid level band struggling with their own limitations in the harsh face of stardom." which is known as "Stillwater." This movie follows "Stillwater" showing everything William writes about and Sees, and shows the life of 70's Rock n, Roll in its last drive before being killed by disco. The Setting for the movie was in San Diego in the early 1970's. Williams's sister Anita (Zooey Deschantel) is shown as a "rebel" who believes in everything her mother is against. She causes conflict and problems at home but decides to leave home when she turned 18 to become a stewardess. Williams mother Elaine, whom is a conservative woman, also a very liberal woman, whom "decided to celebrate Christmas on a day in September when she knew it wouldn't be commercialized." Elaine is a very good mother who tries teaching William "the cliff notes on life." She supports his journey even if she didn't agree with them, and helped give an honest statement to a few of the rock and rollers a time or two. She also put William in first grade when he was five, never telling him till he was eleven. He thought he was thirteen. No wonder he had not gone through puberty yet. William, now fifteen is fully in love with the music of Rock and writes articles and submits them to "Creem Magazine" and a few underground papers. He meets up with legendary rock critic and editor of "Creem Magazine," Lester Bangs. Lester teaches William the ropes of being a rock journalist and tells him certain rules to follow and the tr ...

Fifth Section Essay Example | Topics and Well Written Essays - 500 words

Fifth Section - Essay Example One-year strategic objectives are to identify a market which most effectively exploited its capabilities, the market for cordless segments, and develop this market. The brand in turn should acquire a distinctive identity. That combination, a system of production which gives the company a particular advantage in its chosen market segment, a world-wide reputation for product quality, and a brand which immediately identifies the aims and aspirations of its customers, will make Able Corporation one of the most profitable manufacturers. Five-year strategic objectives are: (1) to develop innovative products and solution which meet needs of target audience and allow Able Corporation to sustain strong market position; (2) to penetrate new market segments of PEPT; (3) to become a leader in cordless market segment. A ten-year strategic objective include: (1) to transform itself from a medium-ranking company with uncertain future to Europe's leading PEPT producer; (2) to build two plants in Eas tern Asia and (3) to penetrate Asian market; (3) increase market share in 50 % (McDonald, Christopher 2003). Business strategy looks at the relationship between the firm and its competitors, suppliers, and customers in the markets which it has chosen.

Seminar on Marketing Personal Statement Example | Topics and Well Written Essays - 500 words

Seminar on Marketing - Personal Statement Example Again, the key is on strategic planning and execution of the plan. Marketers should be able to draw a specific image of their products or service offerings and be able to implement them efficiently. For a typical customer like me, it never occurred to me that marketers are designing each touch point in order to create the brand image that they desire. Yes, I have had spent countless hours chatting and socializing with colleagues at Starbucks but never really understood how the specialty coffee retailer orchestrate everything in order for me to enjoy my stay and differentiate itself from another coffee house like Dunkin Donuts. Through the concepts and tools I have learned in class, I am now able to grasp while Starbucks invest in "green coffee beans," why the place really looks laid back, why they don't offer quick meals, and most importantly why their products are priced at least $3 while I can get coffee from McDonalds are less than 50 cents. Marketing has opened a new road to discovery and understanding for a consumer like me. I hope to utilize everything that I have learned from the seminar discussions in my future career.