An  82-year-old man recently returned to the long-term care facility after  hospitalization for open reduction internal fixation of the right hip.  He has been divorced for over 50 years and has two adult children who  visit him frequently in the nursing home. He has a 5-year history of  mild to moderate dementia and known urinary tract infections. His last  recorded mini mental state examination (MMSE) registered 18, which was 3  months ago. While in the hospital, he did have an indwelling catheter  for 4 days. He has been incontinent since his return to the hospital but  the staff their attributes this to the catheter and his deconditioned  state following hospitalization. His medications include donepezil,  memantine, and acetaminophen for pain and fever as needed. He has no  other known medical problems except a history of multiple urinary tract  infections throughout his lifetime that, according to his son, have  required extensive antibiotic treatment. He enjoys drinking regular  coffee throughout the day, says it is a habit he has had since his days  in the service years ago. His family members and the nursing staff  report that he has been very restless and has been unable to use the  urinal on time the past couple of days.

Vital signs: T 99°F, HR 80, RR 18, BP 128/78, BMI 22. 

Chief Complaint: Foul smelling urine, incontinence, restless

Discuss the following:

1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
2) What additional objective data will you be assessing for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What radiological examinations or additional diagnostic studies would you order?
6) What treatment and specific information about the prescription that you will give this patient?
7) What are the potential complications from the treatment ordered?
8) What additional laboratory tests might you consider ordering?
9) What additional patient teaching may be needed?
10) Will you be looking for a consult?


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