Nursing critique
Grand Rounds Presentation: Recurrent/Chronic UTI
Case Study
Patricia Jones DOB 06/01/1967 53-year-old African American female patient.
History of present illness: urinary frequency, urgency, and burning onset one week ago until present.
Past Medical History: Diabetes mellitus type 2, hypertension, kidney stones, urinary tract infections.
Medication Allergies: NKDA
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Vitals
Temp: 100°F (37.8° C) oral
Pulse: 80
BP: 145/82
Respirations: 18
Pulse Oximetry: 98% on room air
Pain: 2/10
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Physical Exam Findings
Alert and oriented x 4
Lung sounds clear
Heart sounds normal
Abdomen soft, suprapubic tenderness with palpation.
Lab Findings: Urine Sample and Culture
Urine specimen cloudy in appearance.
Urine culture moderate leukocytes in urine.
Description of Disease
Urinary Tract Infections (UTI) occurs when bacteria such as E.coli or Staph enters in the urinary tract causing infection and inflammation (Hunstad & McLellan, 2016).
Recurrent or chronic urinary tract infection is defined as two or more episodes of a UTI within 6 months (Hunstad & McLellan, 2016).
Hunstad, D. A., & Mclellan, L. K. (2016). Urinary Tract
Infection: Pathogenesis and Outlook. Trends in Molecular Medicine, 22(11), 946-957. doi:10.1016/j.molmed.2016.09.003
Description of Disease continue
SIGNS & SYMPTOMS
Burning with urination
Frequent urination
Urgency with urination
Fever
Suprapubic pain
WBCs in urine (leukocyturia)
(Jhang & Kuo, 2017).
Jhang, J., & Kuo, H. (2017). Recent Advances in
Recurrent Urinary Tract Infection From Pathogenesis and Biomarkers to Prevention. Tzu Chi Medical Journal, 29(3), 131. doi:10.4103/tcmj.tcmj_53_17
Description of Disease Continue
Cultural barriers related to Urinary Tract Infections:
In African American and Hispanic cultures, urinary tract infections and the symptoms associated with it are viewed as a normal part of the aging process (Bennett, Callan, & Duane, 2016).
Bennett, K., Callan, A., & Duane, S. (2016).
Using Qualitative Insights to Change Practice: Exploring the Culture of Antibiotic Prescribing and Consumption for Urinary Tract Infections. BMJ Open, 6(1). doi:10.1136/bmjopen-2015-008894
Solution:
Cultural assessment regarding the patient's belief and understanding of UTI’s and proper education.
Mediation Management
First line treatment option
Sulfamethoxazole / Trimethoprim (Bactrim, Septra). First line treatment options because their low cost and efficacy in the treatment of UTI’s (Multum, 2020).
Sulfamethoxazole-trimethoprim 800 mg-160 mg tablet orally every 12 hours for 10 to 14 days.
Adverse Effects: nausea, vomiting, diarrhea, dizziness, loss of appetite (Multum, 2020).
Contraindications: C.Diff, pregnancy, anemia, chronic kidney disease, allergies to sulfa drugs (Multum, 2020).
Drug interactions: losartan, methotrexate, valsartan, warfarin (Multum, 2020).
Optimal Outcome: Treatment and prevention of recurrent UTI.
Follow-up plan: Follow up in office if UTI symptoms persist of worsen during or after the antibiotic course.
Multum, C. (2020, September 23). Sulfamethoxazole and trimethoprim Uses, Side
Effects & Warnings. Retrieved November 29, 2020, from https://www.drugs.com/mtm/sulfamethoxazole-and-trimethoprim.html
Medication Management
Second line treatment option
Fluoroquinolones: Ciprofloxacin (Cipro) and levofloxacin (Levaquin). These medications are second line treatment options because they are more expensive, broader in spectrum, and associated with serious side effects (Durbin, 2020).
Durbin, K. (2020, August 11). Ciprofloxacin: Uses, Dosage,
Side Effects, Warnings. Retrieved November 29, 2020, from https://www.drugs.com/ciprofloxacin.html
Ciprofloxacin (Cipro) 250 mg tablet orally every 12 hours for 7 to 14 days.
Adverse Effects: diarrhea, dizziness, headache, nausea, tendon rupture (Durbin, 2020).
Contraindications: take tizanidine; or allergy to cipro or other fluoroquinolones, c.diff infection, low magnesium or potassium (Durbin, 2020).
Drug interactions: Cymbalta, dexamethasone, hydrocodone, warfarin (Durbin,2020).
Optimal Outcome: Treatment and prevention of recurrent UTI.
Follow-up plan: Follow up in office if UTI symptoms persist of worsen during or after the antibiotic course.
References
Bennett, K., Callan, A., & Duane, S. (2016). Using Qualitative Insights to Change Practice:
Exploring the Culture of Antibiotic Prescribing and Consumption for Urinary Tract Infections. BMJ Open, 6(1). doi:10.1136/bmjopen-2015-008894
Durbin, K. (2020, August 11). Ciprofloxacin: Uses, Dosage, Side Effects, Warnings. Retrieved
November 29, 2020, from https://www.drugs.com/ciprofloxacin.html
Hunstad, D. A., & Mclellan, L. K. (2016). Urinary Tract Infection: Pathogenesis and Outlook.
Trends in Molecular Medicine, 22(11), 946-957. doi:10.1016/j.molmed.2016.09.003
Jhang, J., & Kuo, H. (2017). Recent Advances in Recurrent Urinary Tract Infection From Pathogenesis
and Biomarkers to Prevention. Tzu Chi Medical Journal, 29(3), 131. doi:10.4103/tcmj.tcmj_53_17
Multum, C. (2020, September 23). Sulfamethoxazole and Trimethoprim Uses, Side Effects & Warnings.
Retrieved November 29, 2020, from https://www.drugs.com/mtm/sulfamethoxazole-and-trimethoprim.html
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