A 58-year-old female patient with a history of recurrent urinary tract infections (UTIs) and diabetes presents with symptoms suggestive of pyelonephritis. Her lab results reveal leukocytosis, pyuria, bacteriuria, and elevated blood glucose levels. She is allergic to penicillin. Which nursing intervention is the priority in managing her current condition?

A) Administer prescribed ceftriaxone and monitor for any adverse reactions.

B) Educate the patient on dietary modifications for blood glucose control.

C) Encourage increased fluid intake to promote urine output.

D) Monitor blood glucose levels closely to prevent hyperglycemia.

A 45-year-old female with a history of recurrent urinary tract infections and poorly controlled diabetes presents with symptoms indicative of acute pyelonephritis. Given her penicillin allergy and initial laboratory findings, which nursing intervention is most critical to prioritize while awaiting urine culture results?

B) Initiate intravenous fluids to ensure adequate hydration and renal perfusion

A) Administer acetaminophen to manage fever and discomfort

B) Initiate intravenous fluids to ensure adequate hydration and renal perfusion

C) Monitor blood glucose levels closely and administer insulin as needed

D) Educate the patient on signs of worsening infection for early detection

A patient with a confirmed E. coli infection resistant to ceftriaxone is being treated with meropenem. Her serum creatinine has increased from 1.0 mg/dL to 1.5 mg/dL, and her urine output has been less than 400 mL in the past 24 hours. Given these findings, what is the priority nursing intervention to prevent further renal impairment?

A) Increase the patient's fluid intake to maintain adequate hydration

B) Administer a diuretic to promote urine output

C) Reduce the dose of meropenem to avoid nephrotoxicity

D) Monitor blood pressure closely and administer antihypertensives as needed

A patient receiving treatment for a urinary tract infection has a urine output of less than 400 mL in the past 24 hours and an increase in serum creatinine levels from 1.0 mg/dL to 1.5 mg/dL. The urine culture reveals resistance to ceftriaxone. Which nursing intervention should be prioritized to address the patient's renal impairment?

B) Increase the patient's oral fluid intake to promote renal perfusion and urine output.

A) Administer the prescribed carbapenem antibiotic to effectively treat the infection.

B) Increase the patient's oral fluid intake to promote renal perfusion and urine output.

C) Monitor blood glucose levels closely to ensure glycemic control.

D) Educate the patient on the importance of medication adherence to prevent complications.

A patient with acute pyelonephritis and mild hyperkalemia is receiving aggressive intravenous fluid therapy. What action should the nurse take to prevent complications related to the patient's condition?

B) Monitor the patient's serum potassium levels frequently.

A) Restrict the patient's fluid intake to prevent fluid overload.

B) Monitor the patient's serum potassium levels frequently.

C) Encourage the patient to eat foods high in potassium.

D) Increase the patient's insulin dosage to manage hyperkalemia.

A patient with acute pyelonephritis and suspected acute kidney injury is being managed with aggressive intravenous fluids and meropenem. Which assessment finding would be most concerning and require immediate intervention by the nurse?

C) The patient's urine output decreases to 20 mL/hour.

A) The patient's blood pressure is 110/70 mmHg.

B) The patient reports mild nausea and decreased appetite.

C) The patient's urine output decreases to 20 mL/hour.

D) The patient's blood glucose level is 150 mg/dL.

A patient with acute kidney injury presents with elevated blood pressure, headache, and hyperkalemia. Which nursing intervention should the nurse prioritize to address the patient's current symptoms and prevent complications?

A) Administer calcium gluconate to stabilize the cardiac membranes.

B) Encourage oral fluid intake to increase urine output.

C) Administer a low-dose diuretic to manage fluid overload.

D) Prepare the patient for hemodialysis to rapidly correct hyperkalemia.

A patient with acute kidney injury is experiencing hyperkalemia and hypertension. The healthcare team has initiated treatment with calcium gluconate, insulin with glucose, and recommended a low-dose diuretic. As the nurse caring for this patient, which priority action should you take to ensure patient safety?

C) Administer sodium polystyrene sulfonate as ordered.

A) Monitor the patient's blood pressure every hour.

B) Prepare the patient for dialysis immediately.

C) Administer sodium polystyrene sulfonate as ordered.

D) Educate the patient on a low-potassium diet.

A patient with acute kidney injury is showing signs of hyperkalemia and oliguria. The healthcare team has administered calcium gluconate, insulin, and glucose. Despite these interventions, the patient's renal function continues to decline, and they exhibit symptoms of uremia. Which intervention should the nurse anticipate as the next priority to prevent further complications?

C) Prepare the patient for urgent dialysis to support renal function

A) Increase the dosage of diuretics to enhance urine output

B) Initiate sodium polystyrene sulfonate to further reduce potassium levels

C) Prepare the patient for urgent dialysis to support renal function

D) Administer additional doses of calcium gluconate and insulin

A patient with worsening acute kidney injury (AKI) and hyperkalemia has been temporarily stabilized with calcium gluconate, insulin, and glucose. Despite this, the patient's renal function continues to decline, as evidenced by increasing serum creatinine and BUN levels, and urine output remains low. The patient reports dizziness when sitting up and exhibits mild confusion. Which of the following nursing interventions is most appropriate at this time to address the patient's current condition?

B) Prepare the patient for possible dialysis as recommended by nephrology.

A) Increase the dose of diuretics to enhance urine output.

B) Prepare the patient for possible dialysis as recommended by nephrology.

C) Administer additional calcium gluconate to stabilize cardiac function.

D) Encourage oral fluid intake to improve hydration status.

UTI - Nursing Case Study

Pathophysiology

• Primary mechanism: Urinary tract infections (UTIs) primarily occur when uropathogens, most commonly Escherichia coli, ascend the urethra to the bladder. These bacteria adhere to the uroepithelial cells using fimbriae, leading to colonization and infection.

• Secondary mechanism: The immune response is triggered, resulting in inflammation and the production of cytokines. This causes symptoms such as dysuria and urgency due to irritation of the bladder mucosa and increased bladder pressure.

• Key complication: If untreated, the infection can ascend to the kidneys, causing pyelonephritis. This condition involves renal inflammation, which can lead to systemic symptoms such as fever and flank pain and, in severe cases, can result in renal damage or sepsis.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Recurrent UTIs, Type 2 Diabetes, Hypertension

• Current medications: Metformin, Lisinopril, Probiotics

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Lower abdominal pain and frequent urination

• Key symptoms: Dysuria, urgency, hematuria, mild flank pain, low-grade fever

• Vital signs: Temperature 100.8°F, Blood Pressure 150/95 mmHg, Heart Rate 102 bpm, Respiratory Rate 22 breaths per minute

Section 1

As the medical team proceeds with the initial assessment, they find that the patient's condition is more concerning than initially suspected. Physical examination reveals costovertebral angle tenderness on the right side, indicative of possible kidney involvement. In light of her recurrent UTIs and the presence of diabetes, the healthcare team is vigilant about the risk of pyelonephritis. Given her elevated blood pressure, temperature, and heart rate, there's a significant suspicion that the infection may be ascending, potentially leading to systemic involvement.

The laboratory results return, showing significant leukocytosis, with a white blood cell count of 15,000/µL, and a urinalysis that indicates pyuria and bacteriuria, with a large number of white blood cells and the presence of nitrites, commonly associated with E. coli infections. The urine culture is pending but is expected to confirm the presence of this common uropathogen. Blood glucose levels are also elevated at 210 mg/dL, suggesting suboptimal control of her diabetes, which can complicate the infection. The combination of these findings suggests the development of acute pyelonephritis, which requires prompt intervention to prevent further complications such as renal impairment or sepsis.

Given the patient's penicillin allergy, the healthcare team decides to initiate treatment with a broad-spectrum cephalosporin, such as ceftriaxone, while awaiting specific culture results to tailor the antibiotic therapy accurately. Additionally, the team plans to closely monitor her renal function and blood pressure, considering the potential for hypertension to worsen renal outcomes. The plan includes aggressive hydration, both to aid in flushing out the infection and to address her tachycardia and hypotension risk. As the patient's treatment progresses, the team will need to reassess her response to interventions, focusing on the resolution of symptoms and stabilization of vital signs, to ensure that no new complications arise.

Section 2

As the treatment progresses, the healthcare team closely monitors the patient's response to the interventions. After 48 hours on ceftriaxone, the patient's fever begins to subside, with her temperature dropping to 100°F from a previous high of 102.5°F. Her heart rate stabilizes, decreasing to 92 beats per minute, and her blood pressure is now reading at 135/85 mmHg, reflecting an improvement in her hemodynamic status. However, despite these positive changes, the patient continues to experience significant right-sided flank pain, and her urine output is lower than expected, with less than 400 mL in the past 24 hours, raising concerns about potential renal impairment.

New laboratory results show an increase in serum creatinine levels from 1.0 mg/dL at admission to 1.5 mg/dL, indicating a decline in renal function. The urine culture confirms the presence of E. coli, as suspected, but also reveals resistance to ceftriaxone, necessitating a change in antibiotic therapy. The team decides to switch to a carbapenem, such as meropenem, given its efficacy against resistant strains and its safety profile in patients with penicillin allergies. The patient's elevated blood glucose remains a concern, with levels still fluctuating around 200 mg/dL, prompting an adjustment in her insulin regimen to achieve better glycemic control.

These developments require the healthcare team to reassess their approach, focusing on preventing further renal deterioration and ensuring effective eradication of the infection. The team plans to increase the frequency of renal function assessments and continue aggressive hydration, alongside adjusting her diabetic management. The patient is educated on the importance of monitoring her blood glucose levels and adhering to her medication regimen to prevent further complications. As they await the next set of lab results and clinical assessments, the team is prepared to modify the treatment plan further, based on the evolving needs of the patient, aiming to restore her to optimal health without delay.

Section 3

As the team continues to monitor the patient's progress, a new set of diagnostic results reveals a concerning development. The latest urinalysis indicates the presence of white blood cell casts, suggesting acute pyelonephritis, which could explain the persistent right-sided flank pain and decreased urine output. Additionally, serum electrolytes show a mild hyperkalemia, with potassium levels rising to 5.5 mEq/L, indicating the potential onset of acute kidney injury. The patient's BUN levels have also increased to 30 mg/dL, further supporting the diagnosis of renal compromise.

In response to these findings, the healthcare team intensifies their management strategy. Aggressive intravenous fluid administration is initiated to support renal perfusion, carefully balanced to avoid fluid overload due to the patient's compromised renal function. The switch to meropenem is anticipated to provide broader antimicrobial coverage and potentially reduce the renal infection. Meanwhile, nephrology is consulted to evaluate the need for additional interventions, such as temporary dialysis, should the renal function continue to decline. The patient's blood glucose is now better controlled, with levels averaging around 150 mg/dL following adjustments in her insulin regimen, reducing the risk of hyperglycemia-induced nephropathy.

The patient is closely monitored for any signs of fluid overload or electrolyte imbalances, with frequent checks on her weight, edema, and serum electrolytes. Education is reinforced regarding the importance of adhering to the fluid intake recommendations and monitoring for any changes in her symptoms. As the healthcare team awaits further lab results and continues their vigilant assessment, they remain prepared to adjust the treatment plan as needed to prevent further complications and promote recovery, focusing on maintaining renal function and eradicating the infection.

Section 4

As the healthcare team closely monitors the patient's response to the intensified treatment regimen, a change in her status becomes evident. Over the past 24 hours, the patient reports increased fatigue and a mild but persistent headache. Vital signs reveal a blood pressure of 165/95 mmHg, a heart rate of 98 bpm, a respiratory rate of 22 breaths per minute, and a temperature of 101.2°F. The elevated blood pressure, along with the headache, suggests the possibility of hypertensive complications, possibly exacerbated by the fluid resuscitation efforts and underlying acute kidney injury.

Despite aggressive fluid management, the patient's urine output remains low, averaging about 400 mL over the last 24 hours. Further laboratory tests show serum creatinine levels have risen to 2.2 mg/dL, and potassium remains elevated at 5.6 mEq/L. An electrocardiogram (ECG) is performed to assess for any cardiac changes due to hyperkalemia, revealing peaked T waves, which warrant immediate attention to prevent arrhythmias.

In response to these developments, the healthcare team re-evaluates the current strategy. The nephrology team recommends initiating a low-dose diuretic to carefully manage fluid balance without exacerbating renal stress. Additionally, measures to address hyperkalemia are prioritized, including the administration of calcium gluconate to stabilize cardiac membranes, insulin with glucose to promote intracellular potassium shift, and consideration of sodium polystyrene sulfonate for potassium removal. The team continues to monitor the patient's neurological status, blood pressure, and electrolytes closely, adjusting interventions as needed to stabilize the patient's condition and prevent further renal deterioration.

Section 5

Over the next 12 hours, the healthcare team closely monitors the patient’s response to the revised treatment plan. Initial interventions aimed at managing fluid balance and hyperkalemia show some promising signs. The administration of calcium gluconate, along with insulin and glucose, is effective in temporarily stabilizing the patient's cardiac status, with a subsequent ECG showing a reduction in the amplitude of T waves, indicating a decrease in the immediate risk of cardiac arrhythmias. The patient's blood pressure, however, remains elevated at 160/92 mmHg, necessitating continued vigilance and potential adjustment of antihypertensive strategies.

Despite these positive developments in electrolyte management, the patient's renal function continues to deteriorate. Follow-up laboratory tests reveal that serum creatinine has increased further to 2.6 mg/dL and BUN is now at 45 mg/dL, suggesting worsening acute kidney injury. Urine output remains critically low, with only 350 mL in the past 12 hours, raising concerns about oliguria. The low-dose diuretic has yielded minimal improvement, indicating that the kidneys are struggling to respond to pharmacologic intervention.

Clinically, the patient reports persistent fatigue and now experiences dizziness when attempting to sit up, suggestive of potential orthostatic hypotension despite the overall elevated blood pressure. Neurological assessments reveal mild confusion, which is a deviation from her baseline mental status and may correlate with uremia. These findings prompt the healthcare team to consider the possibility of progressing to more advanced renal support, such as dialysis, to prevent further complications and support the patient's recovery. The team consults nephrology to evaluate the need for urgent renal replacement therapy while continuing to address electrolyte imbalances and manage blood pressure aggressively.