Grand Rounds 1: Patient X

Grand Rounds 1: Patient X.

[Audio] Patient X is a 90-year-old female with multiple conditions. She was brought in by her daughter who stated that the patient's chief complaint was the swelling and discomfort in her left lower abdomen. According to the patient's daughter, the swelling became visible about 3 days ago but it has become more noticeable and the patient complained more frequently about the swelling's discomfort over the past 24 hours. However, she denies experiencing fever, chills, and flank/abdominal pain. The patient was also recently admitted and treated for sepsis, which was directly linked to UTI. She was treated with IV antibiotics then was discharged and put on oral antibiotics, which she took until she completed her dose. She was instructed to continue visiting urology as an outpatient but she did not do so..

[Audio] Creatinine levels were normal at 1.3 and an evaluation of the ER indicated no leucocytosis. Urinalysis indicated WBC of over 100/npf and RBC of 21-50 hPR with large leukocyte esterase. Patient X exhibited a BUN increase from 17 to 40 mg/Dl. Patient X had a history of obstructive uropathy, for which she had a urethral stent placed. The patient's urethral stent was last exchanged on 6/22/23. She also had a history of recurrent UTIs, which challenged the placement and retention of the ureteral stent. In the past, she was also diagnosed with asthma, and stage IV Cervical Cancer, for which was placed on weekly chemotherapy following successful radiotherapy sessions. She exhibited the following symptoms: 1. Dysuria. 2. Severe pyuria. 3. Left lower extremity DVT. 4. Burning sensation during urination. The patient's condition is a suspected case of complicated UTIs. Patient X was prescribed with ceftriaxone and heparin. The infusion was ordered and admission was requested..

[Audio] The following cues should be considered in this case: dysuria, hematuria, frequent urination, chills, fever, suprapubic pain, costovertebral angle tenderness, or flank pain (Sabih & Leslie, 2023)..

[Audio] This is a suspected case of complicated UTI, which is associated with instrumentation. According to Sabih & Leslie (2023), between 15% and 25% of hospitalized patients in the US have urinary catheters installed during their hospital stay. Approximately 21% to 50% of these catheters are unnecessary and fail to meet official guidelines for initial placement. 17& to 69% of all cases of catheter-associated UTIs are preventable with adherence to guidelines for initial placement. Therefore, all healthcare professionals must be properly educated on these preventive measures to help reduce the occurrence of complicated UTIs. Poor treatment of complicated UTIs increases the likelihood of recurrence and failure of antibiotic therapies. Eventually, infection may spread to other organs (such as the kidneys) cause an abscess, and result in sepsis. The importance of proper adherence to medication should be emphasized to all patients diagnosed with complicated UTIs..