Question

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

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

Answer 1

1. Accordingly to lab values patients has severe urinary tract infection.Because in the given result urine is dark and smoky colour,foul smelling,casts are present,PH is high (normal-5-7) protein present, specific gravity ,1.034 is high(normal- 1.016-1.022),RBC 8 /hpf is high (normal- <2 cell/hpf),WBC is high.All these suggestive of severe urinary tract infection.

Along with the lab values patients having back pain, fever, urinary incontinence,pain and burning sensation while mituration high ESR value leads to the confirmation of diagnosis.

2.clean catch urine

It is a method of collecting urine sample without microorganisms in the genitalia.

Instructions should given to patient to collect the clean catch urine specimen.

• Clean the genitalia using sterile wipe.women-(front to back of labia)men-(around the genitalia)
• Women should spread the legs parts to keep urine clean.
• Then urinate small amount of urine to toilet and stop urine flow.
• Next,urinate to a sterile urine cup until the half of the cup.
• Then empty the bladder by urinting remaining urine to the toilet.

Note: Donot touch inside the urine sample sample.

3.Diagnostic test to determine the best medication to treat.

For the treatment of urinary tract infection, antibiotics are the treatment of choice.To determine best antibiotics, doctors usually order for susceptibility rest. It helps to determine which antimicrobial inhibit the growth of particular bacteria more effectively.Here, a bacterial culture get prepared in a media from the patient sample, add antimicrobial disk on the culture and incubate this culture.After incubation interpretation will make about which antimicrobial disk inhibit bacteria more effectively by analysing the zone of inhibition.