Case 1

D.K. is being seen in the clinic for complaints of urinary frequency, urgency, and burning. She reports that her urine appears cloudy and smells abnormal. A urine culture is obtained, and D.K. is given a prescription for antibiotics.

What is the most likely cause of D.K.’s signs and symptoms? urinary tract infection or cystitis
Was antibiotic therapy the appropriate treatment? What organism should the antibiotic be effective against since it is the most common cause of this disorder? yes antibiotic therapy is appropriate for TUI’s. it should be effective against E.coli.
What factors predispose to development of this urinary tract disorder? sexually active women, spermicides, improper hygiene, the female anatomy in general, low estrogen levels, pregnancy, diabetes mellitus, catheters, change in vaginal pH, urine stasis.
What strategies could be suggested to help D.K. avoid recurrence of this problem? wiping from front to back, drinking recommended amount of water, voiding after sexual activity, avoid tight fitting pants/underwear, wear cotton underwear, avoid bubble baths.
Case 2

P.W. was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of the left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.’s vital signs and hematocrit suggest that he has had a major blood loss of about 2000 ml. A catheter is inserted to monitor urine output, and P.W. is fluid resuscitated while his wounds are cleaned and sutured. The urine output is quite low, with high urine osmolality and low urine sodium.

What type of renal failure is P.W. at risk for developing? pre-renal acute renal failure due to blood loss
What is the best therapy to prevent renal failure? isotonic fluid therapy and possibly a blood transfusion to replace