06-15-2010, 12:22 PM
38. An 87-year-old woman who is a resident of a skilled nursing care facility is brought to the physician by staff because of fever for 1 day. A urinary catheter was placed 2 weeks ago because of urinary incontinence. She has dementia, Alzheimer type, and is unable to communicate verbally. Her temperature is 37 8°C (100°F), pulse is 86/min, respirations are 14/min, and blood pressure is 120/74 mm Hg. Mucous membranes are moist and pink. Urinalysis shows:
Color
cloudy brown
PH
8.8
Blood
2+
Glucose
negative
Protein
2+
RBC
too numerous to count
WBC
20-25/hpf
Nitrites
3+
Leukocyte esterase
3+
Bacteria
many
A Gram stai n of uri ne shows gram-negative bad Hi. Whi ch of the follow! ng measures i s most li kely to have prevented thi s pati ent's current conditi on?
O A) Use of incontinence briefs instead of the catheter
O B) Changing the catheter daily
O C) Cleaning the urethral orifice with povidone-iodine daily
O D) Flushing the catheter with an antibiotic solution daily
O E) Oral antibiotic prophylaxis
O F) Oral oxybutynin therapy
Color
cloudy brown
PH
8.8
Blood
2+
Glucose
negative
Protein
2+
RBC
too numerous to count
WBC
20-25/hpf
Nitrites
3+
Leukocyte esterase
3+
Bacteria
many
A Gram stai n of uri ne shows gram-negative bad Hi. Whi ch of the follow! ng measures i s most li kely to have prevented thi s pati ent's current conditi on?
O A) Use of incontinence briefs instead of the catheter
O B) Changing the catheter daily
O C) Cleaning the urethral orifice with povidone-iodine daily
O D) Flushing the catheter with an antibiotic solution daily
O E) Oral antibiotic prophylaxis
O F) Oral oxybutynin therapy