Signs and Symptoms of UTIs in Nursing Homes
Is your loved one acting confused or agitated in a nursing home? It could be a sign of a urinary tract infection (UTI)—a common but often missed condition in elderly residents. If not caught early, UTIs can lead to serious health problems. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Ms. Ethel Wills to talk about the warning signs of UTIs in nursing homes, how they’re diagnosed, and what facilities should do to prevent them.
Wills:
Now some facilities do have standing orders where the nurse can implement. A lot of times they do have to contact the physician to notify. There’s been a change and this is what I’ve seen and this is what, this is how the patient’s presenting, and based on that, then the order’s given. So it could be either R
Schenk:
Hey, out there. Welcome back to the Nursing Gum Abuse podcast. My name is Rob. I’ll be your host for this episode. Today we are talking. Again about UTIs, but this time signs and symptoms of UTIs, timeframes and what we should be doing or what the nursing homes should be doing within those timeframes. So we don’t have that conversation in a vacuum.
We’re not alone here. We have the fantastic at the wills who will be joining us here in a second to talk about UTIs in nursing homes.
As I mentioned, talking all about UTIs, but we’re not doing that alone. We had the fantastic Ethel wills with us today.
Ethel Wills brings extensive experience in intensive care, burns and trauma, ambulatory care, home health, and long-term care. In 2015, she transitioned to legal nurse consulting, founding E.Wills Legal Nurse Consulting, LLC. She has specializes in reviewing and analyzing rehabilitation and long-term care cases with expanded services in future care, cost projection, and life care planning.
And we are so happy to have her with us today. Ethel, welcome to the show.
Wills:
Thank you for having me. Appreciate your opportunity. The opportunity.
What are the most common signs of a UTI in seniors?
Schenk:
So we’ve had a couple of episodes and most recently we had an episode about catheter associated UTIs, but I wanted to back up. A little bit and have you on to discuss essentially UTIs in general, but more specifically how we would typically know in a nursing home setting when someone has a UTI what are we looking for?
And so that’s what I wanted to start with is in your experience, what are some of the more common signs and symptoms that an individual resident has? A UTI.
Wills:
Of course in seniors the doctor symptoms are atypical. They may present as confusion, delirium, lethargy, and a certain change of behavior.
Whereas in a younger individual, they’re quite different, and that’s what’s usually seen in seniors. And the nursing homes, your UTIs are more than one was common infections. So it is wise to take note of those changes in behavior.
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Schenk:
And you, so changes in behavior, like what kind of changes in behavior?
What are we looking at?
Wills:
What thing did I have seen in my practice is the one that may have been. Calm and cooperative patient. A resident may suddenly become aggressive, withdrawal from care, refuse care, and become really confused. Those are things that are typical that I usually staff seen.
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Schenk:
So confusion and in some instances being ornery. That’s if it’s not your baseline.
Wills:
Yes, most, most definitely.
Schenk:
Okay. So that would you say that typically those are the things that present first is that kind of those are the telltale signs and then you would dig deeper?
Wills:
What’s usually presented first may be something that’s more subtle and what’s seen commonly in urinary tract infections, which may be cloudy, smelling urine frequency, things of that nature.
It’s pretty common that we all are very familiar with. And that’s what’s usually seen first. And you may even have a fever and maybe some pain, some discomfort with urinating. And those are things where you first see before you might see those other signs and symptoms I just mentioned.
Learn more on the role of early diagnosis in managing urinary tract infections among older adults.
Schenk:
Okay, so it’s it could be potentially a mixed bag.
You could have somebody have a change in behavior, but then maybe only a day later there might be a change in frequency or urgency or the color of the urine, or vice versa. Correct. That’s true. Vice versa.
Wills:
Exactly. I see. Exactly.
Schenk:
Okay. What then, so let’s say that you have a resident that is now presenting to you with a change in of mental capacity of from baseline.
And maybe there are some of the other telltale signs. So f foul smelly urine or cloudy urine. What do you do then
Wills:
At that point, it’s time to investigate further. Sometimes if there’s a delay, that’s a misdiagnosis thinking that the. Changing behaviors is dementia, progressive dementia, but it’s best then to start doing investigation.
A, a urine culture, for instance, be one of the first things to do to get a urine culture to see whether any bacterial growth in the urine, that’ll be the next thing to do.
Read about interventions that reduce complications on urinary tract infection-related hospitalizations in elder care settings.
Schenk:
So typically h how like. And I know all cases are different, but like typically, how long are you waiting? Is it like, okay, is it after a shift?
Is it after two or three shifts? Like when does, like your, when does the alarm bell go off in terms of these are, everything is lining up. I. That these are symptoms of a UTI. Let’s get the, let’s get the culture.
Wills:
Well, timely diagnosis, as I said, if I didn’t say it already, is key. It’s best to be very timely to prevent any progression of the urinary tract infection.
So it should be within that shift notifying the physician there’s a change, and go ahead and get that urine sample to see whether or not they’ll say any bacterial growth, any delays can cause a progression. Further harm to the patient or to the residents. So that’s not what we want. We want to treat it timely.
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Schenk:
Is that typically something that’s handled by the nurses, or does do, or typically does the nurse need to call the attending physician to get the order for the labs? I.
Wills:
Now some facilities do have standing orders where the nurse can implement orders on based upon those standing orders, based upon the symptoms they perceive.
But a lot of times they do have to contact the physician to notify There’s been a change, and this is what I’ve seen and this is what, this is how the patient is presenting, and based on that, then the order is given. So it could be either or.
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How can a UTI affect a nursing home resident’s health?
Schenk:
Okay. So now you’ve had the resident present with the symptoms of UTI you’ve either had the standing order and sent off for the labs, or you’ve called the attending physician and the attending physician allowed it, the results come back.
Typically, what results will, for lack of a better word, result in there being any change or, the antibiotics being ordered and things like that. Like what is a what? What is the lab result that you’re looking for?
Wills:
With the urine culture, we’re looking at a bacteria count, the white blood count, the red blood cell count, whether or not there any bacterial growth, that’s what you’re looking for.
And based upon the results of that culture. You sometimes they will go ahead and do a sensitivity to show what the bacteria sensitive to antibiotic is sensitive to, and you notify the physician, tell ’em what you found, and of course, orders perceived to give antibiotics, whatever that’s deemed appropriate for that particular criteria.
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What are common interventions to prevent UTIs?
Schenk:
And, i, ’cause I guess in my experience, everybody has a certain amount of bacteria in them. It’s just a matter of when, there’s a line of becoming symptomatic for UTI, it’s, I don’t know how to put it and that’s why my last question was so convoluted. But anyway, so tell me, Ethel, what do you do then?
Like when is it, when would it be appropriate? After you’ve already got the lab result the physician orders, the antibiotics we’ve declared, this is a UTI. What when is it in your experience appropriate to discharge that resident due to the infection?
Wills:
If that infection, there are, sometimes there are signs that infection has progressed.
Travel up there. Ary tract to the kidneys, and there may be signs of intense pain, nausea, vomiting, high fevers, high re respiratory rate, low blood pressure. Those are times that you need to escalate care. That means that facility cannot and do not have the resources to take care of that patient. It sound and it also looks like a sepsis developing.
And we don’t want that. Sepsis can cause a further, unfortunately, it can cause death. And we’re trying to prevent that. We’re trying to escalate care and prevent any further die consequence to the patient to the. Resident.
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When is it appropriate to discharge a resident for acute care due to UTI?
Schenk:
So it’s because they, I guess from what I hear you say, is there, there would potentially be a time prior to unresponsiveness or unconsciousness that it would be appropriate to send the resident out to acute care to a hospital and that might be severe pain increased respirations, that kind of thing.
It’s not just a matter of we’re gonna just see how it goes. Unless the person is unconscious. There is a continuum.
Wills:
Yes, most definitely. There got to be a lot of times you to ask you, you always say U UTIs. Urinary infections can be treated in the facility, but if the patient condition deteriorates with symptoms such as that.
That’s what I just said. High fevers, chills, re, high respiration, low blood pressure. That can mean that they’re deteriorating. There’s sepsis, possibly sepsis developing, and that’s when you want to escalate care and not try to treat it within the facility. IV fluids and antibiotic. Further, further care for the advancement of care.
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Schenk:
I understand that the the elderly population as a whole is more susceptible to UTIs. I get that. Speak about even within that population, are there any subgroups that might be more likely to get UTIs,
Wills:
diabetics are one such group that can, someone that’s in nursing homes. Unfortunately, there’s, they’re not just one condition.
Patients are. They’re a resident there because of other conditions of the health condition. They have diabetes, high blood pressure, heart conditions, and when they have these possible conditions, they can, these chronic conditions and the unit infections can cause a uncontrolled blood sugars and it further.
Risk to the cardiovascular system, and those are subgroups that can be affected. And of course, anyone that’s really severely ill with conditions, those are at risk people that are malnourished, those at greater risk people that incontinent a greater risk. Those are ones I can really think of that can be at a greater risk for urinary tract infections.
And can cause have some die consequences as a result.
If your loved one developed a UTI in care, find out if you may have a legal claim.
What happens if a UTI goes untreated in a nursing home?
Schenk:
If you have a family sitting in front of you and they have a loved one in a nursing home that has some of those symptoms, maybe diabetes, chronic high blood pressure, perhaps incontinence, what are some of the things that you would tell them as a family that might reduce the likelihood that their loved one gets a UTI or heaven forbid, gets a sepsis or septic shock.
Wills:
Hydro. That’s the one thing that’s very common intervention for, to prevent tric infections and that’s hydration, encouraging fluids. And for the family member it might be offering an encouraging their family member to drink more fluids. And as far as staff member might be having a picture. Fresh water at the bedside and say, Hey, every two hours, let’s offer this personal drink of water.
And the family can do the very same thing. If their family member is intact. Mentally, they can say, Hey, Mrs. Hey mom, every and drink some water. Drink some more water. Those are simple. That’s a simple thing that can be done. And of course. Again, if they’re cognitively intact, encourage them to keep, go to the bathroom frequently, not hold their urine urinate frequently.
After each meal, try to use the bathroom, proper hygiene, cleaning the proper way, wiping from front to back. That’s for both staff as well as for the resident. Those are some simple things that can be done to prevent urinary infections. That I can say that the family can be involved in as well.
Hear prevention strategies in our podcast on preventing UTIs in Georgia nursing homes.
Schenk:
Tell me about the way in which the nursing staff can reduce the likelihood of UTIs by.
Experimenting is not the right word, but testing toileting programs. So in other words it, would it have an effect on that resident if the nurses would say, okay, let’s try queuing the resident to go to the bathroom. If they’re cognitively impaired, for example, or let’s do rounding at this time and things like that.
Like getting, like testing out and revising the toileting program as appropriate. What effect does that have?
Wills:
It? Oh, that’ll be a tremendous, effect on the likelihood of reducing unit infections, offering toileting, as I had mentioned earlier, offering toilet every two hours, offering toileting after having eaten and before eating.
All those are called bladder training. Those are things that can be done to help to reduce the likelihood of UR infections. Those are things that really, that is very key.
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Schenk:
Typically, when does a, when would a nursing home start a toileting program? Is that something that’s done at the, at admission?
Is it done when maybe the person might have UTIs?
Wills:
It’s done at admission. Usually the process is to as a process, an admission. There are certain questions and assessments that are being asked, and if the patient’s assessed to be incontinent, that’s an effort to retrain and typically that’s a three day training program that the staff try to implement, try to.
Determine first of all, whether or not there is incontinence, and to try to establish the residents pattern of urinating during this three day period of bladder training they’re trying to assess, and then they will implement a program based upon what they found during that three day period of assessment.
That’s what’s typically done.
Explore common infection types in our podcast, Common Infections Found in Nursing Home Residents.
Schenk:
I feel like anecdotally in my experience, that step is skipped and if the end, if the resident comes in with adult briefs on, they stay in adult briefs for months, maybe even years, like they don’t even try. But again, that’s not every nursing home clearly. But in my experience when I have bad UTI cases, that’s a lot of times part of the reason why that’s, that, that occurred.
So I hear you like the. That toileting program at admission? Very critical, at least in my experience. All right, Ethel, is there a, any, anything else that you wanna impart to the audience today?
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Wills:
Yes, most definitely. Prevention is key and what, as I said earlier, hydration is one is simplest things we can do.
Being proactive and with the resident is one of the key things that we can do. Being proactive. Being aware of the possible signs and symptoms of a urinary tract infection, being timely, ensuring there’s no misdiagnosis. As I said, dementia can be the signs of urinary tract infection can mimic dementia, and we wanna make sure that we’ll treat the correct thing.
Being timely and properly diagnosing and intervening appropriately. Those are key things that we should be doing to prevent escalating unitary infections.
Understand best practices for infection control in nursing homes and how they can prevent outbreaks.
Schenk:
Very well said, Ethel. Thank you so much for coming on the show and sharing your knowledge with us.
Wills:
Thank you for having me. I appreciate the opportunity and thank you again.
Schenk:
Well folks, I hope that you enjoyed this episode. I know that I sure did. If you have an idea for topics that you would like for me to discuss, please let me know. If you have an idea for people that you want me to have conversations with, let me that as, let me know that as well. New episodes of the Nursing Home Abuse Podcast come out every single Monday.
And remember, as always, please. Enter the contest, and I can’t put that in strong enough. Air quotes contest to win the nursing home abuse podcast mug. These things are in my house. No one is entering the contest. No one is answering the question on TikTok. You gotta do it. So go. You look, give it away as a present.
Like when you win it and it arrives to your house, just give it to somebody else. You don’t have to drink at it if you don’t want to. There’s a lot of things that you can do. Put coins in it, put pens in it. Just get it outta my house. And with that folks, we’ll see you next time.
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