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Assessment of Urinary Tract Infection Patient Profile L. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has...

Assessment of Urinary Tract Infection

 

Patient Profile

L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress incontinence. She currently takes the following medications:

  • Omeprazole 20 mg PO daily before breakfast
  • Captopril 50 mg PO BID
  • Furesomide 20 mg PO daily

 

Today she tells the nursing assistant that she has a lot of pain when she urinates. The charge nurse completes a physical exam and notifies the provider of the exam findings and patient's painful urination. A urinalysis is ordered.

 

Subjective Data

 

Objective Data

 

  • Pain with urination began 2 days ago
  • States she usually doesn't drink much because of the stress incontinence and not wanting to have "accidents," and now she is drinking even less because doesn't want to have to urinate due to the pain and burning
  • Wearing feminine hygiene pads she had in her closet since the painful urination started because her stress incontinence "is worse"

 

Physical Examination

  • Temperature 99.7° F, pulse 78, respirations 18, blood pressure 162/80
  • Left flank tenderness

Diagnostic Studies

  • Urinalysis
  • Color:                   Dark, smoky color
  • Odor:                   Foul smelling
  • Protein:               Trace
  • Glucose:              None
  • Ketones:             None
  • Bilirubin:             None
  • Specific gravity: 1.034
  • pH:                        8.2
  • RBCs:                    8/hpf
  • WBCs:                  12/hpf
  • Casts:                   Present

 

 

                     

 

Discussion Questions

 

  1. Based on L.M.'s presentation, what do you suspect is occurring and what assessment data led you to this conclusion?

 

  1. You need to obtain a clean-catch urine sample from L.M. to send for urinalysis. To collect this specimen, what instructions do you give L.M.?

 

  1. Describe how to assess for flank tenderness. What is the significance of L.M.'s left flank tenderness?

 

  1. What are L.M.'s risk factors for developing a urinary tract infection?

 

  1. What diagnostic test would be needed to determine the best medication to treat L.M.'s urinary tract infection?

 

  1. What are some important measures to teach L.M. to prevent recurrence of a urinary tract infection (UTI)?


 Assessment of Urinary Tract Infection

 

Patient Profile

L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress incontinence. She currently takes the following medications:

  • Omeprazole 20 mg PO daily before breakfast
  • Captopril 50 mg PO BID
  • Furesomide 20 mg PO daily

 

Today she tells the nursing assistant that she has a lot of pain when she urinates. The charge nurse completes a physical exam and notifies the provider of the exam findings and patient's painful urination. A urinalysis is ordered.

 

Subjective Data

 

Objective Data

 

  • Pain with urination began 2 days ago
  • States she usually doesn't drink much because of the stress incontinence and not wanting to have "accidents," and now she is drinking even less because doesn't want to have to urinate due to the pain and burning
  • Wearing feminine hygiene pads she had in her closet since the painful urination started because her stress incontinence "is worse"

 

Physical Examination

  • Temperature 99.7° F, pulse 78, respirations 18, blood pressure 162/80
  • Left flank tenderness

Diagnostic Studies

  • Urinalysis
  • Color:                   Dark, smoky color
  • Odor:                   Foul smelling
  • Protein:               Trace
  • Glucose:              None
  • Ketones:             None
  • Bilirubin:             None
  • Specific gravity: 1.034
  • pH:                        8.2
  • RBCs:                    8/hpf
  • WBCs:                  12/hpf
  • Casts:                   Present

 

 

                     

 

Discussion Questions

 

  1. Based on L.M.'s presentation, what do you suspect is occurring and what assessment data led you to this conclusion?

 

2.You need to obtain a clean-catch urine sample from L.M. to send for urinalysis. To collect this specimen, what instructions do you give L.M.?

 

3.Describe how to assess for flank tenderness. What is the significance of L.M.'s left flank tenderness?

 4.What are L.M.'s risk factors for developing a urinary tract infection?

 

5.What diagnostic test would be needed to determine the best medication to treat L.M.'s urinary tract infection?

 

6.What are some important measures to teach L.M. to prevent recurrence of a urinary tract infection (UTI)?


 Patient Profile

E.G. is a 41-year-old male who presents to the emergency department complaining of severe right back pain that started a couple of hours ago, right after he finished his daily run. He has a history of gastroesophageal reflux disease, for which he takes famotidine 20 mg PO once daily at bedtime.

 

Subjective Data

 

Objective Data

 

  • Has been training for a marathon and has been running at least 10 miles a day, but today was so hot that he only made it 6 miles. Shortly after his run, the pain in his right back/side started.
  • States his pain is a level 9 on a 1-to-10 scale
  • States the pain is constant, nothing seems to make it better, and it does not get worse with movement
  • Denies any pain or numbness in his legs
  • While training, he has been supplementing his diet with protein shakes
  • Denies using performance-enhancing drugs

Physical Examination

  • Temperature 99.6° F, pulse 78, respirations 16, blood pressure 122/80
  • No musculoskeletal pain or tenderness in spine
  • Right flank tenderness to fist percussion

 

Case Study Progress

Based on the initial clinical manifestations and exam findings, the health care provider orders a urinalysis. At first, E.G. is unable to urinate, but after drinking several glasses of water, is able to obtain a clean-catch urine specimen.

 

Diagnostic Studies

Urinalysis 

  • Color:                   Dark, smoky color
  • Odor:                   Aromatic
  • Protein:               None
  • Glucose:              None
  • Ketones:             None
  • Bilirubin:             None
  • Specific gravity: 1.035
  • pH:                        6.2
  • RBCs:                    11/hpf
  • WBCs:                  3/hpf
  • Casts:                   None

 

Discussion Questions

 

  1. Based on the data above, what do you suspect is occurring with E.G.? What assessment data led you to this conclusion?

 

2.What additional test(s) may be ordered to confirm this diagnosis?

 

3.E.G. has an ultrasound, and the presence of a large right renal calculus is confirmed. The health care provider orders E.G. IV Morphine sulfate for pain and recommends that he have a right extracorporeal shock-wave lithotripsy (ESWL). Explain this procedure.

 

4.What factors put E.G. at risk for developing a renal calculus?

 


5.What teaching should E.G. receive prior to his being discharged?


 

6.What nutritional instructions should E.G. be given to prevent recurrence of urinary calculi?


 

 

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