08-28-2009, 04:06 AM
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 stain of urine shows gram-negative bacilli. Which of the following measures is most likely to have prevented this patient's current condition?
a) Use of incontinence briefs instead of the catheter
b) Cleaning the urethral orifice with povidone-iodine daily
c) Flushing the catheter with an antibiotic solution daily
d) Oral antibiotic prophylaxis
e) 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 stain of urine shows gram-negative bacilli. Which of the following measures is most likely to have prevented this patient's current condition?
a) Use of incontinence briefs instead of the catheter
b) Cleaning the urethral orifice with povidone-iodine daily
c) Flushing the catheter with an antibiotic solution daily
d) Oral antibiotic prophylaxis
e) Oral oxybutynin therapy