Question

PN 200 Fundamentals of Nursing II CASE STUDY: URINARY TRACT INFECTION You 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) RBC3-6 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 mL/hr. and insert a Foley retention catheter to straight drainage. Because Mrs. Zippo is unable 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

Answer to question no.1:

Hormone replacement therapy is another treatment option to prevent recurrent UTI in elderly besides antibiotics.

Usually, UTI is more common in post menopausal women, as there is decreased production of estrogen.

Estrogen produces antibacterial substances within the body that fights with the bacteria, it also helps in maintaining urinary tract tissue intact and strong. So lack of estrogen in post menopausal women leads to recurrent UTI's.

Use of estrogen gels or creams or suppositories as a prophylactic treatment for recurrent UTI in post menopausal women is beneficial.

Oral estrogen pills are not very useful as they come with serious side effects like breast cancer, increases the risk of blood clots, weight gain, etc.