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student nurse needs ideas : Urinary Tract Infections

I am a canadian student nurse and I am working as a personal support worker on the weekend with a client who always has unusual smelling urine. She complains of buring,itching, frequency and pain on voiding and I have been asked to help with numerous clean catch specimen's for this woman which go off to lab and come back saying she doesn't have a UTI.

I'm confused, she has all the signs and symptoms of a UTI but the cultures are always negative, what the heck could it be for my own curiosity!?!

jennafezz

Specializes in Telemetry.

Urethral syndrome?

I'm a student too :)

It sounds like she needs to see a specialist if her physicians cannot figure it out. I would suggest researching something called interstitial cystitis... some of the s/s sound similar.

GHGoonette, BSN, RN

Specializes in PACU, OR.

How old is she? Has she had previous urological investigations, and if so, what was she treated for?

I would also say to have her referred to a urologist for a cystoscopy. It could be interstitial cystitis, but I don't think there is a smell associated with it--possibly unrelated.

she's 68 not horribly old, she has a history of having Chronic UTI's but I dont know like I said I was curious as to what else it could be and I'd never heard of interstital cystitis, I dont see her EVERY weekend, but it be interesting to find out what is causing this!

GHGoonette, BSN, RN

Specializes in PACU, OR.

As you know, cystitis tends to cause a "fishy" smell where there is infection present. If she is diabetic, you may also get the "green apple" or sweetish smell. If she drinks insufficient water, the resultant concentration can cause the urine to smell pungent. I would suggest you recommend that she ups her water intake.

There might also be bladder prolapse, which could account for the symptoms you describe; a dead give-away is stress incontinence. I don't think you mentioned that, but you can test it by asking her to cough, then see if she has a small "leak" as a result. I agree a cystoscopy is called for, possibly a gynae exam as well; older (post menopausal) women have a tendency to develop uro-genital problems.

Spika RN

Specializes in Oncology.

There is so much that can be wrong the best thing to do is have her go into aspeicaliest all I got sorry

shaas, ASN, RN

Specializes in Aspiring for a CCRN.

If it isn't a bacterial UTI (which most labs are run for), then could it be Candida UTI since she'd probably been on antibiotics for a prolonged duration of time due to her recurrent UTI previously? Fungi tend to flourish with chronic use of antibiotics. Just a thought. :)

http://www.merckmanuals.com/professional/sec17/ch231/ch231c.html

GHGoonette, BSN, RN

Specializes in PACU, OR.

If it isn't a bacterial UTI (which most labs are run for), then could it be Candida UTI since she'd probably been on antibiotics for a prolonged duration of time due to her recurrent UTI previously? Fungi tend to flourish with chronic use of antibiotics. Just a thought. :)

http://www.merckmanuals.com/professional/sec17/ch231/ch231c.html

Quite right, and definitely produces a fishy smell, but there should also be concomitant vaginal and/or oral thrush, visible on examination. Good point though! :)

Ella Halligan RN

Has 8 years experience. Specializes in Pediatrics, Rural, L&D, Postpartum.

I remember having a patient with some seriously stinky urine when I was a CNA... dangit but that was ages ago... VRSA, maybe? Other ideas could be:

  • Asparagus may turn urine green color with odor.
  • Bacterial bladder infection
  • Bacterial kidney infection
  • Cystitis
  • Diabetes
  • Diabetic ketoacidosis
  • Holocarboxylase synthetase deficiency
  • Kidney calculus
  • Urinary tract infections
  • Vitamin B6 supplements

Hope that helps! Let us know what you find out!!

Elisabeth Halligan, RN

Edited by sirI

Okay dumb question but if they were testing for a uti and they had a kidney infection would it show on a dip test? She said she had some mild left flank pain but when you "knock" on it the area is tender but not excruciating like you'd normally see.

GHGoonette, BSN, RN

Specializes in PACU, OR.

OP, I think you'd better be up front with us: is this really your patient or is this a cleverly disguised homework question? You seem to be asking us to diagnose, and you know we're not allowed to do that.

If you do have a patient with these symptoms, she needs to see a urologist, sooner rather than later, so that an accurate diagnosis can be made and appropriate interventions can be decided on.

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