Urinary Tract Infection (UTI): Lab Results, Assessment, and Symptoms (Nursing)

00:00 Now, let's talk about lab results and patient assessment information.

00:04 Symptoms matter.

00:06 So listen closely.

00:07 When your patient reports symptoms of a UTI.

00:10 The urine culture should be evaluated along with the symptoms and the urine analysis.

00:16 Lab work doesn't mean anything unless you compare it to your actual patient.

00:20 In most cases, if the patient is asymptomatic, meaning they are not showing the symptoms of burning urine or urgency or significant changes to their urine treatment may not be necessary.

00:34 I want you to keep in mind that our role as healthcare providers is to make sure that the cultures are accurate.

00:40 We want to make sure if the patient doesn't have a urinary catheter that we use a midstream collection, because we want to avoid contaminating the sample with the patient's external cells.

00:52 I've grouped the symptoms of a UTI in three categories that I want to make sure you recognize as very important.

01:01 First category, the typical symptoms.

01:03 What you'll see predominantly in your practice.

01:06 Second one? Whoa, the special cases of what to watch for if the patient has a catheter.

01:12 The third one, I want to talk about our elderly population because they are at particular risk with UTI.

01:20 Okay, so let's look at the typical stuff.

01:22 Now, we've done some case studies in this video series.

01:25 But when we say dysuria, that's someone who has difficulty with urinating.

01:29 DYS means difficult with whatever comes after it.

01:33 And in this case, it's uria, meaning urinating.

01:36 So they can have strong and frequent urges to urinate.

01:40 When we say frequency, we mean an increase in frequency.

01:44 So put a little upwards arrow by frequency.

01:47 So you know, that's an increased frequency.

01:50 Also, you want an increase in urgency.

01:54 So typical symptoms that you'll see for just a run of the mill UTI, it's going to be difficult for them to urinate, there's going to be pain usually involved.

02:02 They have increased frequency, and an increased urgency when they feel like they need to empty their bladder.

02:08 That's category one.

02:10 Now, let's talk about catheters.

02:13 Now in healthcare, we used to put catheters in far more patients than we do now.

02:19 Now we do everything we can to avoid putting a catheter in a patient unless it's absolutely necessary.

02:26 Why? Because catheters make it very easy, for the bacteria to climb right up that urinary tract and to cause a significant infection.

02:36 If the patients in the hospital, they're already compromised, the last thing we want to do is give them an infection.

02:44 So we're very careful.

02:45 You should have to fill out a lot of paperwork before a catheter is placed in the average patient.

02:51 So if a patient has a catheter, I'm going to keep a Hawk-eye look at those fevers, if they're complaining of weakness, or if I noticed them kind some altered mental status.

03:01 Now, we'll see this much more often with the elderly population.

03:04 However, if anyone starts acting a little different, and we know they have a catheter, you want to immediately think about a possible UTI.

03:14 So that's the typical symptoms.

03:16 These are patients with catheters.

03:17 You know, we try to avoid using those at any cost.

03:21 Let's take a look at group number three.

03:23 The elderly and or those patients with dementia.

03:27 Now, these can be really difficult to assess.

03:30 They're not going to show you fever.

03:32 Now, why would that be? Why would an elderly person not show you fever necessarily with a UTI? Well, a fever is a sign of a strong immune system.

03:44 It's responding to fight back at that infection.

03:47 Elderly patients have an immune system that's winding down, it's wearing out.

03:53 So they may not necessarily show you fever.

03:56 Do you know what I've seen far too many times.

03:59 And I'd like to admit.

04:00 As I've seen a patient come from a nursing home because they thought they'd had a stroke.

04:05 But really what they had was a UTI.

04:07 Now, why can't you tell a stroke from a UTI? Because an elderly patient will show you some very odd mental status changes that might look like a stroke.

04:17 But in reality, it's just a UTI.

04:20 They don't have a fever, because that immune system isn't strong enough to fight back, but they will show you mental status changes.

04:26 So no fever, but they're going to show you a new kind of crazy.

04:31 Be on the lookout for that and know that that's a common problem with the elderly.

04:36 The most common bacteria and uncomplicated UTI is Escherichia coli.

04:41 Usually we say E-coli, but there's three others I want to bring to your attention Klebsiella, Proteus, and Staphylococcus.

04:49 Now, why am I asking you to be aware of these four? Well, besides being the most common, these are things that you should recognize on your urinalysis reports your culture and sensitivity.

05:01 But what happens when it's not one of these four main players? Well, if it's not one of these common ones, we absolutely need some extra follow up.

05:09 Bacteria typically not seen in UTI might be caused by some type of contamination.

05:15 That means somehow that sample got contaminated by a bacteria that isn't part of that patient's body.

05:22 So what you need to do is assess if the patient has risk factors because if they're severely immunocompromised, they might legitimately be in that patient's body.

05:31 But assess if the patient has risk factors for other types of bacteria, and if the sample was appropriately collected.

05:38 So it may have been contaminated after it left the patient's body.