A patient with a history of recurrent urinary tract infections presents with lower abdominal pain, chills, and mild tenderness in the flank area. Urinalysis shows pyuria and nitrites, and urine culture confirms Escherichia coli sensitive to ciprofloxacin. Which of the following nursing interventions is the most appropriate to prioritize in this clinical scenario?

B) Administer the prescribed ciprofloxacin and monitor for adverse reactions.

A) Encourage increased fluid intake to promote renal clearance.

B) Administer the prescribed ciprofloxacin and monitor for adverse reactions.

C) Educate the patient about reducing dietary sodium to manage hypertension.

D) Implement strict bed rest to prevent further complications.

A patient with a history of recurrent urinary tract infections is being treated for a current infection caused by Escherichia coli. The initial treatment includes oral ciprofloxacin. Which of the following assessments is the most critical for the nurse to perform to evaluate the effectiveness of the antibiotic therapy?

D) Assessing the patient’s abdominal pain and tenderness for improvements.

A) Monitoring the patient’s blood pressure for potential hypertension complications.

B) Checking the patient's temperature for signs of fever resolution.

C) Observing the patient's urine output and characteristics for changes.

D) Assessing the patient’s abdominal pain and tenderness for improvements.

A patient with a urinary tract infection began oral ciprofloxacin therapy 48 hours ago and now presents with a temperature of 101.5°F, increased flank pain, and decreased urine output. Which of the following is the most appropriate initial nursing action?

B) Notify the healthcare provider of the patient's condition

A) Administer an antipyretic to manage fever

B) Notify the healthcare provider of the patient's condition

C) Encourage increased oral fluid intake

D) Monitor the patient's urine output more frequently

A patient receiving oral ciprofloxacin for a urinary tract infection exhibits signs of deterioration, including fever, increased flank pain, and decreased urine output. What is the nurse's priority intervention at this time?

B) Notify the healthcare provider about the patient's worsening condition.

A) Administer antipyretics to manage the patient's fever.

B) Notify the healthcare provider about the patient's worsening condition.

C) Encourage increased oral fluid intake to combat dehydration.

D) Maintain the current antibiotic regimen and continue monitoring.

A patient with pyelonephritis and multi-drug resistant Escherichia coli infection is exhibiting signs of acute kidney injury with elevated creatinine and BUN levels. In addition to starting an appropriate antibiotic regimen, what is the most critical nursing intervention to support renal function in this patient?

C) Administer intravenous fluids to maintain adequate hydration

A) Initiate a low-protein diet to reduce kidney workload

B) Monitor vital signs and assess for signs of sepsis

C) Administer intravenous fluids to maintain adequate hydration

D) Educate the patient about the importance of completing the antibiotic course

A patient with worsening pyelonephritis and acute kidney injury is receiving intravenous piperacillin-tazobactam. Which nursing action is most appropriate to monitor for complications associated with this treatment?

C) Measure the patient's urine output hourly.

A) Monitor the patient's blood glucose levels every 4 hours.

B) Assess the patient for signs of an allergic reaction every shift.

C) Measure the patient's urine output hourly.

D) Check the patient's blood pressure every 2 hours.

A patient with acute kidney injury is experiencing decreased urine output despite aggressive fluid resuscitation. Laboratory tests reveal hyperkalemia and worsening renal function. Which of the following nursing interventions is most appropriate to prioritize in this situation?

B) Initiate continuous cardiac monitoring to detect potential arrhythmias.

A) Administer a loop diuretic to increase urine output.

B) Initiate continuous cardiac monitoring to detect potential arrhythmias.

C) Restrict oral fluid intake to prevent fluid overload.

D) Prepare the patient for dialysis to rapidly decrease potassium levels.

A patient with acute kidney injury (AKI) secondary to dehydration and infection is experiencing oliguria, electrolyte imbalances, and mild tachycardia. Which intervention should the nurse prioritize to address the patient's hyperkalemia and prevent potential cardiac complications?

D) Administer sodium polystyrene sulfonate (Kayexalate)

A) Administer isotonic saline infusion

B) Initiate continuous cardiac monitoring

C) Prepare the patient for hemodialysis

D) Administer sodium polystyrene sulfonate (Kayexalate)

A patient with acute kidney injury is experiencing low urine output, signs of metabolic acidosis, and mild pulmonary congestion due to aggressive fluid resuscitation. What is the most appropriate nursing intervention to address the patient's current condition?

B) Administer diuretics as prescribed to reduce pulmonary congestion

A) Increase the rate of fluid infusion to improve renal perfusion

B) Administer diuretics as prescribed to reduce pulmonary congestion

C) Restrict fluid intake to prevent further fluid overload

D) Administer sodium bicarbonate to correct metabolic acidosis

A patient with acute kidney injury is being managed for fluid overload and metabolic acidosis. The healthcare team has decided to introduce diuretics. What is the most important nursing assessment to prioritize after initiating diuretic therapy in this patient?

C) Assessing for signs of electrolyte imbalance

A) Monitoring blood pressure for hypotension

B) Checking urine output hourly

C) Assessing for signs of electrolyte imbalance

D) Evaluating respiratory rate and effort

urinary track infection - Nursing Case Study

Pathophysiology

• Primary mechanism: Pathogenic bacteria, primarily Escherichia coli, ascend the urethra and colonize the urinary tract, leading to an inflammatory response that causes symptoms such as dysuria and urgency.

• Secondary mechanism: Host defense mechanisms, including urine flow and immune responses, may be compromised, allowing bacteria to adhere to the urinary epithelium and evade immune detection, perpetuating infection.

• Key complication: If untreated, the infection can ascend to the kidneys, causing pyelonephritis, which may result in systemic symptoms like fever and flank pain, and potentially lead to renal scarring or sepsis.

Patient Profile

Demographics:

45-year-old female, office manager

History:

• Key past medical history: Recurrent urinary tract infections, hypertension

• Current medications: Lisinopril 10 mg daily, over-the-counter cranberry supplements

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent lower abdominal pain

• Key symptoms: Increased frequency and urgency of urination, burning sensation during urination, mild fever, fatigue, lower back pain

• Vital signs: Temperature 100.8°F, blood pressure 145/92 mmHg, heart rate 98 bpm, respiratory rate 20 breaths per minute

Section 1

Initial Assessment Findings:

During the initial assessment, the nursing team noted that the patient appeared fatigued and uncomfortable, frequently shifting in her seat. Upon further questioning, the patient reported that her lower abdominal pain had intensified and she experienced persistent chills. A focused assessment of the lower abdomen revealed tenderness upon palpation, particularly over the suprapubic region. Auscultation of the lungs and heart was unremarkable, but a careful inspection of the flank area indicated mild tenderness on the right side, raising concerns about potential kidney involvement. Given her history of recurrent urinary tract infections and the current symptomatology, the nursing staff prioritized a urinalysis and urine culture, anticipating the need for targeted antibiotic therapy.

New Diagnostic Results:

The results from the urinalysis revealed significant pyuria, with a high number of white blood cells, and the presence of nitrites, indicating a bacterial infection. The urine culture confirmed Escherichia coli as the causative organism, exhibiting resistance to several common antibiotics but sensitivity to nitrofurantoin and ciprofloxacin. Blood work showed a mild leukocytosis with an elevated C-reactive protein level, suggesting systemic inflammation. Given the patient's history of hypertension and current elevated blood pressure readings, the healthcare team was particularly vigilant for signs of worsening infection that could lead to complications such as pyelonephritis or even sepsis. The decision was made to initiate treatment with oral ciprofloxacin, while closely monitoring the patient's response to therapy and adjusting her hypertension management as needed to avoid further complications.

These findings and decisions set the stage for the next phase of the patient's journey, where her response to the initial antibiotic therapy will be crucial. The healthcare team must remain alert for any signs of exacerbating symptoms or new complications that may indicate the spread of infection or the development of antibiotic resistance, necessitating a reevaluation of her treatment plan.

Section 2

Change in Patient Status:

Within 48 hours of initiating oral ciprofloxacin therapy, the patient began to exhibit concerning signs of deterioration. Her temperature spiked to 101.5°F (38.6°C), and she reported increased flank pain and persistent nausea, resulting in poor oral intake and mild dehydration. Vital signs indicated a blood pressure of 150/90 mmHg, elevated from her baseline, and a heart rate of 110 beats per minute, suggesting increased stress on her cardiovascular system. The healthcare team noted that despite the antibiotic treatment, her symptoms were not improving as expected, raising the suspicion of possible antibiotic resistance or complications such as pyelonephritis.

Further assessment revealed worsening tenderness in the right flank and a new onset of costovertebral angle tenderness, a classic sign of kidney involvement. The patient's urine output decreased, raising concerns about possible acute kidney injury. Recognizing the need for immediate intervention, the team ordered additional blood tests, including renal function tests, to assess her kidney status. They also decided to obtain a repeat urine culture to evaluate for any changes in bacterial sensitivity that might indicate resistance to the current antibiotic regimen.

The clinical team discussed the possibility of escalating care, considering either a switch to intravenous antibiotics or consultation with a nephrologist for further evaluation. They planned to initiate aggressive fluid resuscitation to address her dehydration and ensure adequate renal perfusion. This change in the patient's status underscored the importance of vigilant monitoring and the potential for rapid progression of urinary tract infections to more serious conditions, necessitating a reassessment of her treatment plan to prevent further complications.

Section 3

New Diagnostic Results:

The repeat urine culture results returned showing the presence of a multi-drug resistant strain of Escherichia coli, confirming the suspicion of antibiotic resistance to ciprofloxacin. The blood tests indicated significantly elevated creatinine levels at 2.3 mg/dL, up from a baseline of 0.9 mg/dL, and a blood urea nitrogen (BUN) level of 35 mg/dL, suggesting acute kidney injury likely exacerbated by dehydration and infection. Additionally, the white blood cell count had risen to 15,000/mm³, indicative of an ongoing inflammatory response. These findings aligned with the clinical picture of worsening pyelonephritis and required an urgent reevaluation of the treatment strategy.

In response to these diagnostic results, the healthcare team promptly initiated a change in the antibiotic regimen to intravenous piperacillin-tazobactam, a broad-spectrum antibiotic with efficacy against resistant organisms. The nephrologist was consulted, and they recommended close monitoring of renal function and urine output, as well as the continuation of aggressive fluid resuscitation with isotonic saline to support kidney perfusion. The team also ordered an ultrasound of the kidneys to assess for any structural abnormalities or obstruction that might be contributing to the patient's deteriorating condition.

This escalation in care highlighted the critical need for personalized treatment plans based on evolving clinical and diagnostic information. The new interventions aimed to address the resistant infection and prevent further renal impairment. The healthcare team remained vigilant, aware that timely adjustments in management could significantly impact the patient's recovery trajectory, emphasizing the importance of interdisciplinary collaboration in managing complex cases such as this.

Section 4

As the team closely monitored the patient's response to the new antibiotic regimen and supportive measures, a noticeable change in the patient’s status emerged. Over the next 48 hours, the patient's urine output began to decrease, dropping to less than 0.5 mL/kg/hr, despite aggressive fluid resuscitation. This oliguria raised concerns about the progression of acute kidney injury. Vital signs showed a mild tachycardia at 102 beats per minute, with a blood pressure of 100/60 mmHg, which, although within normal limits, suggested possible hypovolemia. The patient reported increased fatigue and appeared pale, with dry mucous membranes, indicating persistent dehydration.

Further laboratory tests revealed a worsening of renal function, with creatinine levels climbing to 3.1 mg/dL and BUN reaching 45 mg/dL. Electrolyte imbalances were also noted, with hyponatremia at 130 mEq/L and hyperkalemia at 5.5 mEq/L, raising the risk of potential cardiac complications. The ultrasound of the kidneys showed no evidence of structural abnormalities or obstructions, suggesting that the renal impairment was primarily due to the ongoing infection and dehydration rather than an anatomical issue.

The healthcare team recognized the urgency of these developments and responded by intensifying the fluid management strategy, switching to a combination of isotonic saline and bicarbonate infusions to correct electrolyte disturbances and support renal function. A cardiology consult was sought to evaluate the risk of hyperkalemic complications, and continuous cardiac monitoring was initiated. These interventions underscored the need for dynamic and adaptive management strategies in response to evolving patient conditions, highlighting the importance of timely clinical decision-making and interdisciplinary collaboration in mitigating complications and optimizing patient outcomes.

Section 5

As the healthcare team continued to implement the adjusted treatment plan, they observed changes in the patient's clinical status over the next 24 hours. The patient's urine output remained low, despite the intensified fluid therapy, and creatinine levels had risen further to 3.5 mg/dL, indicating a progression of the acute kidney injury. The patient also began to exhibit signs of metabolic acidosis, with an arterial blood gas analysis showing a pH of 7.30 and a bicarbonate level of 18 mEq/L. The mild tachycardia persisted, and the patient's blood pressure slightly decreased to 95/58 mmHg, suggesting that the hemodynamic support was not fully effective.

Additionally, the patient developed new respiratory symptoms, including mild dyspnea and an increased respiratory rate of 24 breaths per minute. A chest X-ray was obtained to rule out pulmonary complications and revealed mild pulmonary congestion, raising concerns about fluid overload as a result of aggressive fluid resuscitation. The team considered the delicate balance required to manage fluid status while avoiding exacerbation of renal and cardiac issues.

In response to these developments, the healthcare team decided to adjust the fluid management strategy by introducing diuretics to alleviate pulmonary congestion, while carefully monitoring electrolytes and renal function. The nephrology and cardiology teams collaborated to refine the treatment approach, emphasizing the importance of maintaining hemodynamic stability and preventing further metabolic disturbances. This situation highlighted the complexity of managing multifaceted complications and underscored the critical role of continuous monitoring and interdisciplinary teamwork in adapting to the patient's evolving needs.