CSA Chapter014
Chapter 14 - Mechanisms of Infectious Disease
A nurse who works in a skilled nursing facility is caring for an 85-year-old woman who has had a fever of 102°F for 2 days. The nurse noted increased agitation, restlessness, and a decreased appetite. The patient has a Foley catheter in place. The physician ordered a urine analysis and the results are below. A diagnosis of a kidney infection was given Color: dark amber in color Appearance: cloudy with sediment Specific gravity 1.025 Glucose Negative Bilirubin Negative Ketones Moderate Leukocyte Esterase +++ Nitrites +++ WBCs/HPF 30 RBCs 10–12 1. How did the bacteria gain entry into the body? In this case, there are several factors you should consider. One is that the patient has a Foley catheter in place. The catheter actually by-passes the normal ability of the urethra to prevent movement of bacteria from the external environment into the urinary tract and maybe responsible for an increased opportunity for infection. The second most important factor is the dehydration that is likely related to the decrease in fluid intake. With dehydration, you will have decreased urinary output, concentration of urine, and increased opportunity for the bacteria to attach to the urinary tract walls.
2. What normal innate host defense mechanisms were ineffective?
The most important host defense mechanism to protect from a urinary tract infection is frequent emptying of the bladder with no stasis of urine. Increased fluid intake will increase urine formation and increase bladder emptying. In this patient, the catheter should empty the bladder continuously, but if there is any obstruction, there is an increased chance of
A nurse who works in a skilled nursing facility is caring for an 85-year-old woman who has had a fever of 102°F for 2 days. The nurse noted increased agitation, restlessness, and a decreased appetite. The patient has a Foley catheter in place. The physician ordered a urine analysis and the results are below. A diagnosis of a kidney infection was given Color: dark amber in color Appearance: cloudy with sediment Specific gravity 1.025 Glucose Negative Bilirubin Negative Ketones Moderate Leukocyte Esterase +++ Nitrites +++ WBCs/HPF 30 RBCs 10–12 1. How did the bacteria gain entry into the body? In this case, there are several factors you should consider. One is that the patient has a Foley catheter in place. The catheter actually by-passes the normal ability of the urethra to prevent movement of bacteria from the external environment into the urinary tract and maybe responsible for an increased opportunity for infection. The second most important factor is the dehydration that is likely related to the decrease in fluid intake. With dehydration, you will have decreased urinary output, concentration of urine, and increased opportunity for the bacteria to attach to the urinary tract walls.
2. What normal innate host defense mechanisms were ineffective?
The most important host defense mechanism to protect from a urinary tract infection is frequent emptying of the bladder with no stasis of urine. Increased fluid intake will increase urine formation and increase bladder emptying. In this patient, the catheter should empty the bladder continuously, but if there is any obstruction, there is an increased chance of