Managing Urinary Tract Infection with Diabetes

This assignment discusses the management of urinary tract infections (UTIs) in patients with diabetes. It highlights the importance of early detection and treatment to prevent complications such as kidney damage and sepsis. The document provides information on antibiotic therapy, fluid therapy, and risk reduction strategies, including cranberry juice consumption and increased water intake. It also mentions the use of extended-spectrum β-lactamase-producing organisms in patients with UTIs. Overall, this assignment is a useful resource for healthcare professionals and students looking to understand the management of UTIs in patients with diabetes.

CASE
STUDY

TABLE OF CONTENTS
1. Connection between urinary tract infection (UTI) and acute kidney disease (AKD)..................1
2. Clinical association and relationship between urinary tract infection and state of confusion in
elderly patient...................................................................................................................................1
3. Description of reasons behind John’s classical clinical signs .....................................................2
4. Therapy needed for John..............................................................................................................3
REFERENCES................................................................................................................................5

1. Connection between urinary tract infection (UTI) and acute kidney disease
(AKD)
Urinary tract infection is caused by microorganisms that are too small to be seen by
naked eyes (Morris and Wiswell, 2013). In general, case most of the UTIs are caused by bacteria
Eschericha coli but in some cases by fungi and viruses. They are most common infection in the
human body. These infections can take place in any part of the urinary tract. In most of the cases,
the UTIs involve ureters and kidney in the upper tract and urethra and bladder in lower tract.
Symptoms are common in both men and women which include blood in the urine, urine with
strong odour, nausea, chills, vomiting and burning in urination.
Acute kidney disease occur when kidney lose their ability to remove fluids, salt and other
waste material present in the blood (Obermüller and et.al., 2014). When kidneys lose the ability
of filtering the blood then fluids present in body may rise at high level which is dangerous for
our body. The most cause of this disease are: severe dehydration, urinary tract obstruction, acute
tubular necrosis and interstitial nephritis.
The bacterium E. coli or many other bacteria that result in urinary tract infection tends to
move upward in the urinary system. After reaching the upper part of urinary system that includes
kidney and ureters, they initiate the process of kidney infection in medical which is known as
pyelonephritis. That is why it is necessary to receive effective treatment in case of UTIs else it
may causes acute kidney disease. These bacteria's generate the condition which obstructs the
flow of urine and pave the ways for them to reach the kidney and increase the risk of infection. It
includes: stones in bladder, kidney and ureter and benign prostatic hypertrophy.
The pyelonephritis can be classified into uncomplicated and complicated infection.
Complicated infection result in Acute kidney disease and causes treatment to become ineffective
and it generally includes abnormalities in the urinary system. Thus, it can be concluded that
urinary tract infection if not treated well can result in acute kidney disease.
2. Clinical association and relationship between urinary tract infection and
state of confusion in elderly patient
Younger people having urinary tract infection faces physical symptoms like pain during
urination, pain in lower abdomen, back ache and fever. But this is completely different in the
case of older people. This is because, as a person increase in age the immune system also
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changes. In the older age people the immune responses decrease and instead of physical
symptoms urinary tract infections results in confusion, hallucinations and delirium. Also, they
suffer from tiredness, incontinence, fatigue and gradual change in the mental status and
behaviour (MacVane, Tuttle and Nicolau, 2014).
Urinary tract infections generally happen when bacteria enters into urinary tract through
urethra than to further part including bladders, ureters and finally kidneys. However, in cases of
older people the bacteria affecting kidney and causing infection tends to infect the blood stream.
They start feeding on the nutrients of body which are present in the body fluids. These nutrients
generally include calcium, sodium, potassium and magnesium and over all these minerals are
termed as electrolytes (Lopes and Jorge, 2013). This disturbance in electrolytes causes
malfunction in brain that effects the proper functioning of brain and creates the state of confusion
and delirium in elderly.
In this condition the person have to go through many misfiring due to shortages of
electrolytes. That particular person faces reduction in the ability to response against the external
stimuli. Along with that, elders also face problems related to disorganised thinking, sensory
misperceptions, hallucinations, impairment of the memory, it also disturbs the patients sleeping
and walking cycles and generation of rambles in speech. Thus, the person suffering from this
type of problem gets frightened and paranoid by this changing state of mind. From above
discussion it can be concluded that older people suffering from UTIs faces problem realted
confusion and delirium.
3. Description of reasons behind John’s classical clinical signs
According to the report regarding the urine test it was found that John Grover is suffering
from a series of health complications. The presence of 1+ RBC in urine in the sign of kidney
stone in John. Also, presence of 2+ Albumin represents the presence of kidney infection. When
the kidney is infected by the bacteria it started releasing abnormal amount of albumin in urine.
Presence of 3+ nitrites in the urine is the indication of urinary tract infection (Nitzan, Elias,
Chazen and Saliba, 2015). The presence of infection was also confirmed by observing the urine
of John which was dark, cloudy and have highly offensive smell. John also have 1+ leukocyte
concentration in urine which indicates the persisting inflammation in urinary tract and urine.
Presence of 1+ ketone in urine indicates the reduction in insulin production of body and burn fat
for achieving the energy requirement by the body. This situation of reduced level of insulin is
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further confirmed by the presence of 2+ glucose level in urine test that reveals that John is
suffering from diabetes too.
The classical clinical sign in John arises because of the increasing effect of urinary tract
infection. The urine test reveal that earlier john was suffering from the initial stage of this
infection but due to lack of symptoms and continuous smoking practice increased the effects
related to this infection. The bacteria that resulted in the John infection are now increasing their
effect to upper urinary tract organs. Bacteria infect kidney and result in stones that help them to
obstruct the flow of urine and result in acute kidney disease (Goetz and et.al., 2013). In case of
John these bacteria also effected the blood stream and result in decreased amount of electrolytes.
Thus, ultimately result in the malfunctioning of the brain and causes confusion in him.
Blood test also reveal the presence of glucose and ketone in urine. This indicates that he
is also suffering from diabetes as ketone in urine depicts the reduced production of insulin in the
body. Diabetes interfere with immune system of the John and that results in development of
urinary tract infection in him. Diabetes also lead to nerve damages that weaken the muscles of
bladder by signaling between brain and urinary system (A UTI & Delirium, 2017). Thus, urine
remaining for longer time in body increase the risk of infection. Thus, it can be concluded that
these particular conditions further complicate the situation and deteriorates the health of John
Gower.
4. Therapy needed for John
John can be provided with the antibiotic therapy as antibiotics act as mainstay of
treatment procedures. Trimethoprim is highly used antibiotic for the treatment of infection in the
lower urinary tract infections. It can help Jack to eradicate the bacteria from lower tract to reduce
their impact in kidney. Although it is cost effective and well tolerated for the people of older age.
Along with this John can also be provided with intravenous antibiotics such as
Nitrofurantoin, Cephalosporins and Norfloxacin to reduce the impact of infection in the kidney
thus lowering down the count of bacteria. It will prevent the further spread of bacteria in blood
that result in the confusion in John. Antibiotic such as amoxicillin can also be helpful in reducing
the level of infection can be used as second line of therapy in case of John.
Due to the presence of diabetes along with infection, John should be provided with oral
antibiotics such as fluoroquinolones, aminoglycosides, piperacillin-tazobacterium and
carbapenems to reduce the risk of infection without complicating the diabetes. This therapy can
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help john to reduces the infection and lower down the bacterial multiplication withing the
duration of 2 weeks (Kim and et.al., 2014).
John can also be provided with fluid therapy by drinking 2-3 liters of water on daily basis
to prevent dehydration that worsen the kidney infection. Drinking 250-300 ml of cranberry juice
daily can also help in reducing the risk related to urinary tract infections and kidney infection in
case of John. From the above made discussion it can be concluded that antibiotic therapy and
fluid therapy can be given to john to overcome the situation.
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REFERENCES
Books and journals
Goetz, L. L., & et.al. (2013). International spinal cord injury urinary tract infection basic data
set. Spinal Cord. 51(9). 700.
Kim, J. H., & et.al. (2014). Predictors of outcomes of contrast-induced acute kidney injury after
percutaneous coronary intervention in patients with chronic kidney disease. The
American journal of cardiology. 114(12). 1830-1835.
Lopes, J. A., & Jorge, S. (2013). The RIFLE and AKIN classifications for acute kidney injury: a
critical and comprehensive review. Clinical kidney journal. 6(1). 8-14.
MacVane, S. H., Tuttle, L. O., & Nicolau, D. P. (2014). Impact of extended‐spectrum β‐
lactamase–producing organisms on clinical and economic outcomes in patients with
urinary tract infection. Journal of hospital medicine. 9(4). 232-238.
Morris, B. J., & Wiswell, T. E. (2013). Circumcision and lifetime risk of urinary tract infection:
a systematic review and meta-analysis. The Journal of urology. 189(6). 2118-2124.
Nitzan, O., Elias, M., Chazen, B., & Saliba W. (2015). Urinary tract infections in patients with
type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes,
Metabolic Syndrome and Obesity: Targets and Therapy. 8.129–136.
Obermüller, N., & et.al. (2014). Current developments in early diagnosis of acute kidney
injury. International urology and nephrology. 46(1). 1-7.
Online
A UTI & Delirium. (2017). [Online]. Available through:
<http://www.livestrong.com/article/225337-a-uti-delirium/>. [Accessed on 21st
September 2017].
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