Question

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 ack pain, incontinency, severe mental confusion, and loose stools. Her physician had recently discontinued her hormone replacement therupy one (l) moath 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 ciprotloxacin, trimethoprim- #1, what role does hormone replacement therapy play in the prevention of UTİO #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 of Dis 0.9%NS at 75 mL/far. and insert a Foley retention catbeter to straight drainage. Because Mrs. Zippo is unable to take oral medications, the physician onders ciprofloxacin 200mg twioe 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. IfMrs. Zippo were on oral ciprofloxacin what dietary considerations would have to be considered with this medication?

Answer 1

1.One of the most common conditions found in women are urinary tract infection and age -related factors contribute to the likelihood of these infections which occurs after when menopause ,when estrogen production plummets.The use of hormonal therapy ,va gi nal estrogen ,in post menopausal women suffering from recurrent UTIs,as it encourages production of natural antimicrobial substances in the bladder.This hormone makes the urinary tract tissue stronger by closing the gaps between cells that line the bladder.Thereby making it harder for bacteria to penetrate the deeper layers of the bladder wall.Giving women low doses intrav a gi n al estrogen replacement acidifies the v agina and maybe effective in treating recurrent UTI.

2. The urinary tract above the urethra is sterile .Several mechanical and physiologic defense mechanisms assist in maintaining sterility and preventing UTIs. An alteration in any of these defense mechanisms increases the risk of contracting a UTI. Menopause also appears to be factor in the incidence of UTI in women.Before menopause ,glycogen rich cells and the normal bacterial flora Lactobacillus keep the vag inal pH acidic.This acidic environment helps to prevent the overgrowth of organisms that usually only proliferate in a pH above 4.5.A common factor contributing to ascending infection is urologic instrumentation .Instrumentation allows bacteria that are normally present at the opening of the opening of urethra to enter the urethra or bladder.The organisms that usually cause UTI s are introduced via the ascending route from the urethra and originate in the perinieum.Other less common routes are via the bloodstream or lymphatic system.Most infections are due to gram-negative bacilli normally found in the GI tract ,although gram-positive organisms such as streptococci ,enterococci can also cause urinary infections.

3 The normal RBC range for women is 4.2 to 5.4 million cells per microliter.but here the RBC of the patient is 3.6.upto 10000 colonies of bacteria /ml are considered normal.Greater than 1,00000 colonies/ml represents urinary tract infection.

4 It helps in determining any urinary problems,infection in kidneys,bladder blocked ,or if the patient has trouble pushing urine out.A normal test result should be 20-25ml/s peak flow rate.A post void residual urine greater than 50ml is a significant amount of urine and increases the potential for recurring urinary tract infections