L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress...

L.M. is an 81-year-old female who lives in a nursing home. She had a stroke 2 years ago and has residual right-sided weakness. She also has gastroesophageal reflux disease, hypertension, and stress incontinence. She currently takes the following medications:

• Omeprazole 20 mg PO daily before breakfast


• Captopril 50 mg PO BID


• Furesomide 20 mg PO daily

Today she tells the nursing assistant that she has a lot of pain when she urinates. The charge nurse completes a physical exam and notifies the provider of the exam findings and patient’s painful urination. A urinalysis is ordered.

Subjective Data

• Pain with urination began 2 days ago


• States she usually doesn’t drink much because of the stress incontinence and not wanting to have “accidents,” and now she is drinking even less because doesn’t want to have to urinate due to the pain and burning


• Wearing feminine hygiene pads she had in her closet since the painful urination started because her stress incontinence “is worse”

Objective Data

Physical Examination

• Temperature 99.7° F, pulse 78, respirations 18, blood pressure 162/80


• Left flank tenderness

Diagnostic Studies

• Urinalysis




• Color:               Dark, smoky color


• Odor:               Foul smelling


• Protein:            Trace


• Glucose:           None


• Ketones:           None


• Bilirubin:           None


• Specific gravity: 1.034


• pH:                   8.2


• RBCs:                8/hpf


• WBCs:              12/hpf


• Casts:               Present

Discussion Questions

1. Based on L.M.’s presentation, what do you suspect is occurring and what assessment data led you to this conclusion?

1. You need to obtain a clean-catch urine sample from L.M. to send for urinalysis. To collect this specimen, what instructions do you give L.M.?

1. Describe how to assess for flank tenderness. What is the significance of L.M.’s left flank tenderness?

1. What are L.M.’s risk factors for developing a urinary tract infection?

1. What diagnostic test would be needed to determine the best medication to treat L.M.’s urinary tract infection?

1. What are some important measures to teach L.M. to prevent recurrence of a urinary tract infection (UTI)?