UTI or not a UTI
These are three common non-specific symptoms that are not a reliable for diagnosing a UTI.
What is mental status changes (confusion, agitation), falls or fever.
This term describes the likelihood that a skilled nursing facility resident has a UTI before any tests are ordered.
What is pretest probability.
True or false: Pyuria (white blood cells in urine) strongly suggest there’s a urinary tract infection regardless of the presence of UTI symptoms.
What is false
The most important first step before calling the provider about a possible UTI.
What is “Assess and document" the patient’s symptoms and vital signs.
About 10% of the population is labeled as penicillin allergic but only this percent are truly allergic to penicillin
What is <1% of the population.
According to Loeb criteria, at least one localized urinary symptom is needed before ordering this test.
What is a urine culture.
The specificity of a urine culture is reduced in long-term care residents because of this common condition
What is chronic colonization or asymptomatic bacteriuria?
True or false: A UA positive for nitrites, leukocyte esterase and pyuria confirms a UTI in a patient with fever.
What is false.
When discussing a patient with a potential UTI, this structured communication method helps ensure all relevant information is shared clearly.
What is the SBAR format (Situation, Background, Assessment, Recommendation).
There are two main reasons for the disparity between the percent of the population that is labeled as penicillin allergic (>10%) and the percent that is truly allergic to penicillin (<1%)
What is 1) penicillin allergy goes away over time and 2) the penicillin reaction was a side effect and mislabeled as an allergy
Unnecessary treatment of asymptomatic bacteriuria can lead to this serious facility-wide problem
What is antibiotic resistance or C. difficile infections?
Sending urine cultures from skilled nursing facility residents without UTI symptoms increases this statistical problem.
What are false positives (low specificity)
The most likely explanation for cloudy or foul-smelling urine in a patient without UTI symptoms is this.
What is dehydration or medications
A key detail to communicate to a provider before requesting a urine culture in a catheterized patient.
What is how long the catheter has been in place and whether it can be removed or replaced.
One way to tell whether a reaction to a penicillin was a side effect or an allergic reaction is this.
What is the timing of the reaction after starting the penicillin
A urine culture should be done only after this test is abnormal and UTI symptoms are present.
What is a urinalysis (UA).
A “positive” urine culture is not definitive for UTI unless combined with this.
What is clinical symptoms suggesting high probability of a UTI
True or false: When yeast are found in a urine culture there is a higher probability of UTI
What is false
Instead of saying, “The urine looks cloudy,” the nurse should provides this type of information to the provider.
Describe specific symptoms or changes in condition.
Patients with a penicillin allergy label are more likely to experience poorer antibiotic treatment outcomes. These are two of the problems that are more likely to occur.
What is 1) lower chance of clinical cure, 2) more side effects, 3) more bacterial resistance
Ensuring the right test, for the right patient, at the right time — to avoid harm and promote appropriate antibiotic use is the goal of this?
What is diagnostic stewardship
The specificity of a urine culture from a skilled nursing facility resident is low (high false positive rate). Selecting patents with high "what" will improve urine culture specificity.
What is high probability of UTI.
True or false: Starting antibiotics before obtaining a urine culture is a best practice in skilled nursing facility residents who have sepsis to ensure timely antibiotic administration.
What is false.
The assessment section of the UTI SBAR should contain this criteria.
What is Loeb criteria.
These are two steps that can be taken to delabel patients who have "low risk" penicillin allergies.
Note: A low risk allergy refers to patients with a history of a reaction that was long ago (>5 years) and the reaction did not not include any symptoms of anaphylaxis (angioedema, hypotension or breathing difficulty)
What is 1) thorough review of the medication history and type of reaction and 2) give an oral amoxicillin challenge.