[NP-Clinical] Re: uti issue

[Carla Anderson]

This may have been mentioned, but have the urologists checked for for pre and post void volume, and urinary retention?  If she has chronic retention, she will feel the frequency and have the polyuria...also she is not on enalapril or any aces is she? As this can cause polyuria..and agree with others, recommend urine cx for thoroughness..  Just some addl thoughts.. Carla/Portland ,OR

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Today's Topics:

1. Re: MRSA UTI (Christine Smith)


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Message: 1
Date: Mon, 15 Jan 2007 09:05:43 -0800
From: "Christine Smith" 
Subject: Re: [NP-Clinical] MRSA UTI
To: "NP Clinical" 
Message-ID: <004c01c738c7$64c70380$6401a8c0 at ChristineNB>
Content-Type: text/plain; charset="iso-8859-1"

Pat,

Thanks for the wisdom - good thoughts. My mother had a TAHBSO in her 40s. She has not had a bone scan, just a bone density to the hip and spine. When she was dx with Osteoporosis several years ago, I must admit I was a bit surprised. At the time she was 5'10 and 180 - shrunk 1 inch since younger days. Now she is about 150 - a bit too thin in my opinion but she feels she is just right. She is an avid cyclist, was walking 3 miles a day until her knee got worse, but always very active - still water ski's and swims a fair amount. Was skydiving with me three years ago. Always a big milk drinker.

I am turning in a urine culture today for her. I think you are right about abx pre and post surgery. I will keep you posted.

CS



----- Original Message ----- 
From: Pat Camillo 
To: NP Clinical 
Sent: Monday, January 15, 2007 6:48 AM
Subject: Re: [NP-Clinical] MRSA UTI


Regarding the MRSA UTI......one of my graduates found and shared a recent USA article with me that is very interesting......
http://www.usatoday.com/news/health/2007-01-10-mrsa-usat_x.htm

Pat 

Pat Camillo PhD,RN,APN,C
Certified Nurse Practitioner in Women's Health,
Gerontology and Menopause
Carmenta Health
1 Kalisa Way Suite 103
Paramus, New Jersey 07652
(201) 265-9042
----- Original Message ----- 
From: Christine Smith 
To: NP Clinical 
Sent: Saturday, January 13, 2007 7:10 PM
Subject: Re: [NP-Clinical] MRSA UTI


I have no thoughts on this, and certainly you are our women's health resident expert so I hope someone has some ideas that you have not considered. However, I have another UTI problem. 

My mother, 69 yo, has frequent UTIs ever since a bladder rupture, S/P motorcycle accident about 10 years ago (my parents were Harley lovers). Anyway, she had severe urge and stress incontinence - was urinating nearly every hour and was always unresponsive to Detrol, Ditropan etc.. She has seen multiple urologists and they felt a cath would be the best option until she did find a female urologist in Portland who did some sort of bladder/urethral repair last Spring. The incontinence resolved but she has continued to have urgency and was ultimately learning to live with it. 

NOW, she is scheduled for a knee replacement 1/31. Her orthopod is adamant no infections, including UTIs, or no surgery. She had her pre-op last week and was found to have another UTI and the Pre-op NP put her on Bactrim. No culture was done, and I don't think my mom was clear to the NP on just how bad and frequent her UTIs get. She is now down here in California with me for one week and has worsened. Peeing every hour - driving her nuts, and driving me nuts too. I took a urine sample to work and spun it - only RBCs. No leukos, nitrites or bacteria. I had switched her to Cipro and after seeing the results of the UA opted to just have her finish the Cipro anyway. 

No pain, just urgency and frequency. No CVAT. Feels otherwise well. Only on Lipitor and Fosamax and was just started on Atenolol 25mg for very mildly elevated BP - 136/84. No other health issues except the bladder and DJD.

With just RBCs it seems I should not need to do a urine culture, right? I can order one for her so she has the results by Tuesday or so - she does not return home until next Monday and so I want to do as much as possible. 

Thoughts?

Christine Smith, NP
Antioch, CA
----- Original Message ----- 
From: Pat Camillo 
To: NP Clinical 
Sent: Saturday, January 13, 2007 6:53 AM
Subject: [NP-Clinical] MRSA UTI


Recently saw a woman who had been having 2-3 UTI's a year, ran a culture - came back MRSA.......tx with cipro which was found to be sensitive.......she also complains of vulvar burning .....tx with terazole thinking it was yeast following multiple antibiotic therapies......some relief but not gone. I'm beginning to wonder if perhaps the vulvar complaint might be related to the MRSA.....

Any thoughts would be appreciated :)

Pat

Pat Camillo PhD,RN,APN,C
Certified Nurse Practitioner in Women's Health,
Gerontology and Menopause
Carmenta Health
1 Kalisa Way Suite 103
Paramus, New Jersey 07652
(201) 265-9042


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