Case Study 7

Case 1
D.K. is being seen in the clinic for complaints of urinary frequency, urgency, and burning. She reports that her urine appears cloudy and smells abnormal. A urine culture is obtained, and D.K. is given a prescription for antibiotics. 1) What is the most likely cause of D.K.’s signs and symptoms?
The most likely cause of the signs and symptoms is a urinary tract infection.

2) Was antibiotic therapy the appropriate treatment? What organism should the antibiotic be effective against since it is the most common cause of this disorder?
Yes, antibiotics are indicated for symptomatic urinary tract infection. E. Coli causes about 80% of UTIs.

3) What factors predispose to development of this urinary tract disorder?
Factors that predispose the development of a UTI are: sexually active women, failure to void after intercourse, incorrect hygiene (i.e. wiping from front to back), female anatomy, low estrogen in postmenopausal women, catheters, tubes or foreign objects placed in the urinary tract, pregnancy and diabetes mellitus.

4) What strategies could be suggested to help D.K. avoid recurrence of this problem?
Strategies that will help to avoid the recurrence of an UTI: If sexually active void after intercourse, wipe perineal area from front to back, wear cotton crotch underwear, drink six to eight glasses of water a day, avoid bubble baths and highly perfumed soaps, avoid douches and feminine hygiene deodorants.

Case 2
P.W. was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of the left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.’s vital signs and hematocrit suggest that he has had a major blood loss of about 2000 ml. A catheter is inserted to monitor urine output, and P.W. is