Chemotherapy for bladder cancer.
Your patient is a 42-year-old female that arrives in the ED with complaints of fever and not feeling well. She is currently undergoing chemotherapy for bladder cancer. She has an indwelling urinary catheter with scant amount of dark, foul smelling urine. She has a temperature of 102.2F, HR 136, BP 110/50 and RR 28. She is allergic to penicillin and Sulfa.
What type of shock is she experiencing?
What interventions do you anticipate the doctor will order?
What can you teach this patient about prevention of infection?
The doctor orders Bactrim. What should you be concern about? Why?
Sample Solution
Based on the provided information, your patient is likely experiencing Septic Shock secondary to a urinary tract infection (UTI) due to her indwelling urinary catheter and chemotherapy-induced immunosuppression.
Supporting evidence for Septic Shock:
- Fever: Temperature of 102.2°F is indicative of fever.
- Tachycardia: Heart rate of 136 beats per minute is above the normal range.
- Tachypnea: Respiratory rate of 28 breaths per minute is above the normal range.
- Hypotension: Blood pressure of 110/50 mmHg is below the normal range.
- Source of infection: Indwelling urinary catheter and dark, foul-smelling urine suggest a UTI.
Full Answer Section
Additional factors:- Chemotherapy: Weakened immune system due to chemotherapy makes the patient more susceptible to infections.
- Catheter: Indwelling urinary catheters increase the risk of UTIs.
- Blood cultures: To identify the specific bacteria causing the infection.
- Urinalysis and urine culture: To confirm UTI and identify the causative organism.
- Intravenous fluids: To restore blood pressure and improve circulation.
- Antibiotics: Broad-spectrum antibiotics like Bactrim are commonly used initially for suspected UTIs, pending culture results for targeted therapy.
- Pain management: Medications to manage fever and discomfort.
- Catheter removal: Depending on the severity of the UTI and the patient's overall condition, the doctor might consider removing the catheter to reduce the risk of further infection.
- Proper catheter care: Maintaining kebersihan of the catheter insertion site and drainage bag.
- Hydration: Drinking plenty of fluids to flush out bacteria from the urinary tract.
- Urination habits: Emptying the bladder regularly and completely.
- Wiping technique: Wiping from front to back after using the toilet to prevent bacteria from entering the urethra.
- Diet: Avoiding bladder irritants like caffeine and alcohol.
- Early recognition of symptoms: Promptly reporting any symptoms of UTI like fever, urinary urgency or frequency, burning during urination, or blood in the urine.
- Allergy to Sulfa: Bactrim contains sulfamethoxazole, which is a sulfa antibiotic. Although cross-reactions with penicillin are less common, it's crucial to inform the doctor about the patient's sulfa allergy to assess alternative antibiotics with a lower risk of allergic reaction.
- Potential for adverse effects: Bactrim can cause side effects like nausea, vomiting, diarrhea, and skin rash. Monitor the patient for these side effects and report them to the doctor if they occur.