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nbme 2#31 - verypositive
#1
You are asked to see a 63-year-old woman who is in the hospital after undergoing an operation 4 days ago for a displaced tibia-fibula fracture. The operation was uncomplicated. Preoperative chest x-ray film was normal. She has a transurethral urinary catheter, which was placed during the operation 4 days ago. Today she has a temperature of 37.9°C (100.2°F). Laboratory studies disclose mild leukocytosis. Urinalysis shows greater than 100 WBC/hpf and many bacteria. You suspect that she has a urinary tract infection.

Which of the following would have been the most appropriate method of preventing a urinary tract infection in this patient?

A) Cleaning the perineum twice daily with povidone-iodine
B) Irrigating the bladder every 8 hours
C) Removing the catheter immediately post-operation
D) Treating the patient with prophylactic antibiotics
E) Using only silver-coated urinary catheters

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#2
aa?
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#3
c...
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#4
ccc
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#5
REMOVING AS EARLY I AGRRE
BUT IMMEDIATELY SEEMS CONFUSING
WE REMOVE ON 2ND OR 3RD DAY AFTER GRADUAL CLAMPING THE CATHETER AND ASK PT TO TELL U WHEN THAY FEEL SENSATION,WE REMOVE CLAMP AND WE REMOVE CATHETER DAY AFTER, SO NOW WHAT U CHOOSE
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#6
I agree with nimi, "immediately" makes me feel comfortable to choose C. any supporting idea?
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#7
how can we remove the catheter immediately post operation when the operation was for tibia fibula fracture...do u guys want the patient to ambulate immediately post op to releive herself....i would still go with aaa given the circumstances in this q....
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#8
sorry, unconformable
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#9
CCC ... if catheter has been in for only a short duration like during surgery in this case then we can remove immediately after surgery. In this patient if he develops urinary retention after catheter removal then we can do intermittent catheterisation few times.

if catheter has been in for a longer time as in sepsis patient being treated in ICU ... then we have to wean him of catheterisation by intermittent clamping of catheter to look for patients bladder sensation.
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#10
a?
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