Case Study: Mr. Rover - Urosepsis Treatment and Monitoring for a Diabetic Patient

Background Information on Mr. Rover

Mr. Rover is a 59-year-old man admitted from the ED to the medical unit at 0930 for antibiotic treatment and monitoring due to urosepsis. His PMHx is significant for Type 1 Diabetes with an A1C last month of 8.2. He has BPH and HTN. His wife of 35 years states that he has not been compliant with his diabetes in all the years she has known him.  He has no surgical history. No known allergies.

His admission orders are:

1.Vital Signs q4hr
2.IV NS 0.9% 100ml/hr 
3.Flagyl 250 mg IV q12 hr
4.CBG monitoring TID before meals. 

Based on the above information:

1.Due to the patients PMHx and current diagnosis, what do you want to check prior to insertion of an IV cannula into the patient’s skin. (2 marks)

2.Where on this patient is the best place to have an IV and why? (3 marks)

Later That Day

You started his IV NS at 120ml/hr and hung the first bag of Flagyl IV which is premixed and a total of 200 ml of fluid at 1130hrs. Mr. Rover’s vital signs were within normal limits and his CBG pre-lunch which you took at 1145 hrs was 6.8mmol/L. You left him sitting up in bed waiting for lunch while you left to check on another patient.

At 1330 you return to see Mr. Rover.  Another nurse had turned off the Flagyl while you were busy with your other patient and your lunch. Mr. Rover is asleep, but you notice that he is holding his hand over the IV site.  You check and notice this:

Based on the above information:

1.Looking at your fluid intake how much fluid has he had by 1330? How much should he have had by 1330 if the IV has started at 0930? Is there
a discrepancy yes or no, if yes, state why? (5 marks)

2.Write out your assessment of the patient’s IV site.  Identify all the normal and abnormal findings. Give your next steps and identify why you would do the next steps. (5 marks)