Diagnosis: Urinary tract infection

vSim for Nursing | Gerontology

Millie Larsen Part 1


Instructor’s Overview:

Millie Larsen Part 1

Scenario Overview

Patient: Millie Larsen

Diagnosis: Urinary tract infection

This scenario is part of the Millie Larsen Unfolding Case. The scenario can be used as a standalone scenario or as part 1 of the case.

The Unfolding Case

Millie Larsen is an 84-year-old Caucasian female who lives alone in a small home. Her husband Harold passed away a year ago and she has a cat, Snuggles, who is very important to her. Millie has one daughter, Dina Olsen, who is 50 years old, lives nearby, and is Millie’s major support system. Millie’s current medical problems include hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia.

The scenarios take place over 3 days when Millie is in the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical, and she is confused. The scenarios depict varied situations Millie encounters during her brief hospital stay. The objectives focus on assessment; appropriate use of assessment tools such as the SPICES: An Overall Assessment Tool for Older Adults, a fall risk assessment tool, and Confusion Assessment Method (CAM); communication skills; conflict between Millie and her daughter on living arrangements; functional assessment; discharge teaching; and making appropriate referrals.

Brief Summary of Present Scenario

The scenario is set at 7 p.m., and Millie is in the emergency department. She was brought in with confusion by her daughter Dina three hours ago. As the scenario unfolds, it will become clear that due to her confusion, Millie has not been taking her medications properly in the days prior to admission and, as a result, her blood pressure is very elevated. Millie’s daughter Dina is at the bedside and is quite concerned about the confusion and elevated blood pressure. The students receive a report from the emergency room triage nurse and are expected to perform a general assessment as well as use the Confusion Assessment Method (CAM) and Morse Fall Scale tools. Objectives for this scenario include the identification and use of appropriate assessment tools for older adults, recognition of an elevated blood pressure, and notification of the physician, using SBAR format.

Learning Objectives

Upon completion of the scenario, the student should be able to:

· Perform a head-to-toe physical assessment and focused assessment of the patient’s mental status

· Assess the patient’s individual aging pattern and functional status using standardized assessment tools, including:

· Confusion Assessment Method (CAM)

· Morse Fall Scale

· Identify critical assessment findings, including elevated blood pressure and confusion

· Identify the need to communicate with other members of the health care team using SBAR format

· Report pertinent assessment findings and relate which findings are commonly found in the older adult patient

· Recognize geriatric syndrome(s) present in simulation, including:

· Urinary incontinence

· Confusion

Patient Case Introduction to Students

Time: 1900

Report from emergency room triage nurse:

Millie Larsen is an 84-year-old female who lives alone in a small home. She arrived with her daughter, Dina, three hours ago. Her daughter noticed that Millie wasn’t making sense or acting normally during a visit earlier today. She was seen by Dr. Lund an hour ago. He suspects urinary tract infection and has written preliminary orders. An IV has been started and labs have been drawn. They just came back. I haven’t had a chance to look at them. Her antibiotic also just arrived from the pharmacy and needs to be given. I completed a SPICES assessment, which indicated problems with incontinence and confusion. The result is in the health record. The confusion needs to be further assessed, and her fall risk should also be assessed. Can you please do that?

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