Welcome back to my series addressing sepsis and why it is important to your cases. Feel free to email me with any questions regarding the information I have provided so far or if you would like some help with one of your cases.

Today we’ll start to review Urinary tract infections (UTI)  and what happens if they progress without treatment.

You may be asking yourself what the standard of care for sepsis is for the LPN that works in a nursing home. We are going to cover that as well in my series addressing sepsis issues.

Urinary output is a key indicator of kidney health and perfusion. Abnormalities will indicate potential acute kidney injury development. Therefore, it is important for nursing to monitor and assess urine output every shift daily. Decreased urine output can indicate a few issues such as dehydration, or a late-stage symptom in infection.

Key facts:

• Any resident/patient with a foley catheter Is at risk for infection development.
• Any resident/patient with a foley catheter should have a plan of care initiated with preventative interventions in place.
• Any resident/patient with incontinence should have a plan of care initiated with preventative interventions in place.

Having a Foley catheter makes meeting the nursing standard of care in assessment of urine output in a resident/patient easier and more precise. Paige Legal Nurse consulting knows it requires nursing attention in monitoring and documenting urine outputs to ensure a minimum of 30 ml/hr. (120 ml/4 hrs.) is met. When urine output is decreased, Nursing is expected to alert the medical team who will typically order fluids intravenously, and most often the urine output resumes to normal levels. LPN’s working in hospitals and Nursing homes are supervised by an RN. When the LPN observes urine output decreased, standard of care requires them to report to their supervising RN and the medical team.

Residents in nursing homes that have Foley catheters require that they be changed routinely. This requires nursing to follow and maintain that this standard of care occurs.

Paige Legal Nurses also know that this requires the plan of care to have a focus problem of ‘At risk for infection’ related to the foley catheter with appropriate monitoring interventions for infection. If decreased urine output is not addressed, our nurses know a standard of care has not been met.

When residents/patients don’t have a catheter but are incontinent, it becomes challenging to accurately monitor urine output. If an elderly resident/patient is not drinking enough their urine output will be decreased. This puts them at an added risk for urinary tract infection as well as dehydration.

This means nursing should be educating the assistant staff on the importance of helping to monitor 1) how often a resident might be incontinent (is it only once in an 8–12-hour vs 3- 4 times?), 2) what are the characteristics of the urine such as odor (is it malodorous? is it blood-tinged?) and also important is 3) reporting abnormalities in the findings to the nurse supervisor.

A lot of LPN’s work in nursing homes, and in some hospitals. Paige Legal Nurses know that the LPN contributes to the nursing assessment of a patient /resident by collecting and documenting objective and subjective data related to their patient /resident and then are obligated to report abnormal findings to their directing RN or medical team provider.

Critical nurse thinking involves assessing how often the resident is incontinent daily (is it adequate?), noting abnormalities in urine such as odor or the presence of blood, and reporting them to the medical team so they can be addressed as potential UTI symptoms. If a UTI is suspected, the expectation would then be an order for the nurse to obtain a urine sample for testing to include a culture and sensitivity if bacteria is identified. Paige Legal nurses know a suspected UTI would also include an update to the plan of care with all findings.

We will be reviewing these areas more in-depth in the upcoming posts. 

Paige Legal Nurse Consulting is a Certified Legal Nurse Consulting firm with experienced acute care and nursing home nurses that are qualified to review cases involving infection and sepsis. Call 508-292-2372 or schedule your case development review online with us today!