What other assessment data would be helpful for the nurse practitioner to have?
The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%; therefore, the NP should be vigilant and pay attention to additional assessment data (Allen, Manilal & Gezmu, 2019). For example, patient population is typically premenopausal women of any age with risk factors of diabetes, diaphragm use, especially those with spermicide, history of UTI or UTI during childhood, mother or female relatives with history of UTIs, and sexual intercourse.
What are the organisms most likely to cause an UTI?
Urinary tract infections are primarily caused by gram-negative bacteria, but gram-positive pathogens may also be involved. More than 95% of uncomplicated UTIs are monobacterial. The most common pathogen for uncomplicated UTIs is E.coli (75%–95%), followed by Klebsiella pneumoniae, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococci, and Proteus mirabilis (Bollestad, Vik, Grude& Lindbæk, 2018).
What is the pharmacological treatment for Shelly? Keep in mind safe dosing.
The first step in treating Shelly is to classify the type of infection, such as acute uncomplicated cystitis or pyelonephritis, acute complicated cystitis or pyelonephritis, CA-UTI, asymptomatic bacteriuria (ASB), or prostatitis (Allen, Manilal & Gezmu, 2019). The Infectious Diseases Society of America (IDSA) recommends that empiric regimens for uncomplicated UTIs be guided by the local susceptibility, particularly to E. coli. They recommend considering trimethoprim/sulfamethoxazole if the local resistance rate is less than 20% and fluoroquinolones if the resistance rate is less than 10% (Bollestad, Vik, Grude& Lindbæk, 2018). The empiric regimen for complicated UTIs should also be guided by local susceptibility trends of uropathogens, and definitive regimens should be tailored according to susceptibility results, when available.
What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?
The teaching priority for Shelly is hydration. During UTI management, hydration dilutes the uropathogen and removes infected urine by frequent bladder emptying. However, the bacterial count returns to the prehydration level after hydration is discontinued. Potential problems with forcing fluids include urinary retention in a patient with a partially obstructed bladder and decreased urinary antibiotic concentration.