NRS 202 A Homework 2
Assessment of urinary tract infection
by Lee Gilbert · about a month ago
Patient Profile
L.M. is an 81-year-old female who lives in a
nursing home. She had a stroke 2 years ago and has residual right-sided
weakness. She also has gastroesophageal reflux disease, hypertension, and
stress incontinence. She currently takes the following medications:
• Omeprazole 20 mg PO daily before breakfast
• Captopril 50 mg PO BID
• Furesomide 20 mg PO daily
Today she tells the nursing assistant that she
has a lot of pain when she urinates. The charge nurse completes a physical exam
and notifies the provider of the exam findings and patient’s painful urination.
A urinalysis is ordered.
Subjective Data
• Pain with urination began 2 days ago
• States she usually doesn’t drink much because
of the stress incontinence and not wanting to have “accidents,” and now she is
drinking even less because doesn’t want to have to urinate due to the pain and
burning
• Wearing feminine hygiene pads she had in her
closet since the painful urination started because her stress incontinence “is
worse”
Objective Data
Physical Examination
• Temperature 99.7° F, pulse 78, respirations
18, blood pressure 162/80
• Left flank tenderness
Diagnostic Studies
• Urinalysis
• Color: Dark, smoky color
• Odor: Foul smelling
• Protein: Trace
• Glucose: None
• Ketones: None
• Bilirubin: None
• Specific gravity: 1.034
• pH: 8.2
• RBCs: 8/hpf
• WBCs: 12/hpf
• Casts: Present
Discussion Questions
1. Based on L.M.’s presentation, what do you
suspect is occurring and what assessment data led you to this conclusion?
2. You need to obtain a clean-catch urine sample
from L.M. to send for urinalysis. To collect this specimen, what instructions
do you give L.M.?
3. Describe how to assess for flank tenderness.
What is the significance of L.M.’s left flank tenderness?
4. What are L.M.’s risk factors for developing a
urinary tract infection?
5. What diagnostic test would be needed to
determine the best medication to treat L.M.’s urinary tract infection?
6. What are some important measures to teach
L.M. to prevent recurrence of a urinary tract infection (UTI)?
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