Question

Urinary Tract Infection

• E.L. is a 27-year-old woman who complains of urgency to urinate, frequent urination, and urethral burning sensation during urination.
• Symptoms began 48 hours ago.
• She has a history of recurring urinary tract infections since age 22, when she got married.

1. What type of UTI does she probably have?

2. What is the most likely reason she has recurring UTIs?

• E.L. is allergic to penicillin.
• Vital signs are as follows:
• Temperature 98.6° F orally
• Blood pressure 114/64
• Dipstick urinalysis indicates WBCs and bacteria.

3. What is the next step in diagnosis for E.L.?

4. How will you instruct E.L. to obtain the specimen?

• Urinalysis results:
  • Color: dark yellow
  • pH: 6.5
  • Nitrates: positive
  • WBCs: large amount
  • Occult blood: trace

• Urinalysis results:
  • Urine culture: E. coli exceeding 106 CFU/mL
  • Sensitivity to ampicillin, nitrofurantoin, ciprofloxacin, cephalexin, trimethoprim/sulfamethoxazole
  • E.L.’s urine culture is positive for
  • E. coli.

6. Given her history, what is the likely course of treatment?

7. How will her treatment differ from an uncomplicated UTI?

• E.L. states that because of her penicillin allergy, she has taken Cipro for 7-day courses in the past.
• She asks about what could be causing the recurring infections.

8. What other assessment data would you gather regarding her current infection?

9. What other questions would you ask her about her urinary hygiene?

• E.L. is given her antibiotic prescription.
• However, she does not think this treatment plan is going to work.

10. Develop a care plan for E. L.

Answer 1

1. What type of UTI does she probably have?

Recurrent Lower urinary tract infection.

2. What is the most likely reason she has recurring UTIs?

Most likely Ecoli is the pathogen behind the recurrent UTI.

3. What is the next step in diagnosis for E.L.?

Urine analysis and culture,sensitivity.

4. How will you instruct E.L. to obtain the specimen?

A sterile urine specimen is needed for culture .Instruct her to wash hands and clean the perineal region,void the initial urine and catch a midstream clean urine in the give sterile bottle for sampling.

6. Given her history, what is the likely course of treatment?

As a case of recurrent UTI for five years started after marriage.It needs a continuous antibiotic treatment for longer duration.More over she need to take post coital prophylactic antibiotics as the UTI episode started after marriage .

7. How will her treatment differ from an uncomplicated UTI?

Most likely her case is originated from a post coital bacterial exposure .so need to be treated with continous antibiotic therapy for a specific duration and post coital prophylactic antibiotics for the rest fo time.

8. What other assessment data would you gather regarding her current infection?

Further assessment data include:

History of UTI with time of UTI symptoms develop,whether it is post coital origin.

Voiding pattern with amount ,frequency,dysuria etc.

Use of spermicides as it can provoke the recurrent post coital UTI.

post coital voiding .

Post coital hygiene.

Previous reports to findout any urological anatomical issues causes UTI.

9. What other questions would you ask her about her urinary hygiene?

• post coital hygiene -cleaning habits whether from front to back or back to front
• post voiding hygiene
• use of scented solutions ,spray,bubble bath for the hygiene as these products will alter the PH and pose risk of UTI.
• use of tight undergarments which can pose infection.

10. Develop a care plan for E. L.

a.Impared urinary elimination related to recurrent UTI.

Evidenced by dysuria and increased voiding frequency

Interventions:

asses the voiding pattern

assess the urinary hygiene.

Encourage to drink 3to 4 liters of water daily as tolerated.

Advice the patient to do a perineal wiping from front to back following urination or coitus.

Advice to take antibiotics as prescribed.