Introduction
Paty Jefferson is a 64-year-old female in the emergency department complaining of increased micturition urgency, abdominal pain, and discomfort during urination over the last few weeks. Her urine sample was taken, and the urine culture was 107 CFU/mL of Escherichia coli (Odongo et al., 2020). The lady had visited the hospital over three times, and past medical history reveals they have diagnosed her ten times within the past five years with five cases of ascending UTIs. The practitioners used antimicrobial agents like fluoroquinolones and cephalosporins during the hospital visits, and the lady’s condition improved (de Souza da-Silva et al., 2020). The woman has diabetes and is on insulin therapy at Longhorn Hospital. She is married to Jackson White, and there is a confirmation that the lady is still sexually active. The doctor kept the personal information about the woman secret. They recorded her first case of UTI when she was 17 years old after she was married. A diagnosis of the following UTI was when she was 50 years old and her blood sample showed bacteremia.
The doctors administered cephalosporin and cefazolin during the current hospital visits, and the patient’s condition did not improve. The practitioners thought of the microbe’s resistance toward the agent (Lee et al., 2018). The medical personnel administered nitrofurantoin and fosfomycin, and the patient’s condition improved. The patient was discharged eight days after restoring her health and was always advised to urinate after sexual activity. Doctors gave her some antimicrobials to use for her therapy at home. In the therapeutic management of UTIs, co-trimoxazole, fosfomycin, and nitrofurantoin are the first-choice microbial agents. Medical practitioners advise the ladies to maintain a high level of hygiene as poor hygiene causes some UTIs. Frequent changing sanitary pads and avoiding antibacterial soaps can help reduce UTI cases, especially in premenopausal women. Antibacterial soaps kill important commensal bacteria in the female reproductive tract, favoring colonization by pathogenic bacterial strains.
Health education is vital in sensitizing patients who have diverted away from the prescribed management of UTIs. The advice for following the prescription is to the ladies, improving their seriousness of taking the medications (Ahmadi et al., 2020). The women are also advised to wipe from front to back after urinating. It helps reduce the chance of the gram-negative bacteria in the gut gaining entry into the urinary tract. The ladies are also encouraged to wear dry pants and always keep the genital area clean. Plenty of water should be taken by females to help wash away the bacteria in the urinary tract. Any female who suspects having a UTI should visit a doctor for the best advice.
Diagnosis, Management, and Resolution of UTIs caused by Escherichia coli
For the best diagnostic procedure, I would request a urine sample from Paty Jefferson and send it to the lab for further investigation. The laboratory technician is supposed to culture the urine and use Gram’s staining method to detect the microbes in the sample (Tripathi & Sapra, 2020). A high concentration of many gram-negative bacteria in the culture may show UTI because of Escherichia coli. The above diagnostic procedure for UTIs caused by Escherichia coli is appropriate and in line with the diagnostic metrics guideline. The practitioners used a combination of mecillinam and cefotaxime to manage the condition. They did the management in the best way by stopping the use of antimicrobial agents like cefazolin to which the patient had developed resistance. Recent evidence also showed that some patients had resistance toward ampicillin and co-trimoxazole (Alanazi et al., 2018). These drugs were used together with other antimicrobial agents to reduce this resistance. Mecillinam and cefotaxime can effectively treat a wide range of multidrug-resistant Escherichia coli.
In recent years, the resistance of Escherichia coli to a wide range of antimicrobial agents has increased. The microbe has become more resistant to ampicillin, ampicillin-sulbactam, co-trimoxazole, and levofloxacin (Ramírez-Castillo et al., 2018). Clinical data shows that most Escherichia coli strains are highly susceptible to mecillinam and cefotaxime (Zykov et al., 2020). It thus indicates that these drugs can manage UTIs caused by Escherichia coli in a case of suspected antimicrobial resistance. The lady’s advanced age, diabetes, and sexual activity make it hard for the condition to be entirely resolute. Diabetes increases the chance of developing UTI, and postmenopausal women lack the protection offered by estrogen to prevent the growth of pathogenic bacteria in the reproductive tract (Chita et al., 2016). The prolonged use of antibiotics may lead to resistance to a wide range of antibiotics.
Palliative Nursing Care in Terminally Ill Pancreatic Cancer Patients
In modern-day lives, the emergency and critical care by nurses for terminally ill patients is increasing. These nurses have a role in devising the treatment plans for Mrs. D’Angelo, who is critically fighting for her life (Frey et al., 2019). The health practitioner approaching Mrs. D’Angelo’s case needs to be honest and tell her about her condition (Kirkbride, 2018). These practitioners can even visit the homes of terminally ill patients like D’Angelo and offer psychological support to the challenges of pancreatic cancer. The nurse should also listen to the patient as it helps improve their psychological well-being. Answer the questions asked by the sick and the relatives of the ill.
Conclusion
Complicated legal and ethical decisions will always face nursing palliative care for terminally ill patients. There is a legal basis for stopping life-sustaining treatment in sick terminally patients and even the fear of speeding up death by administering opioids and sedatives (NT Contributor, 2018). A patient may be in deep pain, but a nurse may face ethical and legal dilemmas regarding administering sedatives or analgesics as they speed up the death process. It is even unlawful to direct a life-sustaining patient who does not want it. Effective communication must be part of the nurse with Mrs. D’Angelo and the patient’s family (Arahata et al., 2018). Physicians should provide detailed information to the sick and her relatives regarding the state of the patient’s illness throughout the course. Listening to and responding to their questions is a crucial strategy.
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