Nursing Care Plan: Ellie Matthews

Ellie Matthews is a seventy-four-year-old female who was admitted to the hospital from the assisted living center. When she arrived, Ellie had a temperature of $38.3^{\circ}\text{C}$ ($101^{\circ}\text{F}$). She has a history of hypertension and high cholesterol and wears incontinence briefs. Medications include lisinopril and simvastatin. A urinalysis was completed which showed cloudy urine, elevated white blood cells and a specific gravity of $1.040$. A urine culture and sensitivity was obtained and results are pending. The client received the first dose of levofloxacin (Levaquin) IV and acetaminophen (Tylenol). Last vital signs were temperature $38.8^{\circ}\text{C}$ ($100.8^{\circ}\text{F}$), blood pressure $122/82\text{ mmHg}$, heart rate $98/\text{ min}$, respiratory rate $20/\text{ min}$, oxygen saturation $97\%$ on room air. Upon assessment the nurse notes that Ellie's brief is saturated with urine. The nurse asks Ellie if she always wears a brief and the client states that she just started having difficulty holding her urine "on and off for a while now". Once she has the urge, she leaks urine on the way to the bathroom and must urinate frequently. The client reports she is embarrassed in public and is not going to social gatherings because she is concerned about "having an accident and the odor". The client states, "I don't have any control of my bladder anymore. I guess most women my age have the same problem." Vital signs are blood pressure $128/78\text{ mmHg}$, heart rate $100/\text{ min}$, respirations $20/\text{ min}$, temperature $38.2^{\circ}\text{C}$ ($100.8^{\circ}\text{F}$), oxygen saturation $97\%$ on room air. Which of the following concerns should the nurse plan to address? (Select all that apply.)

- Physiological: Elimination

- Physiological: Infection

- Psychosocial: Stress and Coping