Case #1: A 55-year-old woman presents to the office with bloody urine and dysuria
of 12-hour duration. She was recently married and has never had similar
symptoms. She denies chills and fever. On physical examination she is afebrile, has normal vital signs, and has mild tenderness in the midline above the pubis. Her urinalysis shows too many to count (TNTC) red blood cells.
1. What is the definition of bacteriuria? Bacteriuria is the presence of bacteria in the urine (Huether & McCance 2018, p.1256).
Asymptomatic bacteriuria is the presence of bacteria in the urine with no signs or symptoms of a UTI (Cai et al, 2016).
2. What additional history do you need to make a diagnosis? The onset of symptoms and a thorough medical history is needed for diagnosis.
3. What diagnostic studies would you order and why? I would order a urinalysis and a urine culture. A urinalysis is a diagnostic procedure obtained from a fresh, cleanly voided specimen (Huether & McCance 2018, p.1256). It includes urine color evaluation, turbidity, protein, pH, specific gravity, sediment, and supernatant. There are few or no red blood cells in normal urine (Huether & McCance 2018, p.1256). A large number of red blood cells in urine is hematuria (Huether & McCance 2018, p.1256). The urine sediment may be red or brown. A urine culture is also from freshly voided urine. To diagnose an uncomplicated uti, urine is tested for positive leukocyte esterase or nitrite reductase (Huether & McCance 2018, p.1256). If bacteria is found in the urine, the urine culture and antibiotic sensitivity warrants treatment with microorganism specific antibiotics (Huether & McCance 2018, p.1256). Follow up urine cultures should be done 1 week after treatment has started.