A nurse is caring for a client in a clinic who has foul-smelling urine, a low-grade fever of 37.7°C (100°F), and pain with urination. Which of the following should the nurse expect the health care provider to order? (Select all that apply.)
A.
WBC count
B.
Blood cultures x2
C.
Foley catheter placement
D.
Broad-spectrum antibiotic
E.
0.9% sodium chloride infusion at 100 mL/hr
F.
A clean-catch urinalysis and urine culture
The Correct Answer and Explanation is:
The scenario suggests that the client is experiencing signs and symptoms of a urinary tract infection (UTI). These include foul-smelling urine, a low-grade fever, and dysuria (pain with urination). UTIs are common and can be caused by bacteria entering the urinary tract. Based on the signs and symptoms, the following interventions are expected:
Correct Answers:
A. WBC count
D. Broad-spectrum antibiotic
F. A clean-catch urinalysis and urine culture
Explanation:
A. WBC Count:
A complete blood count (CBC) with a white blood cell (WBC) count is often ordered when infection is suspected. The WBC count helps assess the body’s immune response. An elevated WBC count (leukocytosis) may indicate a systemic response to infection. In the case of a UTI, an elevated WBC count can provide additional evidence that an infection is present, particularly if the infection has progressed or is systemic (e.g., pyelonephritis, or kidney infection).
D. Broad-Spectrum Antibiotic:
A broad-spectrum antibiotic is typically prescribed initially while waiting for urine culture results. These antibiotics are effective against a wide range of bacteria and are chosen to begin treatment quickly, especially in clients exhibiting symptoms of infection. Once the results of the urine culture and sensitivity tests are available, the antibiotic may be adjusted to target the specific pathogen causing the infection.
F. Clean-Catch Urinalysis and Urine Culture:
This is one of the most crucial diagnostic tests for identifying UTIs. A clean-catch urinalysis assesses for the presence of white blood cells (pyuria), red blood cells (hematuria), bacteria (bacteriuria), and other abnormalities in the urine, which help confirm the diagnosis of a UTI. A urine culture is done alongside urinalysis to identify the specific bacterial organism responsible for the infection. The sensitivity test, part of the culture, determines which antibiotic the organism is most susceptible to, guiding more effective treatment.
Incorrect Answers:
B. Blood Cultures x2:
Blood cultures are used to detect bacteremia or sepsis (the presence of bacteria in the bloodstream), which is unnecessary in the absence of signs of systemic infection such as high fever or hypotension. In this scenario, the low-grade fever and localized symptoms of a UTI make blood cultures unnecessary unless there is suspicion of sepsis.
C. Foley Catheter Placement:
Inserting a Foley catheter in a client with a suspected UTI is contraindicated unless there is a clinical necessity, such as urinary retention. Catheterization can introduce new bacteria into the urinary tract, potentially worsening the infection. Since this client can void, a Foley catheter is not indicated.
E. 0.9% Sodium Chloride Infusion at 100 mL/hr:
IV fluid administration is not typically necessary for treating a simple UTI unless the client is dehydrated or there is a need for fluid resuscitation, which is not indicated in this scenario. This client’s low-grade fever and localized symptoms do not suggest the need for aggressive fluid management.
In summary, the nurse should anticipate diagnostic testing with a urinalysis and urine culture, monitoring the WBC count, and the initiation of broad-spectrum antibiotics while awaiting culture results. This approach ensures timely treatment and appropriate antibiotic selection based on culture findings.