Case Study: Urinary Tract Infection in Elderly Patients
School
Central Philippine University - Jaro, Iloilo City**We aren't endorsed by this school
Course
BSN 3
Subject
Nursing
Date
Dec 12, 2024
Pages
5
Uploaded by GeneralCrabPerson1102
CENTRAL PHILIPPINE UNIVERSITYCollege of NursingThe First School of Nursing in the Philippines since 1906 Jaro, Iloilo City,PhilippinesMedical-Surgical Nursing 1 (NCM 3114):Care of Clients with Problems in Oxygenation, Fluids & Electrolytes, Infectious,Inflammatory, and Immunologic Response, Cellular Aberrations, Acute, and ChronicClinical Studies IUrinary tract infection in an older patient:a case study and reviewSubmitted to:Prof.Submitted by:Jesa Mae G. BrasilenoBSN 3-BOctober 13, 2024
CENTRAL PHILIPPINE UNIVERSITYCollege of NursingThe First School of Nursing in the Philippines since 1906 Jaro, Iloilo City,PhilippinesApril 2, 2023Urinary tract infection in an older patient: a case study and reviewPatient’s DataName: Mrs MAge: 87 years oldGender: FCC: Dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinationsWorking Diagnosis: Urinary Tract InfectionVital SignsHR: 112 bpmRR: 17 bpmO2 Sat: 98%BP: 116/70Temp: 37.3 CMrs M, an 87-year-old lady living in a nursing home, had a complaint that wasreported as dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinations. The carer reported a history of disturbed night sleep, withhallucinations of spiders crawling in bed, followed by agitation, lethargy and poor oralintake the next morning.In this case, the carer highlighted that Mrs M had been treated for suspected UTItwice in the last 12 months. She had never smoked or drank alcohol. Documentedfamily history revealed stroke, ischaemic heart disease and breast cancer. Mrs Mwas unable to provide an uncontaminated urine sample due to incontinence.Research's PurposeUTIs are one of the most common infections worldwide. Lajiness and Lajiness(2019) define UTI as the presence of colonising bacteria that cause a multitude ofsymptoms affecting either the upper or lower urinary tract. NICE (2021) furtherclassifies UTIs as either uncomplicated or complicated, with complicated involvingother systemic conditions or pre-existing diseases. Geerts et al (2013) postulatearound 30% of females will develop a UTI at least once in their life. The incidenceincreases with age, with those over 65 years of age being five times more likely todevelop a UTI at any point. Further increased prevalence is found in patients wholive in a care home, with up to 60% of all infections caused by UTI (Bardsley, 2017).
CENTRAL PHILIPPINE UNIVERSITYCollege of NursingThe First School of Nursing in the Philippines since 1906 Jaro, Iloilo City,PhilippinesMethodsThe SBAR (situation, background, assessment, recommendation) tool was adopted,ensuring structured and relevant communication was obtained.FindingsOn examination, it was noted that Mrs M had mild pallor with normal capillary refilltime, no signs of peripheral or central cyanosis, and no clinical stigmata to note.Heart and chest sounds were normal, with no peripheral oedema. The abdomen wasnon-distended, soft and non-tender on palpation, with no reports of nausea,vomiting, supra-pubic tenderness or loin pain.During the consultation, confusion and restlessness were evident. Therefore, it wasdifficult to ask direct questions to Mrs M regarding pain, nausea and dizziness. MrsM's most recent blood tests indicated CKD stage 2, based on an estimatedglomerular filtration rate (eGFR) of 82 ml/minute/1.73m2. Previous urine samples ofMrs M grew Escherichia coli bacteria, sensitive to nitrofurantoin but resistant totrimethoprim.ConclusionsBased on Ms M's clinical history and physical examination, a working diagnosis ofsuspected symptomatic uncomplicated UTI was hypothesised. A decision was made,based on the local antibiotic prescribing guidelines, as well as the NICE (2021)guidelines, to treat empirically with nitrofurantoin modified release (MR), 100 mgtwice daily for 3 days, to avoid further health or systemic complications.Discussion of its importance to nursing practicea. As a nursing student, what is the significance of the clinical studies or journalarticles?Nursing students need clinical study and journal articles as this builds a solidbackground to the research-based presentation offering secure patient care. It alsohelps them stay updated with new research, treatment protocols and best practicesso that their theoretical knowledge can meet real-life clinical situations.Research-trained nurses also promote critical thinking as students are required toreview and apply research thus preparing them in making clinical decisions. Inaddition, interpreting studies helps nursing students to learn research literacy andkeep up with medical advances throughout their working lives.
CENTRAL PHILIPPINE UNIVERSITYCollege of NursingThe First School of Nursing in the Philippines since 1906 Jaro, Iloilo City,Philippinesb. What is the significance of the study for your future nursing practice? Provideexamples of how you apply these in the clinical area.The elderly female study has important nursing implications for future practicewith an emphasis on prophylaxis, prompt diagnosis and appropriate therapy in UTIsafter the age of 50. Using this understanding in clinical practice would includeseveral preventive measures such as proper hydration, scheduled regular bowelmotions and mobilization to reduce UTI risk whilst hospitalised.The study also highlights the importance of identifying non-typical symptoms for UTIshigh-risk community-acquired UTI populations. Factors such as urinary retention,decreased estrogen levels and catheter use leave women especially susceptible toin older people — such as confusion or sudden mental status changes, beyondclassical fever or pain. This would enable nurses to monitor patients more regularlyand provide early interventions in order to save lives, and reduce risks ofcomplications like sepsis. When nurses use evidence-based strategies in caring forthese patients, it directly results in better health outcomes and patient comfort alongwith a lower risk of hospital readmissions.c. Are the findings applicable to the other cases of disease processes we discussed?What are the challenges you anticipate facing when managing this patient? Pleaseelaborate and cite one example.Yes, the findings from studies on urinary tract infections (UTIs) in older femalepatients are applicable to other disease processes, particularly those involvinginfections in vulnerable populations. Recognizing symptoms early, treatingpneumonia or a wound infection with the right antibiotic and staying hydrated canprevent complications. However, one of the most challenging issues in themanagement of UTI in older patients is that the presentation of symptoms is oftenatypical with confusion or fatigue rather than the classic signs, with a likely delay indiagnosis and increased occurrence of complications such as sepsis. In addition,intellectual deterioration-such as dementia-may lead to non-compliance withantibiotic therapy or inadequate fluid intake, further complicating the situation. Forexample, a patient can forget to take medicines or avoid drinking water so as tominimize visits to the toilet. Nurses can encourage these patients to take medicationreminders and patient education by including their families to improve adherenceand reduce recurrences.
CENTRAL PHILIPPINE UNIVERSITYCollege of NursingThe First School of Nursing in the Philippines since 1906 Jaro, Iloilo City,PhilippinesReferences:Read, H., & Mortimore, G. (2023, April 2). Urinary tract infection in an older patient: acase study and review. Practice Nursing.https://www.practicenursing.com/content/clinical/urinary-tract-infection-in-an-older-patient-a-case-study-and-reviewBardsley A. Diagnosis, prevention and treatment of urinary tract infections in olderpeople. Nurse Older People. 2017; 29:(2)32-38https://doi.org/10.7748/nop.2017.e884Geerts AF, Eppenga WL, Heerdink R Ineffectiveness and adverse events ofnitrofurantoin in women with urinary tract infection and renal impairment in primarycare. Eur J Clin Pharmacol. 2013; 69:(9)1701-1707https://doi.org/10.1007/s00228-013-1520-xLajiness R, Lajiness MJ. 50 years on urinary tract infections and treatment-Has muchchanged?. Urol Nurs. 2019; 39:(5)235-239https://doi.org/10.7257/1053-816X.2019.39.5.235National Institute for Health and Care Excellence. Urinary tract infection (lower) –women. 2021.https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/(accessed 13 March 2023)