CASE STUDY

 

John Gower is a 78-year old Australian Aboriginal man who is living alone in remote Community. He was found collapsed at home by his grandson Simon; ambulance was called and he was transferred to the Emergency Department of Royal Melbourne Hospital. He worked as a manual labourer, often smoking during outdoor work in Melbourne 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 Renal Department for further investigation and treatment. A urine analysis reveals:+ RBC ++ albumin+++ nitrates+ leucocytes++ glucose+ ketones and specific gravity 1.025.
Questions: Answer all 4 questions (word count: 250 words each per question excluding references)
1. Provide a basis for the connection between urinary tract infections (UTI) and acute kidney disease (AKD).

2. Explain the clinical association or relationship between UTI and confusion in the elderly.

3. Describe why John’s classical clinical signs have climbed now.

4. What therapy is needed for John?