Question

CASE STUDY: URINARY TRACT INFECTION You are working in an extended care facility when Maria Zippo's daughter brings her mother i 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 tes 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 UTIs? #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 o urine in the bladder to be expected? The medical director makes rounds and writes the order to start an IV of D5 0.9%NS at 75 mlhr. and insert a Foley retention catheter to straight drainage. Because Mrs. Zippo is unablo 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? # 7. If Mrs. Zippo were on oral ciprofloxacin what dietary considerations would have to be considered with this medication?

Answer 1

Q. No. 1 answer :

Due to some estrogen imbalance after the menopause there is lower levels of estrogen which may cause for urogenital atrophy , it leads to reccurent chance or risk to get urinary tract infections in older women, here the client age is above 60 years.

So by replacement of hormones we can reduces the chance of occurring urinary tract infections, by maintaining normal levels of estrogen.

Q. No 2. Answer :

* Due to decreased Estrogen levels,

* decreases in vaginal lactobacilli, which is act like normal flora.

* so that vaginal pH may be decreases and

* due to that increased colonization of enterobacterias from rectum.

* so that there is a infection in the urinary tract, which may leads to dysuria, back pain, incontinence, severe loose stool, mental confusion. (this we will abserve only in elderly).

* mental confusion is a possible sign of urinary tract infection in elderly.

Q. No. 3 answer :

* WBC normal value is 4500 - 11000 per microliter, here client is having 11000 , so it is boarder line for the infection.

* in urine sample + 100 wbc is under high power field , it should be below 5, or 2 - 5.

So it indicates infection.

* RBC are in the urine for the client 3 -6 , but normal is below 2 - 4.

* bacterias normally present up to 10000 in normal persons urine, as a protective bacteria.

* here in urine culture and sensitivity shows E coli bacteria more than 1,00,000 it considered as UTI.

Q. NO 4. answer :

Post voiding catheterization is important one in elderly people, because post voiding residual urine is present in the bladder due to loss of detrusor muscle contractility.

So to remove that amount of urine post voiding catheterization is important.

At least 50 - 100 ml of urine remain in the bladder after voiding, which may cause still more infections.

The normal bladder can hold at least 600 ml of urine,  

And desire to urinate from 150 ml onwards.