He was found collapsed at home by his grandson Simon; St John ambulance was called and he was transferred to the Emergency Department of Royal Darwin Hospital, Tiwi, NT. He worked as a manual labourer, often smoking during outdoor work in Palmerston City Council, as he mainly worked alone. On presentation to the triage,
His clinical signs are:
Temperature: 40 degree Celsius
Pulse: 102 bpm
Respiratory rate: 26 breaths/minute
BP: 90/60 mmHg.
John is conscious at the Emergency Department, however confused to time. He has a past medical history of congestive heart failure and asthma. He requests to go to the toilet and you assist him onto a bedpan. He voids 80 ml of dark, cloudy concentrated and highly offensive smelling urine. Flank pain is observed. The Emergency physician recommended moving John into inpatient ward in the NT Renal Department for further investigation and treatment.
A urine analysis reveals:
+ RBC
++ albumin
+++ nitrates
+ leucocytes
++ glucose
+ ketones and specific gravity 1.025.
INSTRUCTIONS
- You will be answering FOUR questions;
- Brief introduction answer to the question and a conclusion is expected for each question.
- Each answer is worth of 250 words;
Questions
- Provide a basis for the connection between urinary tract infections (UTI) and acute kidney disease (AKD).
- Explain the clinical association or relationship between UTI and confusion in the elderly.
- Describe why John’s classical clinical signs have climbed now.
- What therapy is needed for John?
