Question

PN 200 Fundamentals of Nursing II CASE STUDY: URINARY TRACT INFECTION Tou are working in an extended care facility when Maria Zippo's daughter brings her mother in for a week stay while she goes on vacation. Mrs. Zippo is a 69 year-old widow with a 4 day history of dysuria, back pain, incontinency, severe mental confusion, and loose stools. Her physician had recently discontinued her hormone replacement therapy one (1) month ago. Her most current vital signs are 118/60, 88, 18, 99.4 F. The medical director ordered several lab tests on admission. The results were as follows: WBC 11,000 CMP all values were within normal limits Post-voiding catheterization yielded 100 mL and urinalysis showed: WBC +100 under HPF (high power field) RBC 3-6 Bacteria - rare Urinary culture and sensitivity results are as follows: E.coli >100.000 colonies: sensitive to ciprofloxacin, trimethoprim- sulfamethoxazole, and nitrofurantoin. #1. What role does hormone replacement therapy play in the prevention of UTI's? # 2. Explain the pathophysiology of the symptoms the patient displayed. #3. Which of the above laboratory values are abnormal; what are the normal values? 4. What is the significance of the post-voiding catheterization? What is the normal amount of urine in the bladder to be expected? The medical director makes rounds and writes the order to start an IV of D/5 0.9%NS at 75 m /hr. and insert a Foley retention catheter to straight drainage. Because Mrs. Zippo is unable to take oral medications, the physician orders ciprofloxacin 200mg twice daily IVPB. # 5. Is the type of fluid and rate appropriate for Mrs. Zippo and condition? Explain your rationale. # 6. What type of adverse effects would you look for in a patient receiving IV ciprofloxacin?

Answer 1

1.Hormone replacement therapy are commonly given to women after their menopause. The hormone estrogen released by it has the potential to prevent the growth of harmful bacteria and maintain vaginal pH. Hence it can prevent urinary tract infection

2.The microorganisms when grows in the perineal region leads to invasion of this bacteria into the urinary tract by ascending upto the kidney.In order to fight this infection the immune system reacts and released WBC which leads to symptoms of fever.Meanwhile the infection causes pain at back ,decreased or painful micturation. The bacteria is tried to be flushed out by the body through urine which shows the presence of bacteria, WBC in the urine test.

3.The abnormal laboratory values are

• WBC: increased (less than or equal to 5HPP)
• RBC:Present (usually absent)
• Bacteria: Present (it should be absent)

4.Post voidal urine refers to the amount of urine present in the bladder after passing urine.Normally it should be less than 50ml .If it is 100ml or more it suggests that there is us some urinary system problem in emptying the bladder completely which needs further evaluation.