Diagnosing and treating

Urinary Tract Infections

Case Study Presentation

MaryLou Jorgensen, RN,

BSN
NUR 580

2/20/201
4

Definition:
A symptomatic UTI is identified by the
presence of clinical symptoms that can be
attributed to the presence of bacteria in
the urinary tract. Simple infections are
infections that occur in normal urinary
tracts. Complicated infections occur in
abnormal urinary tracts. Infections can be
confined to the lower urinary tract or can
involve the upper urinary tract (Nazarko,
2009).

Pathophysiology
The most common route of infection in females is
via an ascending pathway. Colonization of the
vagina may occur first, and then ascends into the
urinary tract. Ascending UTI is amplified by factors
that promote the introduction of bacteria at the
urethral meatus and by iatrogenic means. Stasis of
bladder urine impairs the defense against infection
provided by bladder emptying. While the
mechanical model of ascending infection explains
the means of onset of bacteriuria, host and
bacterial factors explain the variability of risk for
UTI among women (Epocrates, 2014).

Patient Encounter:

Sick Visit
Frequent urination
Nocturia
Dehydration
Recent travel
Elevated blood glucose
levels
Fever of 101

Findings
Urinalysis:
Blood
Nitrates
Ketones
Bacteria
Culture Sent
CBC negative WBC

Medical History

Diabetes

Hypertension

Heart disease

Hyperlipidemia

UTI twice in last 12 months

Health Risk?

UTI history

Diabetes

Dehydration

Seeking late treatment

Other information:

Illness:

Disability:

Family problems:

(Epocrates,
2014)

Differential diagnoses
Disease/Condition
Overactive bladder

Urothelial carcinoma
of the bladder or
upper urinary tract
Noninfectious
urethritis
Foreign body in
bladder

Vaginitis due to
Candida

Differentiating
Signs/Symptoms
Urinary urgency and
frequency in the absence of a
UTI.
Microscopic and/or gross
hematuria in the absence of a
UTI.
Dysuria, possibly with
irritative voiding symptoms, in
the absence of a UTI.
Recurrent or unresolved UTI.

Differentiating Tests

Negative urine dipstick,

microscopic urinalysis, and
urine culture.
Positive urine cytology.
Tumor seen on cystoscopy or
upper tract imaging.
Negative urine dipstick,
microscopic urinalysis, and
urine culture.
Foreign body (e.g., stone,
stitch from prior pelvic
surgery) visualized on
imaging or cystoscopy.
Presence of vaginal discharge Negative urine dipstick,
and/or vaginal irritation.
microscopic urinalysis, and
urine culture; positive
vaginal cultures.
Direct examination yields
budding yeasts and hyphae.

Review of Systems:
Gastrointestinal:
Urinary:
Female Reproductive:

Screen for risk

Risk Factors:

Further diagnostic testing:

Plan

Interventions:

Client Education:

Family Education:

Follow Up:

Plan
The patient was prescribed Ciproflaxin
500mg daily for 10 days. The patient had
an allergy to sulfa, so a sulfa drug would
not be prescribed. The antibiotic course
was increased to 10 days due to the
history of frequent urinary tract
infections and the diagnosis of diabetes.

Analysis
Treatment for a urinary tract infection is
recommended at trimethoprim/
sulfamethoxzole (septra, bactrim),
second line treatment includes
amoxicillin. Up to 25 to 70 percent of E.
coli is resistant to amoxicillin; therefore it
should not be used as the first line
therapy unless patient factors warrant its
use (Woo, 2012).

Why is this patient

interaction significant?
Evidence based research and
clinical experience differences
Text book treatment vs. patient
Medical history and its play on
treatment
What I learned?

Question
s

References:
Epocrates Online. Urinary Tract Infections (2014). Retrieved
from:
https://online.epocrates.com/u/293577/Urinary+tract+i
nfections+in+women/Diagnosis/Differential
Nazarko, L. (2009). Combating antibiotic resistance in urinary
tract infection. Nurse Prescribing, 7(10), 450-455.
Woo, Teri Moser. Wynne, Anita Lee (2012).
Pharmacotherapeutics for Nurse Practitioner
Prescribers. Third Editions. F.A. Davis.