Question

an 89 year old woman is living with her 91 year old partner in a very remote rural area of NY. The woman, Laura, seems to be getting confused often and also is experiencing nocturia. Her driver’s license expired on her 87^th birthday and she did not renew it. Her partner’s eyesight has been diminishing rapidly due to glaucoma and he no longer feels comfortable driving. He also has trouble hearing and has to wear hearing aids to assist. One night, Laura is getting up to use the bathroom and she is very confused and ends up falling. Her partner calls 911 but is struggling to communicate bc he does not have his hearing aids on. Answer the following questions: A.) Explain all of the potential obstacles to care that you can see in this example for Laura. B.) Discuss some information or questions a provider might ask and history info that a provider might want to know. C.) You suspect she has a UTI, how could you confirm this?

Answer 1

A. }

potential obstacles to care are

.a)main concern is to get a medical aid for laura as soon as possible since both of them are unable to drive themseleves to a nearby hospital.

b)lack of communication due to difficulty in undersatnding the situation due to partner's hearing disability

other reasons of concern in this case are

1.Age

2.its mentioned she often gets confused which means there is an underlying cns pathology

3.nocturia- which maybe also due to an underlying pathology

B)

Provider might want to know if the patient has suffered any critical injury from the fall like hemorrhage

is the patient breathing

is the patient conscious

for history of case the provider should ask the patient

-whether she feels pain during urinating

-frequency of urination

-whether she had/has fever, abdominal pain,

C}

specimen collection:urine collected in a sterile container with wide screw cap. it should be clean midstream sample.

urine should proceesed as soon as possible , incase oof delay refrigerate it or store by adding boric acid to prevent contamination

direct examination:

a)wet mount examination- look for pus call

b)leukocyte esterase test

c)nitrate test- to detect nitrate reducing bacteria

d)gram staing of urine

culture:

urine sample---inoculated onto MacConkey agar

10^5 cfu indicate of uti.----significant bacteriuria

Antibody coated bacteria test;

helps in differentiating upper and lower uti