Fever OR leukocytosis

Question Description

I’m working on a health & medical discussion question and need support to help me study.


Post at least three times to this discussion forum, following the guidelines below. Your posts should include responses to any questions asked, as well as replies to classmates.

Read your textbook, and review the Agency for Health Care Research and Quality site and the On-Time Quality Improvement Manual for Long-Term Care Facilities. Then select ONE key priority for quality in the long-term care settings (possibly prevention of pressure ulcers, use of restraints, etc).

1. In your first post, describe WHY this is a priority for quality and identify the steps you would take as a leader to make this a quality indicator for your long-term care organization.

• Be sure your post incorporates key characteristics of quality improvement tools and involves the interdisciplinary care team.

2. Post responses to at least two of your classmates’ initial posts providing feedback to their ONE key priority for quality.




Student 1:

Hello Class,

I selected prevention of pressure ulcers the key priority for quality in the long-term care settings. As people age, the skin becomes drier, thinner and more fragile. According to Bergstrom (2011), the Centers for Medicare & Medicaid Services has designated pressure ulcers as one of three sentinel events for long-term care. A sentinel event is a patient safety event in which loss of life or extremely serious physical or phycological injuries to a patient. Any disease process that renders an elderly person immobile for an extended period of time will increase the risk for pressure-ulcer development. Pressure. Variables that appear to be predictors of pressure-ulcer development include age 70 years or older, bed or chair bound residents, impaired mobility, frailty, urinary and fecal incontinence, malnutrition, restraints, diabetes mellitus, stroke, dry and scaly skin, history of pressure ulcers, anemia, and failure to thrive.

Because of the myriad of risk factors associated with pressure-ulcer development, various scales have been developed to quantify a person’s risk by identifying the presence of factors in several categories. The Braden Scale and the Norton Scale are probably the most widely used tools for identifying elderly patients who are at risk for developing pressure ulcers. The prevention and healing of pressure ulcers requires the cooperation and skills of the entire interdisciplinary health care team

Pressure ulcers are a serious and costly condition. The cost of treatment is about $2000-$40,000 per pressure ulcer depending on the stage of development. Additional costs of hospitalization, survey penalties, potential litigation, pain and suffering, and marred public image are inestimable! Prevention of pressure ulcers is a clinical imperative. Nurses and CNAs provide the first line of defense in pressure ulcer prevention. This module is intended to assist you, the staff development educator and instructor, in assuring the knowledge and skill of direct care staff to meet these responsibilities.

The following will help prevent skin ulcers even with risk factors present:

Staff education. Training of healthcare providers such as nurses and nurses aid in prevention and care of skin ulcers is a fundamental in entire prevention or elimination process of skin ulcers.

Prevention and management. People at risk of skin pressure must have skin inspection at a minimum once per day. Recommended that caretakers move the resident every 2 hours.

Cleaning: The skin should be cleansed with warm water and a mild cleansing agent to minimize irritation and dryness of the skin. Massaging over bony prominences should be avoided. Previously, it was believed that massaging the bony prominences promoted circulation.

Incontinence: When the patient is incontinent of both urine and feces, and disposable briefs are used to manage incontinence, the patient must be checked and changed frequently because skin ulcer may develop quickly.

Minimize Friction: Unnecessary friction increases the chances for an at-risk patient to develop ulcer. Minimizing friction is important. This can be accomplished through proper repositioning, transferring, and turning techniques.

Apply lubricants: The use of lubricants , protective dressings (eg, hydrocolloids), and protective padding may be used to reduce the possibility of friction and shear.

Fluid Intake: Providing adequate water and other fluid intakes.

Proper nutrition: Providing nutritionally balanced diet on a regular basis will help.

Link: Preventing bedsores – Harvard Health


Student 2:

Hi Class,

I have selected the prevention of urinary tract infections (UTI) and asymptomatic bacteriuria (ASB) on non-catheterized patients as a priority for quality. I selected this prevention because urinary tract infections are the most common bacterial infections that occur in people living in long-term care facilities and according to Rotjanapan (2009), they are the most common reason for antimicrobial prescriptions. It is so important to attain the best possible management for a UTI in this population because they are more susceptible due to their health care burden. Urinary symptoms can create a challenge when attempting to evaluate them. UTI symptoms can be variable and there can also be mistake encountered when collecting and testing the specimen.

According to Arizona Center on Aging the following is common criteria of a UTI

Microbiological: Urine culture is with ≥100,000 cdu/ml of one organism

Clinical Criteria: Acute dysuria OR

  • Fever OR leukocytosis AND one of the following
  1. Suprapubic pain or tenderness
  2. Gross hematuria
  3. New or marked increase in urgeny, frequency, or incontinence

** If no fever or leukocytosis, then two or more of 1-3 must be present

Because of the high percentage of UTI’s in long term care facilities, it should be considered a reason to do quality improvement interventions. This means the process will be changed and will have more implementations for interventions happen sooner. The effects can be quantified by making this part of the daily assessment. Knowing preexisting history will be helpful to know which residents are more susceptible. Monitoring fluid intake (or lack thereof) should be closely monitored especially if they are experiencing any of the symptoms listed above. Ensuring they are increasing their fluid intake (including cranberry juice to help fight a UTI) and then closely monitoring them for the next 24-48 hours will tell what the next step is. The extra fluids may have helped the UTI resolve and saved the patient from being put on antibiotics. If the patient is still having symptoms a urine test can be ordered. If the urine sample comes back positive and the patient is deteriorating, then antibiotics will be prescribed.

Rotjanapan, P., M.D., & Dosa, David,M.D., M.P.H. (2009). Asymptomatic versus symptomatic urinary tract infections in long-term-care-facility residents. Medicine and Health Rhode Island, 92(11), 377-9. Retrieved from https://search.proquest.com/scholarly-journals/asymptomatic-versus-symptomatic-urinary-tract/docview/195808778/se-2?accountid=89121

Urinary Tract Infections in Long Term Care | Center on Aging Care Sheets (uofazcenteronaging.com)


HCA 410 Pima Medical Institute Quality Improvement in Long Term Care Discussion