Lab 3 Assignment - Noah M

Nance, an ACP student, is calling OLMC for a CCP consultation regarding Martha, an 88-year-old female patient at a nursing home. Martha is showing signs of a possible UTI and bladder infection, with restless behavior, decreased mental status, and decreased appetite. Her vital signs show an elevated temperature. Nance plans to administer acetaminophen, saline, and fentanyl for fever, dehydration, and pain, respectively. Martha's goals of care indicate she should not be brought to the hospital. Nance requests CCP assistance for a urine sample, bladder scan, and evaluation for a possible urinary catheter. Antibiotics are also needed for treatment, with CCP tracking Martha's progress. OLMC, this is ACP student Nance with Calgary Medic 3. I'm calling OLMC for a CCP consultation for my patient. How do you read? I'm currently at Whitehorn Village Nursing Home with Martha Marthra, healthcare number 11111111. An 88-year-old female, approximately 50 kilograms. Martha has signed a goals of care that is designated as a C1. I am suspecting a possible UTI and bladder infection. Care home staff have mentioned that Martha normally is compliant with medications and bedtime. However, staff have told EMS that Martha is extremely restless and not compliant with her bedtime tonight. Staff have also told EMS that they have noticed for the past two days, and a decrease in Martha's mental status. She is unable to answer to her name, as well as a decrease in her appetite. During EMS assessment, Martha's GCS was 14, and she has an elevated temp at 39 degrees Celsius. Unfortunately, due to Martha's altered mental status, she is unable to answer questions about her pain. However, throughout EMS's assessment, she has been holding to her lower abdomen and groaning periodically. Martha's past medical history includes the following. She has stage dementia, AFib, coronary artery disease, and COPD. Martha's current vital signs are as follows. Heart rate, 104. Rest rate, 22. Blood pressure, 110 on 60. SpO2, 98. End tidal, 35. BGL, 4. Temp, 39. Pupils, 3 mm. Equal in reactive, and lung sounds are clear and equal bilaterally. My intended treatment plan for Martha includes the following. Acetaminophen and 975 mg to combat her fever. A 250 ml bolus of normal saline to help with her dehydration, which we will reassess to determine the need to potentially continue. I would also like to give 25 mg of fentanyl for Martha's pain. I am contacting CCP to assist me in fulfilling the rest of my intended treatment plan for Martha. As per Martha's goals of care, she is designated as a C1, and staff have contacted Martha's daughter, who is her current acting power of attorney, and have determined that Martha is not to be brought into the hospital for any treatment. I am requesting an acute response by CCP to perform a urine sample, as well as a bladder scan. I would also like the responding CCP to evaluate the need for a urinary catheter after the patient has been treated with antibiotics. The urine dip is to confirm the suspected UTI and bladder infection. ACP student Nance has decided to avoid catheterization, catheterizing the suspected UTI and would like the CCP to gain lab results to make a determination on the catheterization. Finally, I would like the antibiotics to help treat the potential UTI and bladder infection. I would also like the CCP to track Martha's progress with the antibiotic treatment. Do you have any further questions about Martha's intended treatment plan?