Foul Smelling Urine

[RN BSN 2009]

Hi, I'm a 1st year nursing student and I'm currently working as a home health aide.

A little background, my client is an elderly male, permanent foley. He has a larger bag at night and a smaller one during the day. He gets his foley re-instered by a urologist every couple weeks.

I had an evening shift tonight, 7-11 p.m. When I came in, around 7:20 I noticed the bag was pretty full, and I emptied out 500 ccs, and there was a foul smell. I figured it may have smelled because it was probably sitting for a while as day shifter had not emptied it in a while.

I then did his night routine, and emptied his bag at 9:15 and the smell just about knocked me over. For some strange reason, I wanted to say it smelled like marijuana! It was 300 cc's.

Now every shift that I work, I empty his bag. I usually work NOC shift and empty in the morning, and afternoon shifts I empty it after dinner.

Usually when I empty the bag, if his urine is dilute I do not smell it at all. When his urine is concentrated, I don't smell it until I bring the urine-catch jug up to eye level to measure the CC's.

Is there anything that can cause this other than a UTI? He doesn't have a temp or anything else that would cause me to believe it's a UTI. At 10:00 pm I emptied a little out, smelled it, it wasn't so bad but it was only about 50 cc's. I still called his son around 9:30 and said the urine was foul smelling.

I don't have much experience as I've only worked with one other patient that had a cath.

Could it be something other than a UTI that I should watch out for?

THANKS!

Jamie

[vashtee, RN]

It might be food supplements/vitamins, but I don't think the lack of fever is sufficient reason to assume it is not a UTI.

[RN BSN 2009]

It might be food supplements/vitamins, but I don't think the lack of fever is sufficient reason to assume it is not a UTI.

I know he takes a multivitamin once per day, and takes one cranberry pill per day, along with his other routine medications. He hasn't changed any medications since I've been on his case. I read his chart on what he had eaten the past few days (he gets 24 hour care with aides), and nothing was really out of ordinary of what he usually eats.

I've been assigned to him for over a month and empty his foley every shift -- and had never smelled this scent before - it was like urine mixed with something else.

Thank you!

[nursemary9, BSN, RN]

Hi

First off, I think it's good that you have noticed a smell that is out of the ordinary & that you are concerned about it.

As the previous poster says, lack of temp does not mean there is no UTI.

It could be either food or med that is causing the odor.

Some antibiotics cause urine to smell bad.

Does this pt. have a Home Health RN?? When I worked HH, our CNA's would communicate with us regarding changes in the pt. If there is a HH RN, maybe you could give her a call or an interoffice memo.

If not I would alert the pt's family & ask them to communicate this to the Urologist when they go for a catheter change.

Or, if it persists, & you are not sure the family is reliable, maybe you could leave a message with the Urologist.

Another thing, you could communicate your concerns to your Agency.

Your concern for the change in your patient tells me that you're in the right field!!

[sshannon]

Definitely don't assume it's not a UTI.

Toward the end of my third semester of nursing school I noticed my urine was smelling very funky and had gotten slightly cloudy. Didn't have a fever and only other symptom was fatigue (but hey, it was the end of the semester). Right after my last final I got myself into my GP and low and behold, it was a UTI. A nice broad spectrum abx cleared it up, along with this nagging headache above my right eye (can you say chronic sinus infx).

Anyway, I'd get the home health nurse to get orders for a specimen and dip it.

[leslie :-D]

another thought.

when you switch cath bags from day to night, do they get a good washing inbetween use?

leslie

[kstec, LPN]

I would definitely get a UA and atleast get that possibility eliminated. Also ask a nurse what meds he is on and what are prone to cause odor of the urine. I remember this resident that I took care of in clinicals who had the worst smelling urine ever, and it was because of some pill (don't remember the name) that he was on to help prevent UTI's in people with permanent catheters.

[TazziRN, RN]

In the elderly fevers are often a late sign of a problem. The foul smell when there was none before indicates a UTI. I have a HH pt that, a few weeks ago, had foul-smelling urine. We did a straight cath and it came out clean, so we just pushed fluids and watched her. A week later she spiked a temp and I cathed her again. This time the sample was loaded and she ended up on Cipro. Talk to whoever is managing his case a suggest a UA. If it comes back negative, keep a close eye on him and expect to have to retest in a week or so.

[RN BSN 2009]

another thought.

when you switch cath bags from day to night, do they get a good washing inbetween use?

leslie

Hi...

They are rinsed out with water and then rinsed again with bleach/water mix, then another rinse of water.

[RN BSN 2009]

Thanks for the suggestions! I did contact the RN oncall and the family. We are going to monitor for now!!

[sphinx, BSN, RN]

A lot of times UTIs have no symptoms at all. Although the elderly often show behavioral changes.

Sometimes if the urine smells nasty and there is no UTI present, if you change the bag, the smell goes away. The cleaning should help, but I'v found that sometimes there's nothing quite like a totally new bag!

[ZippyGBR, BSN, RN]

the answer here is

1. bin the current urine bags and swap to fresh ones - as even with good washign reusablt bags can get pretty manky ... I have a habit of all fresh bags if anyone with a long term catheter gets admitted through the assessment unit i work on - then we are sure that it's the urine that is cloudy, smelly etc...

sounds like this patient could do with either NPT urine testing and/or a MSU/CSU sending off - as has been suggested by other posters UTIs don't always present with obvious 'infective' signs and symptoms