QLexNursing

Blood pressure 100/50 mm Hg → Indication of Potential Worsening Condition

🔶 Trend down: BP fell from 106/64 to 100/50; a falling MAP (~67) can signal progressing sepsis or unresolved hypovolemia.

🔶 Older adults: Often show subtle hypotension before overt deterioration; watch for dizziness, cool skin, ↓ urine.

🔶 UTI risk: Gram-negative bacteremia can produce vasodilation → hypotension.

🔶 Action: Reassess volume status, compare with prior readings, check urine output, consider fluid bolus and sepsis protocol.

🔶 Monitor labs: Lactate, repeat WBC, cultures; evaluate for antipypertensive meds that could compound the drop.

Disoriented to person, place, and time → Indication of Potential Worsening Condition

💠 New change: Client was oriented to person & place; now global disorientation = acute delirium.

💠 UTI link: In elders, delirium is a classic sign of worsening infection even when fever is modest.

💠 Other contributors: Hypoxemia, sodium changes, medications (anticholinergics, opioids), or hypotension.

💠 Safety: High fall risk—implement close observation and re-orient frequently.

💠 Work-up: Check vitals, O₂ sat, glucose, electrolytes, pain/retention; review meds and treat underlying cause.

Pink-tinged urine → Indication of Potential Worsening Condition

🔴 Hematuria: UTI can inflame the mucosa → blood in urine; pink tinge = microscopic to mild gross hematuria.

🔴 Complication clue: Could indicate cystitis irritation, stone passage, or catheter-related trauma; needs evaluation.

🔴 Correlation: Align with UA (↑ RBCs previously); persistent or increasing blood suggests worsening lower-tract involvement.

🔴 Assess: Ask about dysuria, suprapubic pain, clots; inspect catheter technique if present.

🔴 Plan: Push hydration (if not contraindicated), send repeat UA/urine culture, notify provider.

Hct 45% (previously ~50%) → Indication of Potential Improvement

🟢 Toward normal: Now within female ref range (37–47%); earlier hemoconcentration from dehydration is improving.

🟢 Fluids working: Suggests effective rehydration and hemodilution after therapy.

🟢 Clinical tie-in: Should parallel better skin turgor, improved cap refill, and steadier vitals.

🟢 Keep going: Continue fluids as ordered; track I&O and daily weight.

🟢 Watch anemia: Ensure Hgb trends remain safe while Hct normalizes.

Butterfly (malar) rash → Unrelated to Diagnosis

◼ SLE feature: Malar rash is a hallmark of systemic lupus erythematosus, not an indicator of UTI status.

◼ Chronic baseline: May wax and wane with sun/flare but doesn’t track UTI progression.

◼ Different pathway: Autoimmune inflammation vs. bacterial infection.

◼ Note only: Document presence/skin care; no change to UTI plan solely for the rash.

◼ When relevant: If on immunosuppressants for SLE, infection risk is higher—but the rash itself isn’t the UTI marker.

O₂ sat 95% on 2 L/min NC (was 95% on 3 L/min) → Indication of Potential Improvement

🔷 Less support, same sat: Maintaining 95% with lower FiO₂ means gas exchange has improved.

🔷 Lungs: May reflect better ventilation (mobilized bases, IS use, ambulation) and less atelectasis.

🔷 Safety: Consider cautious wean per protocol; keep sat ≥92–94% unless otherwise ordered.

🔷 Correlate: Improved work of breathing, clearer bases, stable RR.

🔷 Continue care: Pulmonary toilet, early mobility, hydration to thin secretions.