Fever, Catheter, and a Bag on the Floor
Mrs. Nowak, 79, has had an indwelling urinary catheter for six days and a stage 2 pressure injury on her sacrum. At 0700 you are assigned her bed bath and vital signs. You find: oral temperature 38.3 °C (101 °F), pulse 96, respirations 20, blood pressure 138/76. The urine in the tubing is cloudy with visible sediment and has a strong odor. The drainage bag is lying on the floor beside the bed, and the tubing is looped in a dependent U below the level of the bag. The sacral wound edges are reddened and warm, and there is new tan drainage on the old dressing. She says her lower back "aches."
1. Sort your findings into (a) what you report immediately and (b) what you can correct yourself. Justify each choice.
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Report immediately - these suggest infection and are outside my scope to treat:
- Temperature 38.3 °C in an older adult with a urinary catheter. New fever plus cloudy, foul-smelling urine is a red flag for a catheter-associated urinary tract infection, and older adults can decline quickly.
- New tan drainage, redness, and warmth at the sacral wound - possible wound infection or worsening pressure injury. Only the nurse can assess and decide on a dressing change or a new order.
- Her complaint of lower back aching, taken together with the above.
The fever is the finding that moves this out of "finish the bath first" - report it before you leave the room if possible, or have a coworker page the nurse.
Correct myself - routine catheter and infection-control care within aide scope:
- Pick the drainage bag up off the floor and hang it on the bed frame, below bladder level and above the floor. A bag on the floor is a direct contamination path.
- Straighten the dependent loop so urine cannot pool and back up into the bladder.
- Keep the tubing unkinked and off the floor, and make sure the bag outlet valve does not touch the floor.
Do NOT on my own: irrigate the catheter, change the wound dressing without an order, apply ointment, or give any medication for the fever.
2. How do you word your report, and what belongs in your documentation versus what does not?
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Report format - use the same structure the nurse can act on:
- Who and where: Mrs. Nowak, room and bed.
- What I found: "Temp 38.3 oral at 0705, pulse 96, respirations 20, BP 138/76. Urine cloudy with sediment and strong odor. New tan drainage on the sacral dressing, wound edges red and warm. She says her lower back aches."
- What I already did: repositioned bag off the floor, straightened the tubing loop.
- What I need: "Can you look at her and the dressing?"
Document:
- Exact values, times, and the route used for the temperature.
- Objective descriptions: "cloudy urine with sediment," "tan drainage on old dressing," not "looks infected."
- What you reported, to whom, and the time.
Do not document:
- A diagnosis ("UTI," "wound infection") - that is the nurse's or provider's conclusion.
- Vague entries such as "patient fine" or "nothing unusual" when something was found.
- Anything about another resident, or opinions about the previous shift.