Unfolding Case Study • Physiological Integrity
76-year-old male • Long-term care resident • Medical-Surgical Unit
A 76-year-old male resident of a long-term care facility is admitted to the medical-surgical unit for evaluation of fever and altered mental status. Past medical history includes benign prostatic hyperplasia with chronic indwelling urinary catheter, type 2 diabetes mellitus, and chronic kidney disease stage 3. Family reports he has been more confused and less responsive for 24 hours. Vital signs on admission: T 38.6°C (101.5°F), BP 128/72 mmHg, HR 102 bpm, RR 20 breaths/min, SpO₂ 95% on room air. Skin is warm and flushed. Urine from catheter is cloudy with a foul odor. Current medications: metformin 500 mg PO twice daily, tamsulosin 0.4 mg PO nightly, atorvastatin 20 mg PO nightly. The client is drowsy but arousable and answers questions slowly.
The client becomes more lethargic. Vital signs: T 39.4°C (103°F), BP 88/54 mmHg, HR 124 bpm, RR 28 breaths/min, SpO₂ 90% on room air. Urine output over the past hour is 20 mL. Point-of-care glucose is 9.8 mmol/L (176 mg/dL). A bedside lactate is 4.2 mmol/L (elevated). The provider documents suspected urosepsis and orders IV fluids, blood cultures, a broad-spectrum IV antibiotic, and repeat vital signs every 15 minutes.
Complete 6 clinical judgment questions based on the client scenario. Questions appear one at a time. You cannot return to previous questions.
NGN 2026 • Clinical Judgment Measurement Model
Your clinical judgment score for Urosepsis Management