Medical Surgical UTI & Pyelonephritis #15

Question

The emergency department (ED) nurse receives hand-off communication for an older adult client with sudden onset delirium. Assessment findings are as follows: Temp: 101.2°; Pulse: 115/min; Resp: 22/min; BP: 88/54 mm Hg. The nurse interprets these findings as being consistent with which condition?

Answers

  1. Ureteritis
    • Rationale:

      This answer is not correct because ureteritis is defined as an inflammation of the ureter; it is rare and is often associated with cystitis or pyelonephritis. Based on the current data, this is not the likely cause for this client’s delirium.

  2. Urosepsis
    • Rationale:

      This answer is correct because based on the client’s current vital sign abnormalities (hypotension, tachycardia, and fever) urosepsis is suspected. For the older adult populations, delirium may occur with infection.

  3. Urinary calculi
    • Rationale:

      This answer is not correct because urinary calculi are solid particles in the urinary system that presents with chills, fever, hematuria, nausea, pain, and vomiting due to a secondary infection. Based on the current data, this is not the most likely cause for the client’s delirium.

  4. Hydronephrosis
    • Rationale:

      This answer is not correct because hydronephrosis occurs when the client’s kidney has an excess of fluid due to a backup of urine, often caused by an obstruction in the upper part of the urinary tract. Based on the current data, this is not the most likely cause for the client’s delirium.

Overview

Delirium is sudden and severe confusion caused by rapid changes in brain function that occurs with mental or physical illness. The older adult client often develops delirium as a result of acute physical illness, such as urinary tract infection (UTI).

Explanation

Learning Outcomes

The older adult client often develops delirium as a result of acute physical illness, such as urinary tract infection (UTI). Urosepsis may occur if UTIs are untreated or from indwelling urinary catheters. This condition may become life-threatening if it progresses to septic shock (see tachycardia and low blood pressure readings). Fever is also a common manifestation.

Test Taking Tip

Consider the client’s age and clinical manifestations to answer this question correctly.

Video Rationale