A nurse who works in a skilled nursing facility is caring for an 85-year-old wom

Question

A nurse who works in a skilled nursing facility is caring for an 85-year-old woman who has had a fever of 102°F for 2 days. The nurse noted increased agitation, restlessness, and a decreased appetite. The patient has a Foley catheter in place. The physician ordered a urine analysis and the results are below. A diagnosis of a kidney infection was given Color: Appearance Specific gravity Glucose Bilirubin Ketones Leukocyte Esterase+++ Nitrites WBCs/HPF RBCS dark amber in color cloudy with sediment 1.025 Negative Negative Moderate 30 10-12

Explanation / Answer

Positive leukocyte esterase and nitrate test, and presence of WBC indicates bacterial infection in urinary tract. Generally, these bacteria enter through urethra and start multiplying in bladder. The second mechanism is entrance of bacteria present in gastrointestinal tract to urethra through rectal area in females. Human urine has bacterial inhibitory property which acts as defense along with draining of urine works for clearance of bacteria entered. The urinary tract maintains sterility as the bacteria gets flushed out when the bladder gets emptied. Innate immunity is also active against such infections. Several mechanisms which must be ineffective are: inappropriate mucosal production, proper emptying of bladder, production of cytokines, chemokines, phagocytic cells etc. The patient is 85 year old woman. At this age there is retention of urine. As urine is not flushed out properly it leads to growth of bacteria. With age the immune system of body becomes weak, improper diet, GI infections result in urinary infections. Positive nitrite and leukocyte esterase points the urinary infection. Bacteria are responsible for producing nitrites from nitrates. The presence of WBCs and leukocyte esterase indicate presence of bacteria in urinary tract.

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