Question

URINARY SYSTEM CASE STUDY

Etiology

K.N. is a 24-year-old woman who presents to the family practice clinic complaining of sudden urgency to urinate, frequent urination, and pain with urination. Symptoms began approximately 48 hours ago. She awoke from sleep with urgency and suprapubic discomfort two nights ago. Her urine now has a strong odor and a cloudy appearance. She has no fever.

History

UTI at 30,14, and 8 months ago

Iron deficiency anemia

Gonorrhea and chlamydia 2 years ago

Denies tobacco use

Social alcohol and marijuana use

Sexually active with multiple partners

On Phenazopyridine, Ortho-Novum, and Ferrous sulfate

Allergy – to Trimethoprim-Sulfamethoxazole combination – hives with pruritus

Clinical Manifestations

BP 100/60  Pulse 74 Resp.Rate 15 Temperature 98.2

WBC 6,400  Urinalysis – SP 1.035 pH 5.5 Positive for Leukoesterase, Nitrites, and E.coli, trace blood  

Diagnosis?

Treatment

Use of Fluroquinolones and nitrofurantoin

  

1. What is the relationship between Nitrites and E.coli?

  

2. What is the significance of the patient’s absence of fever?

  

3. What diagnoses should be considered? and how would the diagnosis be confirmed?

4.    What is the most serious complication from a mild lower UTI?

              5.    What cautions/instructions should the nurse give the patient on discharge?

Answer 1

1. Nursing diagnoses:

a) Impaired urinary elimination.

b) Infection.

c) Acute pain.

d) Disturbed sleep pattern

2. Nursing intervention/treatment

a. The patient’s age and gender should be noted

b. The patient’s bladder should be palpated q.4 hours.

c. Encourage the patient to increase fluid intake to up to 4 liters a day.

d. Encourage the patient to void q.2-3 hours.

e. Educate the patient about the importance of wiping the area from front to back and avoiding bathtubs.

f. Educate the patient about the importance of maintaining an acidic environment by using vitamin C as needed.

g. Educate the patient about the use and action of antibacterial antibiotics like nitrofurantoin and fluoroquinolone and the importance of taking the prescribed one as directed.

3. Nitrofurantoin and fluoroquinolone are antibiotics used to treat UTIs caused by bacteria. Fluoroquinolone is also used to treat bacterial infections of skin, lungs, etc.

4. E. coli, converts nitrate to nitrite and a positive urine nitrite is indicates UTI caused by bacteria like E. coli; however, this is not a reliable screening tool, as only 25% of UTI cases have a positive nitrite test.

5. The absence of fever shows that the UTI is limited only to the patient's lower urinary tract and has not spread to the kidneys.

6. Diagnoses to be considered are:

a) Impaired urinary elimination.

b) Infection.

c) Acute pain.

d) Disturbed sleep pattern.

These diagnoses can be considered because of positive nitrites and E.coli in urine

7. Most serious complication from a mild lower UTI if left untreated is kidney infection and sepsis.

8. Cautions/instructions given by the nurse to the patient on discharge are:

a. Instruct the patient to increase fluid intake to up to 4 liters a day.

b. Instruct the patient to void q.2-3 hours.

c. Instruct the patient about the importance of wiping the area from front to back and avoiding bathtubs.

d. Instruct the patient about the importance of maintaining an acidic environment by using vitamin C as needed.

e. Instruct the patient about the use and action of antibacterial antibiotics like nitrofurantoin and fluoroquinolone and the importance of taking the prescribed one as directed.