UTIs: Early Warning Signs and Treatment
Could confusion or agitation in your loved one be more than just aging? UTIs in the elderly often show up in surprising ways and can become serious fast if missed. Nursing homes must know how to spot and treat these infections early. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Tiffany Puckett to talk about the signs of UTIs and how proper care can prevent complications.
Puckett:
Again, you and I, we could probably, we’ll notice it real quick with urinary symptoms. We’ll get on our Cipro or macro bit or whatever. We’ll take it for a few days and within probably two or three days we’ll start feeling better. But it just tends to take a lot of things. It just takes longer in the elderly population.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking once again about UTIs, but this time we’re talking essentially about the early warning signs and treatment protocols for UTIs. But we’re not doing that alone.
We have Tiffany Puckett on the program today. Tiffany has been our registered nurse since 1995, almost about the time that I saw that Prince concert. And a legal nurse consultant since 2003. She’s currently working full-time as an a legal nurse consultant independent contractor, and has extensive experience with reviewing various types of cases, including auto accidents, medical malpractice, birth injuries, long-term care, nursing homes, slip and fall, and workers’ comp, and we are so happy that Tiffany is in the program to talk with us today.
Why do UTIs sometimes cause confusion or memory loss in seniors?
Schenk:
Tiffany, welcome to the show.
Puckett:
Thank you for having me.
Schenk:
So we had an episode about kind, like in general UTIs a little while back, and one of the symptoms that the guest talked about was confusion and memory loss. Yes. And I wanted to get an understanding as to when does that kind of come on? When there’s a UTI and kinda why is that? Like why are we talking about confusion when we’re dealing with a UTI.
Puckett:
Yeah, it does seem strange, an odd symptom to have. But interestingly it can be one of the first, and usually if it, with the UTI, it’s typically gonna come on very quickly.
You’re gonna see a pretty big shift in. What we call baseline behavior what their normal functioning is. And when you see that, and typically this can happen even before the patient even starts complaining of anything that we typically, I. Think of as TI symptoms. That can be the first indicator.
So it’s one of those things that people really need to pay attention to and be aware of, especially if you know the resident really well and if you know what their baseline is and if you see a market change from that an alarm bell maybe should go off that. There might be something else going on that you might wanna text at least look for the UTI.
This article outlines evidence-based best practices for UTI care in older adults on the impact of preventive health measures in elderly populations.
How can a UTI be mistaken for dementia or other cognitive disorders?
Schenk:
If you have a resident that is showing confusion, okay? What are typically what is the process by which you get from everything else in the world that can cause confusion to UTI I, what are the questions that you’re asking yourself to get to UTI.
Puckett:
Yeah you probably wanna just triage it a little bit in your head. But you look at things like the hydration state of the patient elderly population, typically, a lot of them are dehydrated. For that matter, most of us are dehydrated in some form. We don’t drink enough, but that’s a big one. What type of medications are they on? Are they on diuretics?
Episode 127: Dementia Care and Residents’ Rights discusses how cognitive impairment affects infection risk and oversight.
Are they something on something that will pull fluid out of them? Is it something? You know that if you’re seeing a lack of activity, if you’re seeing things that the patient just becomes really sedentary and lethargic, things like that those are things that, that you would say this makes me want to delve further into this and see, and you’re right now, if you have a patient with known issues such as, Alzheimer’s, Parkinson’s, maybe history of a stroke or something of that nature, yes, you need to take that into consideration. But again, even those patients are going to have their own baseline or somewhat norm that they would have. And so with the U UTI I added on with that, you’re still gonna see probably a different picture of that resident than you normally see every day.
Explore diagnostic challenges and recurrence risks in elderly populations on the impact of preventive health measures in elderly populations.
What are the warning signs that a UTI is affecting brain function?
Schenk:
And I think if I understand you correctly the confusion, memory loss, these cognitive issues come along typically first before other symptoms.
Puckett:
They can. Yes. Oftentimes that can be one of the first things that tips off either a caregiver or a family member to a potential UTI. Of course, if they have something like an indwelling catheter or even if they self-catch, if they straight catch, that can still happen as well.
Hygiene is also an issue, bathing all of this kind of stuff. It all plays a part into. The, potential for the infection of UTI.
This study investigates antibiotic resistance patterns related to UTIs in long-term care on the impact of preventive health measures in elderly populations.
What role does dehydration play in UTIs and cognitive decline in the elderly?
Schenk:
You mentioned a minute ago, something about hydration. Like you wanna look at hydration levels. What does hydration have to do with UTIs?
Puckett:
Huge, just because, like I said, the majority of elderly population are gonna be to some degree dehydrated. Typically when you get older you tend to lose your desire to, to drink and to eat. Quite honestly. We see that in a lot of that population. So it really does play a very big role in that.
And trying to get them to drink more can often be a little challenging. They just don’t, like I said, they don’t have the desire to do it. And it’s like anything where you’re trying to make yourself do something you don’t really wanna do it’s hard to do that. But again, you combine that dehydration with medications on board that can be dehydrating such as Lasix or something like that’s gonna make it all the more challenging for sure.
Learn how delays in treatment for UTIs may escalate into systemic infections on the impact of preventive health measures in elderly populations.
Schenk:
Once we have a resident that’s presenting with confusion, maybe they’re complaining of pain while they go to the bathroom, or it’s more often where we’re okay, it’s likely that it’s a UTI. What is the next step for that nurse?
Puckett:
I would say the next step would be to get the patient tested for sure. Either, whether it’s you can do it in the nursing home or if they have to be transported out to a primary care or a physician of some sort. But I would definitely say to get a urinalysis, ASAP to see what you’re dealing with. And, the majority of the time, once it is determined that there is the UTI and we start them on the antibiotic they turn around pretty quickly.
Explore best practices in Preventing Catheter-Associated UTIs: What to Know.
Now. A slightly different scenario. If you’re dealing with someone that has maybe chronic UTI, sometimes it can take more than just one round of an antibiotic. It might take multiple, unfortunately. And of course, the potential for a. Longer lasting cognitive effects does play into that issue as well.
A quality improvement initiative successfully reduced catheter-associated UTIs on the impact of preventive health measures in elderly populations.
Are there long-term cognitive effects from recurrent or untreated UTIs?
Schenk:
What do you mean by that? What are we talking about in terms of long-term cognitive effects?
Puckett:
They can have just the cognitive effects that you do see with the u uti i, the memory loss, the confusion things, just the. It may be a patient or a resident not recognizing people like they normally had or not being able to recall certain events that they’ve always been able to do.
If that infection is allowed to hang around for a while, those. Potential cognitive effects can become a little bit more, now I’m not gonna say permanent or, but they do tend to stick around a little bit longer. It might be a little bit harder to get that part out of their system even with the antibiotic on board.
Once the antibiotic starts getting the infection out, I think you’re gonna start to see the diminishing of the cognitive effects.
Learn what legal rights you may have if your loved one developed a UTI at a nursing home.
How quickly can cognitive symptoms from a UTI appear, and how long do they last?
Schenk:
How long is that typical antibiotic treatment? Is, are we talking a month, weeks?
Puckett:
It, no. Typically, for a, a, a. Just a regular UTI that, maybe comes on every now and then you’re gonna be looking at a round of about seven to 10 days of an antibiotic.
And of course there are different ones that they use. It just depends on the physician’s preference and also whatever the, they typically will also do a culture maybe on the urine to see what the, what bacteria it is, what it’s sensitive to. So they’ll give the patient that specific antibiotic. But usually you’re looking at around seven to 10 days.
Repeated infections may signal mistreatment—explore whether multiple UTIs could be a sign of nursing home neglect.
Schenk:
It’s interesting to me in the course of doing this podcast, learning that it’s the cognitive symptoms that are the best indicators of the UTI versus anything in terms of like frequency of urination, the smell or the color of the urine. It’s the cognition. That’s the first warning signs. Yes.
Is that something as a nurse of 30 plus years, like it, that’s something that you should know, right? As a nurse, like that? That is correct. That’s what you’re looking for.
Puckett:
Correct. And I will say it is, I feel like it’s pretty specific to the elderly population. If you or I, happen to come down to the UTI, we are not ty, we’re not gonna have those symptoms like that, like they do.
It’s. Research is showing that this is basically a reaction to, it’s an inflammatory response reaction to the infection itself. And for whatever reason, typically because they’re older and more compromised, it’s going to affect that population more. Again, you and I, we could probably, we’ll notice it real quick with urinary symptoms. We’ll get on our cipro or macro bit or whatever. We’ll take it for a few days and within probably two or three days we’ll start feeling better. But it just tends to take a lot of things, it just takes longer in the elderly population.
Find out whether a urinary tract infection can lead to death in nursing home residents.
Schenk:
Okay, so we have typical antibiotics lasting seven to 10 days or so. And then what, like what happens if the symptoms don’t get better? What’s the next step after that? What are we looking out for? What are we gonna do?
Puckett:
Where this is, like I said, where typically you would then progress to probably getting a urine culture which is where you take a sample, goes to the lab and it, they actually see what grows out after a period of days to see what the specific organism is that you’re dealing with.
And then you know exactly what it’s susceptible to and what it’s resistant to in terms of being able to treat it. Of course, the worst case scenario you may be looking at. IV type antibiotics that you might have to be inpatient for. That doesn’t happen too frequently, I don’t think, but it’s a possibility it can happen. And a lot of this also depends on how compromised the patient is otherwise with, a litany of other things that could be potentially going on as well.
Families have legal options when a nursing home resident walks out unsupervised.
How can caregivers and nursing home staff recognize and respond to UTI-related cognitive changes?
Schenk:
What in general is the difference between the information that you get from a urinalysis versus a culture?
Puckett:
So the urinalysis is basically just gonna tell you if there’s blood in the urine, if there’s any protein, if there’s bacteria, they’ll tell you the specific gravity of the urine, just your basic information about it.
The culture is, like I said, where they send it to the lab and they actually. I think they put it on a little Petri dish. I’m pretty sure we did that in school. And they actually let it grow out. And then they, after they, after a certain number of days, they check it and they determine what the actual organism is. ’cause usually what happens is with a, when you get a urinalysis back and you’ve determined that yes, you do have an infection.
Signs and Symptoms of UTIs in Nursing Homes helps families understand early indicators.
We don’t know exactly what it is, but we’re gonna throw a broad spectrum antibiotic at it just to see if we can cover everything and see if we can take care of it with that. If it seems to be resistant and it’s not clearing up, then you move forward with the culture, get more in depth with it and see what’s, what are we resistant to? What are we susceptible to?
Episode 87: Preventing UTIs in Georgia Nursing Homes offers insight into infection control and resident care.
Schenk:
In your experience, has there ever been a time where you’ve skipped the urinalysis test and went and go to a culture, or is that just, that’s just not done?
Puckett:
I have not ever seen that done, I’ll be honest with you. It’s mainly because the culture is gonna cost more, right? So urinalysis is usually cheaper. Less invasive way to start things. Sure. I, one of the things I was gonna say too, that is really important with UTIs, and I had touched briefly on if patients or family and friends come to visit them, and a lot of times they are sometimes the first people to notice that something is off with these people.
It’s, of course as nurses, we see them every day, but the family and friends that are closest to ’em, a lot of times will be the ones to say. Something’s off with her. She’s, and ’cause they know those people better than we do for sure.
In Can You Sue a Nursing Home for UTIs?, we examine liability and warning signs.
Schenk:
Very well said. Tiffany, thank you so much for coming on the show and You’re welcome. Sharing your knowledge.
Puckett:
Awesome. You’re welcome. Thank you for having me.
Schenk:
Sure. Have a great day. Folks. I hope that you found this episode educational. If you have an idea for a topic that you would like for me to talk about, please let me know. If you have an idea for somebody you want me to talk to, please let me know that as well as always.
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