Data collection to recognize and report complications that may impact the morbidity and mortality of clients

Full Answer Section

• Metabolic imbalances: Fluctuations in blood sugar or electrolytes due to her diabetes and medications could have affected her brain function and led to confusion (American Diabetes Association, 2023).
• Dehydration: The fever and lack of fluid intake could have contributed to dehydration, which can exacerbate confusion in older adults (National Institutes of Health, 2023).

2. Pivotal Decision in the ER:

While the ER chart doesn't explicitly mention a pivotal decision, the insertion of the Foley catheter could be considered a contributing factor. Urinary retention due to the catheter, especially in combination with other risk factors, can increase the risk of UTIs and dehydration, potentially leading to complications like confusion and sepsis (Jarvis, 2019).

3. Type of Incontinence:

Mabel's incontinence is likely overflow incontinence, characterized by involuntary urine leakage due to a full bladder. This can be caused by various factors, including weak bladder muscles, neurological problems, or medications (Mayo Clinic, 2023).

4. Contributing Factors in Mabel's Medical History:

Several factors in Mabel's medical history could have contributed to her worsening condition:

• Diabetes: Uncontrolled diabetes can increase the risk of UTIs, dehydration, and electrolyte imbalances, all of which can contribute to confusion and other complications (American Diabetes Association, 2023).
• Atrial fibrillation: This irregular heartbeat can cause blood clots, potentially leading to stroke or other complications that could affect mental state (Mayo Clinic, 2023).
• Medications: The diuretics and antihypertensives Mabel was taking can cause dehydration, electrolyte imbalances, and increased risk of UTIs, all of which could contribute to her decline (UpToDate, 2023).

5. Communication and Poor Outcome:

Communication gaps could have played a role in Mabel's poor outcome:

• Daughter's concern not adequately addressed: The daughter's concerns about a potential stroke and her mother's fever were not immediately addressed, potentially delaying necessary interventions.
• Lack of information sharing between departments: The ER chart was not readily accessible to the floor nurses, potentially hindering their understanding of Mabel's full picture and contributing to delayed recognition of her deteriorating condition.
• Incomplete handoff: The handoff from the LPN to the RN at 1600 might not have adequately communicated Mabel's confusion and elevated blood sugar, leading to delayed intervention.

Note: These are just possible explanations based on the information provided. A thorough investigation and review of all medical records would be necessary to determine the precise cause of Mabel's complications.

Sample Solution

1. Why Mabel Became Confused and Combative:

Mabel's confusion and combative behavior could have resulted from several factors, including:

• Urinary tract infection (UTI): The cloudy urine draining from the Foley catheter suggests a potential UTI, which can cause confusion and delirium in older adults (Jarvis, 2019).
• Medication interactions: The combination of medications Mabel was taking, particularly diuretics and antihypertensives, could have interacted and contributed to her altered mental state (UpToDate, 2023).