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What other assessment data would be helpful for the nurse practitioner to have?

           The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%; therefore, the NP should be vigilant and pay attention to additional assessment data (Allen, Manilal & Gezmu, 2019).  For example, patient population is typically premenopausal women of any age with risk factors of diabetes, diaphragm use, especially those with spermicide, history of UTI or UTI during childhood, mother or female relatives with history of UTIs, and sexual intercourse.

What are the organisms most likely to cause an UTI?

           Urinary tract infections are primarily caused by gram-negative bacteria, but gram-positive pathogens may also be involved. More  than  95%  of  uncomplicated  UTIs  are  monobacterial.  The most common pathogen for uncomplicated UTIs is E.coli (75%–95%), followed by Klebsiella pneumoniae, Staphylococcus saprophyticus,  Enterococcus  faecalis,  group  B  streptococci,  and Proteus  mirabilis (Bollestad, Vik, Grude& Lindbæk, 2018).

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

           The first step in treating Shelly is to classify the type of infection, such as acute uncomplicated cystitis or pyelonephritis, acute complicated cystitis or pyelonephritis, CA-UTI, asymptomatic  bacteriuria  (ASB),  or  prostatitis  (Allen, Manilal & Gezmu, 2019).  The Infectious Diseases Society of America (IDSA) recommends that  empiric  regimens  for  uncomplicated  UTIs  be  guided  by  the  local  susceptibility,  particularly  to  E.  coli.  They  recommend   considering   trimethoprim/sulfamethoxazole if the local resistance rate is less than 20% and fluoroquinolones if the resistance rate is less than 10% (Bollestad, Vik, Grude& Lindbæk, 2018). The empiric regimen for complicated UTIs should also be guided by local susceptibility trends of uropathogens,  and  definitive  regimens  should  be  tailored  according  to  susceptibility  results,  when available.

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

           The teaching priority for Shelly is hydration.  During  UTI  management,  hydration  dilutes  the  uropathogen  and  removes  infected  urine  by  frequent  bladder  emptying.  However, the bacterial count returns to the prehydration  level  after  hydration  is  discontinued.  Potential problems with forcing fluids include urinary retention in a  patient  with  a  partially  obstructed  bladder  and  decreased  urinary antibiotic concentration. 

References

Allen, M., Manilal, A., Gezmu, T., (2019). Prevalence and associated factors of urinary tract infections among women. Journal of Urology, 45(1), 56–62. https://doi.org/10.5152/tud.2018.32855

Bollestad, M., Vik, I., Grude, N., & Lindbæk, M. (2018). Predictors of Symptom Duration and Bacteriuria in Urinary Tract Infection. Scandinavian Journal of Primary Health Care, 36(4), 446–454. https://doi.org/10.1080/02813432.2018.1499602

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What other assessment data would be helpful for the nurse practitioner to have?

           Nurse practitioners are well positioned to have important roles in the assessment and management of UTIs.  The bacterial count is an assessment data helpful to the NP.  Urine dip sticks are one of the most frequently used instruments for diagnostic testing if there is clinical evidence that a patient is suffering from UTI. Multistix are most often used, which may be able to detect nitrite (a metabolic product of typical pathogens of the urinary tract), leukocyte esterase, protein and blood (as a marker of inflammation).

What are the organisms most likely to cause an UTI?

           Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.  Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

           Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Drugs commonly recommended for simple UTIs include:

   Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)

   Fosfomycin (Monurol)

   Nitrofurantoin (Macrodantin, Macrobid)

   Cephalexin (Keflex)

   Ceftriaxone

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

           In many states, NPs already have the authority to manage UTIs, to varying degrees.  Teaching priority includes drinking plenty of water. Water helps to dilute the urine and flush out bacteria.  Avoiding drinks that may irritate the bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate the bladder and tend to aggravate the frequent or urgent need to urinate.  Use a heating pad. Apply a warm, but not hot, heating pad to the abdomen to minimize bladder pressure or discomfort.

           Some alternative remedies may include drinking cranberry juice to prevent UTIs. There’s some indication that cranberry products, in either juice or tablet form, may have infection-fighting properties. Researchers continue to study the ability of cranberry juice to prevent UTIs, but results are not conclusive.

References 

Collins, L. (2019). Diagnosis and management of a urinary tract infection. British Journal of Nursing, 28(2), 84–88. https://doi.org/10.12968/bjon.2019.28.2.84

Duncan, D. (2019).  Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria.  British Journal of Community Nursing, 24(3), 116–119. https://doi.org/10.12968/bjcn.2019.24.3.116

 

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While there are many regimens for the treatment of H. pylori infection, significant efforts in research and innovation have been made as well. The latest research results indicate that  the new triple therapy comprising of amoxicillin, protein pump inhibitor (PPI) and levofloxacin has recorded the highest rate of eradication of this bacterial infection (Woo and Robinson, 2015). Alternatively known as hybrid therapy, it delays the overall duration of amoxicillin treatment for about 14 days (Woo and Robinson, 2015). Essentially, the prolonged treatment accounts for a significant percentage of H. pylori eradication by this hybrid therapy as well.

   The prevalence resistance worldwide to the triple therapy has enhanced more effort on vonoprazan-based therapy, particularly in regions with a significantly limited rate of clarithromycin resistance. With the evolution of vonoprazan therapy, the treatment options and generally the eradication of helicobacter pylori problems are broadened (Chey et al, 2017). More profoundly, switching the vonoprazan as an acid blocker for H. pylori means that there is a chance for a further reassessment of the triple therapy. It equally improves the efficacy of triple therapy through a significant reduction to the resistance in clarithromycin as previously noted.      Additionally, concomitant therapy has also been introduced for the reduction of the metronidazole resistance estimated to be about 50% in Asian countries (Woo and Robinson, 2015). Concomitant therapy implies using conventional antibiotics to reduce resistance levels in triple therapy.

   Patients should be advised against consuming contaminated food, water, and other consumables. Such factors exacerbate bacterial infection on the walls of the small intestine through releasing toxins and enzymes. Furthermore, it is imperative that the patient is advised to seek proper counseling. In addition, the interventions can be employed in the control, prevention, and management of H. pylori. Supporting and emphasizing programs on patient’s compliance with drugs, specifically, pharmacists will result in an increase in the number of patients who will be taking medication. While antibiotics are recommended, patients should be watchful of the side effects and report immediately to the healthcare facilities (Woo and Robinson, 2015). Patients are also encouraged to seek for medical checkups frequently. The earlier detection and treatment for this infection will result in a better positive result, unlike the late time action.

                                                                  References

Chey, W. D., Leontiadis, G. I., Howden, C. W., & Moss, S. F. (2017). ACG clinical guideline: treatment of Helicobacter pylori infection. The American journal of gastroenterology, 112(2), 212.

Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. FA Davis.

 

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