Question: John Is A 53-year Old Male Admitted For Abdominal Pain. He Has Rated The Pain At 10, On A 1 To 10 Scale. His Admitting Diagnosis Is Urinary Tract Infection And Urosepsis. He Has A Recent History Of Prostate Cancer. His VS On Admission Are 37.9° C, 88/min, 18/min, 148/88; SaO2 95% He Reports Incontinence Related To A Long Term Indwelling Catheter Left …

John is a 53-year old male admitted for abdominal pain. He has rated the pain at 10, on a 1 to 10 scale. His admitting diagnosis is urinary tract infection and urosepsis. He has a recent history of prostate cancer. His VS on admission are 37.9° C, 88/min, 18/min, 148/88; SaO2 95% He reports incontinence related to a long term indwelling catheter left in place during chemotherapy and removed last week. On catheterization, the nurse obtains only 30ml of dark brown urine with no visible blood noted. The Foley is attached to a drainage bag. The patient states he has not been drinking fluids much because it hurts when he voids. He has no unintentional weight loss or gain. No visible edema noted. He has a saline lock in the left forearm for antibiotic therapy during his admission. The site is mildly reddened and the lock is patent. While in the Emergency Department, he was given Morphine for pain relief, which brought his rating down to a 6/10. He was started on antibiotics. Unfortunately, the Cefazolin was ordered as igm IV Q6h, but the order was transcribed wrong and he received 1gm Q4h x 2 doses. The patient is aware of the error and the MAR has been corrected. He quietly expressed to the nurse that he wonders if the hospital has good standards. During assessment, John says he feels ‘dizzy’ when he stands up. Skin turgor is flaccid, mucous membranes dry, and he seems to move with minor weakness. He is somewhat diaphoretic. He expresses worry and concern that his cancer has returned. He completed his chemotherapy several weeks ago. He had minimal concerns with his chemotherapy, except for some loss of hair. It is noted that he stayed in Toronto during his treatment, although lives in a First Nations town north of Thunder Bay. His wife and children are at home. HGB HCT BUN Cr K+ Na WBC 166 g/L 59% 29 80 3.2 144 mmol/L mcmol/L mEq/L mmol/L 16.5 x 109/L Urinalysis: Specific gravity: 1.020 Blood: 3+ Protein: 1+ Ketones: trace PH: 5