ADVICE ON CAREGIVING

Proactive Managment of Cronic UTIs

Managing Constantly Present UTIs in the Urinary Tract.

One of the most persistent and potentially dangerous problems that disabled seniors with late stage Dementia have to live with are multiple UTI bacteria which consistently exist in their urinary tract. Here is my personal experience as a Caregiver.

There can be several reasons why this happens. With our mom, the reason had been partially due to kidney stones.  And her weakened immune system had not been strong enough to render these residing organisms completely harmless even with the aid of antibiotics.  So, these bacteria ended up ever present in certain localized areas in the body.

This situation is especially true for, what I consider, “special needs” seniors with two or more other physical ailments. These types of people                 are essentially confined to the bed. They have to be turned and fed by g-tube.  And most often Nursing Homes are not the ideal place for them. The majority of them do not talk. They have contractures and they are incontinent. More important, they are totally dependent on the care of a live-in primary caregiver.  It is for these reasons that they are considered “special needs”.

The goal then becomes not to get rid of the infections, but to manage or control their severity.  If these germs are not treated and/or properly managed, they can cause some real damage like kidney failure or death.  

Understand, however, that many bacteria reside in the body with symbiotic relationships. It is when certain ones unintentionally are allowed to compromise (via wounds and surgeries) their unique living arrangements that they then can create damage.

First, what are UTI?  According to The National Kidney and Urologic Diseases Information Clearinghouse, it is an infection in the urinary tract. 1 in 5 women will experience UTIs in her lifetime. These infections are caused by microbes which are organisms too small to be seen without a microscope. This includes fungi, viruses, and bacteria. However, bacteria are the most common cause of UTIs. There are basically three kinds of UTIs:

      1. Urethritis is an infection in the urethra.

      2. Cystitis is an infection in the bladder.

      3. Pyelonephritis is an infection in the kidneys

So, what are some of the names of the bacteria which can cause so much damage in the body? Three of the most recognized are: (a) Escherichia coli, (b) Klebsiella pneumoniae, (c) Streptococcus epidermidis.

Managing them can be tricky and a real inconvenience.  Every time my mom had urine samples done at the hospital or clinic, two of these bacteria are always more prominent in my mom’s urine than some others: Escherichia coli and Klebsiella. Her doctors had decided years ago to keep her on a low dose maintenance of antibiotics at home to control them. They also become resistant to certain antibiotics.  Whenever these germs occasionally did manage to progress to a more dangerous level–for whatever reasons–they required us to take our mother to the hospital for a few rounds of intravenous antibiotics. That usually stabilized any potential harm.

At home, however, we eventually had learned how to manage these infections in our mom by way of monitoring, early detection, proper hydration and vitamin intake. These routines should be performed daily to ascertain that the level of bacteria growth in her system remains low.

MONITORING THE URINE:

    • Visually check the adult underwear throughout the day. Whenever it becomes full and ready to be discarded, always check the color, odor and volume of the urine.

    • Make a note of it in a daily care journal. Usually, foul smelling urine, bad color and/or low urine volume mean that the status of severity has increased.

    • Remember. All three of these areas of concern (color, odor and volume) might not progress at the same rate.  Only one area might be noticeably dominant.

    • Always consider these three areas in relationship to each other. Check the urine often.

When the odor is noticeably foul and/or strong, chances are likely that the infection has multiplied to a dangerous level.

Lemon yellow is the normal color of urine. Light, medium or dark tea colors signifies guarded caution. Rust or Red colors means full alert–SOME APPROPRIATE AND TIMELY ACTION MUST BE TAKEN!!  

The volume of urine is important as well. Water in; water out! If there is not sufficient amount of urine in the adult underwear, it might mean that your senior could be withholding voiding for fear of pain which means the infection has elevated. It could also mean possible blockage–especially if the senior has kidney stones. You may need to call your doctor if that condition continues–especially if it is accompanied by higher body temperatures or other related symptoms.

EARLY DETECTION IS KEY:

    • When looking at the color of the urine in a soiled adult underwear, make note of first signs of discoloration and odor.

    • Journalize the advent of the change and watch its progress.

    • Slow down the rate of growth, if possible.  Sometimes simply giving the patient more water or some kind of acidic juice can slow the growth of the germ.

    • Continue to maintain daily ingestion of maintenance antibiotic.  Your daily recordings ae your early detection tool.

PROPER HYDRATION:

    • The Institute of Medicine determined that an adequate intake (AI) for men is roughly 3 liters (about 13 cups) of total beverages a day. The (AI) for women is 2.2 liters (about 9 cups) of total beverages a day. So how much water is enough to employ as a tool to control constant UTIs in the urine.

    • Too much water can cause hyponatremia . It is a condition where more than normal amounts of sodium is flushed out of the system from drinking too much water. Marathon runners can experience this condition when drinking excessive amounts of H20.

    • We discussed with our mom’s urologist and doctor about finding a workable consumption of water to help treat UTIs and to help flush out Kidney stones.  Water can be a useful tool in managing UTIs. Remember:  Each doctor often has a different opinion.  At home, we had been following different doctors’ advice for years and found that every one of them had a different opinion to offer.

    • Ultimately it depends on the caregiver to take notes, closely monitor his love one’s water-infection rate relationship and act accordingly. High tempts can signify elevated growth. All in all, it had been my experience to hear one doctors tell us his advice and then we get blamed by another doctor when the previous advice didn’t  “pan out”.  

    • The key to this water technique of controlling UTIs is to make scheduled visits to the doctor and/or clinic and have complete blood work done  Lab reports will show current changes in the levels of sodium or potassium in the bloodstream. Thus, water can indeed be a useful flushing technique in controlling the growth of permanently residing or recurrent infections in the urinary tract.

 VITAMIN INTAKE:

    • Vitamin C is a good source of ascorbic acid. When the urinary tract is coated with a sufficient amount of acid, germs find a difficult time sticking to the surface. Vitamin C can limit bacteria growth.

    • Cranberry juice is often praised by doctors and nurses as the number one juice which inhibits the growth of UTIs.  What they fail to also mention is that if your ailing senior has kidney stones, cranberry juice often exacerbate the condition as it creates stones as well.

    • Remember:  Cranberry juice is not the only juice that contains ascorbic acid. Lime, lemon or a simple vitamin C tab can be an adequate substitute for Cranberry juice.

    • Make sure that vitamin C is a daily part of your Senior’s diet.

So yes.  These diseases can be a menace! Everyone’s body is different.  However chronic or ever present UTIs can be managed with a plan that should be collaborated between the primary caregiver and the doctor.   Talk with him or her about a water and low dose antibiotic regimen.  It worked for my mom.

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