Question:
Discuss about the Diagnosis and Management of Urinary.
This paper interrogate the accuracy of proclamation “Urinary tract infections in the older person can lead to alterations in mental status such as confusion and challenging behaviours and these alterations have safety and communication implications for the older person and for provision of safe, person-centred nursing care” and present a judgment about its accuracy. A detailed investigation will be done to unearth accuracy of above statement. Pathophysiology and symptomology of the infection are investigated and presented to reveal the challenging behaviours and confusions arising from this infection. The implication for patient’s safety and communication between nurse and patients also presented.
The urinary-tract, from the kidneys to urethral meatus, is usually disinfected as well as resilient to the colonization of bacterial even though often distal urethra contamination with colonic-bacteria. The key shield against the UTI remains thorough bladder emptying in the course of urination. Additional means which maintains sterility of the tract include acidity of urine, vesicoureteral valve, as well as several immunologic as well as mucosal obstacle. Around 98% of UTIs are as result of bacteria ascending urethra to bladder and, ascending ureter to kidney if pyelonephritis (Detweiler, Mayers & Fletcher, 2015). The rest of UTIs remain haematogenous. Systemic-infection will culminate from UTI, especially in ageing. Around 6.50% of incidence of hospital-derived bacteraemia remain attached to the UTIs.
The complicate UTIs take place in context of a urinary-tract with metabolic-/structural-/functional-abnormalities. The UTIs (complicated) could entail upper and lower tracts. The main importance is UTIs substantially upsurge the therapy failures rate. The pathophysiology of complicated UTIs has four aspects:
The Pyelonephritis is nearly frequently the outcome of bacteria migrating to renal-parenchyma from bladder that is improved by reflux of vesicourethral. For the uncomplicated-pyelonephritis, invasion by bacterial as well as damage to renal remain confined to the area of pyelocalyceal-medullary whereas all kidney areas could be impacted if complicated-pyelonephritis.
With progress in infection, bacterial invasion can reach bloodstream, culminating in bacteraemia. The UTIs (complicated) may encompass all sexes irrespective of age. It is frequently regarded to be cystitis or pyelonephritis which fails to achieve criteria for being regarded un-complicated. The patient might have structural or functional urinary-tract idiosyncrasy as well as blockade of stream of urine. The comorbidity which increases the infection acquisition risks or resistance to the treatment like inefficient controlled-diabetes, immunocompromise and chronic-kidney.
The UTI (uncomplicated) remains normally regarded as pyelonephritis or cystitis which take place in premenopausal females in absence of structural or functional urinary-tract anomaly as well as those non-pregnant as well as without substantial comorbidity which might culminate in more severe outcomes. Further, some experts have considered such an infection an uncomplicated one even when it is diagnosed in postmenopausal female/patients that have diabetes that are well-controlled. Most UTIs (complicated) in males take place in ageing patients due to anatomic aberrations or instrumentation.
The symptoms of urinary tract infections in older persons can be illustrated. While it might be difficult to know if an elderly is UTI positive since ageing do not continuously showcase definitive signs. This might be as a result of sluggish immune rejoinder. Some of the characteristic symptoms of UTI entail: burning of urethra with urination, a fever, chills, foul-smelling urine, an urgent need to urinate, pelvic pain and frequent urination. Where an elderly individual has the definitive symptoms of UTI, such adults being unable to talk about them. That might be as a result of age-linked issues like dementia or Alzheimer’s disease.
The classic symptoms of the UTI include burning-pain as well as recurrent urination. The infection might fail to trigger such characteristic symptoms in ageing. Rather elderly, particularly the ones with dementia, could show behavioural symptoms including confusion.
The symptoms like a confusion could be vague as well as mimic additional conditions. The UTI’s non-classic symptoms could entails agitation, falls, decreased appetite, decrease mobility, urinary retention, lethargy, and incontinence. Additional symptoms could take place where the infections spreads to the kidneys. Such severe symptoms could encompass, flushed skin, a fever, back pain, nausea, and vomiting.
The UTIs cause delirium or confusion and challenging behaviour. The UTI will lead to health breakdown of confusion and challenging behaviour among the elderly persons. In older individuals especially those with dementia, UTIs always cause sudden behaviour changes instead of common physical symptoms (Nicolle, (2016). Being aware of the UTIs signs in older person will help in early treatment of elderly before it culminate in severe health problems. Unlike in young individuals with UTIs that can show discrete physical-symptoms like sore urination, surged demand for urination, pain in lower abdomen, one sided back pain, chills alongside fever, UTIs in elderly might never showcase those same symptoms. Instead, the UTIs might showcase increased signs of confusions, agitation as well as withdrawal. This is because the elderly immune system have changed as they get older and hence responds differently to the UTIs (Rowe & Juthani-Mehta, 2014).
For elderly with dementia, such behavioural alterations could encounter as portion of such a condition/signs of ageing. Where the said UTI is unnoticed hence not treated for such an extended time, UTIs is able to stretch to bloodstream thereby being an extremely life-threatening infection. The infection will cause distressing behaviour changes for the elderly person. Such changes are called delirium capable of developing within 1 or 2 days. Delirium/confusion symptoms range from restlessness, agitation, hallucination or delusions (Rowe & Juthani-Mehta, 2013).
UTIs can as well accelerate the dementia progression hence being vital for the caregivers to comprehend how to acknowledge as well as restrain risk for the UTIs in elderly. UTIs will cause a sudden change in behaviour which is, indeed, one of the best indicators of the UTIs in the elderly persons. Some common warning signs among the elderly include onset of elderly incontinence, confusion or incapability to do tasks that the elderly could easily do a day or two before. It might make an elderly anytime to change to extent of being unable in a day to dress himself or feed himself and coupled with a sharp change.
Many UTIs patients are positively diagnosed for the UTIs based on confusions and challenging behaviour. In elderly patients, confusion alone can be a straight way towards a positive diagnosis. The challenging behaviour among the elderly UTIs can as well tell when one is UTIs positive. This is because unlike the younger patients, the elderly will never be easily diagnosed where one wants to focus on the classic symptoms of UTIs. The challenging behaviour might impede the early diagnosis as the UTIs might showcase the conventional signs. However, for the elderly who show confusion, the realization of such a confusion has always led to a positive diagnosis even at an early age (Buhr, Genao & White, 2011). Simple test can follow the realization of confusion even done at home where a dipstick is held in urine stream. Such a home test remains convenient way for the chronic UTI patients to swiftly diagnose whether they have the infection. Other diagnoses include ultrasound exam, X-ray and CAT scan.
The first implication is to minimize the risk of getting an elderly UTI by frequent diagnosis especially elderly at higher risk including those with kidney stones, those with diabetes, those who required a catheter in urethra and bladder and women who have gone through menopause (Genao & Buhr, 2012). This will help detect UTIs early enough even through home test for early treatment. Another implication is to check on confusion and challenging behaviour rather than the classic symptoms when dealing with elderly (Cove?Smith & Almond, 2007). This is because the elderly might fail to manifest signs show by the younger UTIs patients and hence a difficulty to provide patient-centered care.
The first implication is that nurses should always get to know the behaviour of their patients through the patient-centered nursing care so that they can get to identify even the slightest change in behaviour or confusion so that they can diagnose the elderly for UTIs for early treatment. Another implication is that as a result of the challenging behaviour and confusion, the nurse should be more careful to notice a change in behaviour including how he communicates, falls, confusion for early diagnoses. The nursing must like a detective-like index of suspicion when dealing with her patient in the person-centered care approach.
Conclusion
To this end, it is true that UTIs cause confusion and challenging behaviour in elderly. These changes have implication for safety and communication for both elderly persons and the provision of person-centered care. This statement is accurate and valid as supported by the discussion. The patient-centered approach will be highly affected by the confusion of the infected elderly who will not be able to communicate or speak about their problems with the nurses. The caregiver and the nurses will hence be required to be extremely keen to always keep track of the behaviours of the patient for effective patient-centered care.
References
Buhr, G. T., Genao, L., & White, H. K. (2011). Urinary tract infections in long-term care residents. Clinics in geriatric medicine, 27(2), 229-239.
Cove?Smith, A. N. D. R. E. A., & Almond, M. K. (2007). Management of urinary tract infections in the elderly. Trends in Urology & Men’s Health, 12(4), 31-34.
Detweiler, K., Mayers, D., & Fletcher, S. G. (2015). Bacteruria and urinary tract infections in the elderly. Urologic Clinics, 42(4), 561-568.
Genao, L., & Buhr, G. T. (2012). Urinary tract infections in older adults residing in long-term care facilities. The annals of long-term care: the official journal of the American Medical Directors Association, 20(4), 33.
Nicolle, L. E. (2016). Urinary tract infections in the older adult. Clinics in geriatric medicine, 32(3), 523-538.
Rowe, T. A., & Juthani-Mehta, M. (2013). Urinary tract infection in older adults. Aging health, 9(5), 519-528.
Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and management of urinary tract infection in older adults. Infectious disease clinics of North America, 28(1), 75.
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