Urine dip=> + blood, negative nitrates

[lvan0904]

Hello,

I am almost too embarrassed to ask this question, but still bold enough to do so- even though I may get mocked or criticized by some readers. So here it goes: I am a new Adult NP working in a nursing home. Today, an LPN reported to me that a resident had frequent urination and she wanted to do a urine dip test. I recommended a UA C&S because the resident (like many others) has a complex medical history and had a recent fall and has demonstrated some periodic confusion. Nevertheless, the LPN proceeded to obtain a urine dip (never mind my recommendation) and the results came back: pH normal, nitrates negative, blood +1, WBC

Please share your thoughts. I tried to research tx recommendations after receiving the findings from the urine dip, but I was not able to gather any useful info.

Thank you,

lvan0904

[traumaRUs, MSN, APRN]

I work in nephrology so UA dips are NEVER used for my pts. However, UA C&S would be indicated in this case. I would also place them on some type of broad spectrum antibiotic to cover as much as I could while awaiting the C&S results.

[lvan0904]

Thank you. I am following up w/ this resident tomorrow. It was a long day and I was starting to question my treatment approach. Thanks again for the input. I'm sure I'll be posting more questions in the future:)

[traumaRUs, MSN, APRN]

You are very welcome. Post away!

[BostonFNP, APRN]

Interesting to hear nephrology's take on this.

Based on the clinical picture and the urine dip results I wouldn't treat this patient unless the culture came back positive. I would look for other organic causes of her confusion though while the culture was pending.

[uronurse1]

Interesting to hear nephrology's take on this.

Based on the clinical picture and the urine dip results I wouldn't treat this patient unless the culture came back positive. I would look for other organic causes of her confusion though while the culture was pending.

Absolutely this^^^

Im an NP in urology and 1+ blood on a dip stick is a very non specific finding. Culture is the definitive test and in the absence of specific symptoms (pain, gross hem, etc.), i would await culture prior to initiating antibiotic treatment. Another reason to look for other causes of confusion is in view of the prevalence of asymptomatic bacteriuria in elderly residents of long-term care facilities. This is a significant contributing factor to antibiotic resistance, c diff, etc.

So to me, i dont care which ua you decided on, as long as a culture was done. This is of course my thoughts without knowing the patient's urologic history. That being said, regardless of culture results, a ua microscopy should be repeated in the future to reassess the microhematuria as further evaluation may be warranted.

[woofyrn]

I don't think you need to apologize, Ivan0904 -- I (and i'm sure many others) appreciate that you took the time to post, so we can see the different responses and (more importantly) the rationale behind those responses.

Frankly, I wish more people would do it!

[hutch304]

Agree with uronurse and Boston.

[lvan0904]

Thank you for being so kind!!! As a new NP I second guess myself quite a bit. To make matters more complicated, I am stationed at this nursing home by myself so I don't have another NP or an MD to bounce ideas off of on site. I do use Lexicomp and my text books, and I do reach out to my collaborating MD who is helpful. Hearing from other NPs is beneficial, like you mentioned woofyrn- "seeing different responses and the rationale behind those responses" is valuable to me.

[traumaRUs, MSN, APRN]

Up to Date is a wonderfully concise resource too. Get your practice to purchase it for you.