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Hi all! First post!



My dad just moved to a new nursing home 3/18/2022. Before that he was at another facility.



He can't control his urination or his feces. He had an undetected urinary tract infection that flash forward to Wednesday became sepsis and septic shock. THANKFULLY he is doing so much better and it looks like he's nearly out of the woods.



Now I don't want to take all the blame out on his nurses as I know (or would assume) that in order to detect a urinary tract infection one would need output from the individual. I don't know if my dad had been telling them anything or what. His BP has been so low that it's been hard to communicate with him and those questions haven't been on the forefront of my mind.



Would it be unreasonable for me to request a move within his current facility just in case he has an inexperienced nurse? I know they have to be able to clean him very well to prevent bacteria from his feces to get inside his penis.



How does a nursing staff detect a UTI before it becomes sepsis?



My dad just broke his hip about 2 months ago so it could be that him complaining of soreness in that general area could have been confused for the UTI?



Thank you!

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When my mom gets them, she becomes more confused, paranoid, and very tired. She has had 6 different UTI’s in memory care. I can spot hers right away by noticing these behaviors. However, there’s so much staff turnover and different shifts that our loved ones can get lost in the shuffle. I even had to fight her primary Dr to test her for UTI because he just wanted to raise her dosage of Seroquel. She even had a UTI with pneumonia. The only symptoms she had with that one was extra confusion and wanted to sleep all the time. Since she had no fever and vitals were good, they assumed it was just her dementia getting worse. If I hadn’t fought for her to get looked over, she probably wouldn’t be with us now. I also had to fight for her to get two showers a week and make sure they check if she soiled her pull up. They now document what clothes she wears everyday so the staff knows if she’s been changed. This happened because I saw she was in her same clothes, night and day, through a weekend.
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Moving room will not do any good. You think that if that is done he will have a different, more experienced team to care for him? CNA's take care of the large majority of those kinds of things, most inexperienced medical team members. Dad likely has had this infection for a long time. How often do you visit him? Did you notice any change yourself? Family could very well detect something is wrong before any staff would. Elderly do not experience the same discomfort with UTI's that younger people do.
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Hi!

I've had a lot of experience with elderly male members in my family getting UTIs (and sepsis). Luckily every time, OK after hospital.

If the person has a catheter: more likely to get UTIs. The catheter must be kept clean. Even so, you can still get UTIs.

Keep in mind, that in facilities/hospitals, you can more easily catch resistant bacteria ---- resistant bacteria can't be killed with antibiotics. For this reason also, the UTI might come back again and again.

"How does a nursing staff detect a UTI before it becomes sepsis?"

Your father doesn't need to say anything.

The signs are quite obvious sometimes. Sometimes, more subtle. My family members said nothing. It was the aides (very competent) at home who noticed.

Here signs (examples of what to look for). My elderly male family members:
- fever (but my family members never had fever)
- very tired, don't want to get out of bed (every time there was big UTI)
- feel very weak (every time)
- sometimes suddenly in a bad mood, speaking a little strangely (not every time)
- more dizzy than usual
- color of urine is darker than usual
- urine can have little stones, or sediment
- sometimes pain in private area (not necessarily) (my family members, never)
- wanting to urinate more frequently (my family members never)

"My dad just broke his hip about 2 months ago so it could be that him complaining of soreness in that general area could have been confused for the UTI?"

I don't think so.
UTIs in males have the symptoms I outlined above.

Small UTIs can be solved with simply drinking more water. Not all UTIs need to be treated with antibiotics. Antibiotics have side-effects too. Not very good for the stomach.

BIG UTIs can lead to sepsis, and must be treated quickly at hospital.

In order to help prevent UTIs, drink lots of water daily. Your father might need to be forced to drink water (we had to force my male family members).
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The problem with UTIs in older people is there is no symptoms like in younger people. No burning, no itching. The people you are talking about that clean him up are certified aides not Nurses. RNs rarely do the dirty work. As an aide they have no medical training. They may learn a long the way to notice signs and report them but thats about it.

Your father has a Dementia and probably cannot express to an aide or nurse how he is feeling. He may not realize any symptoms he has had are symptoms. One of the UTI symptoms is confusion and aggressiveness a lot like Dementia. I do feel that him getting to the point of sepsis there should have been a noticeable symptom. A strong smell of urine for one, color for another. Even an aide should be aware of these symptoms.

UTIs are very serious in men. They can kill. Was Dad hospitalized or are they caring for him at the facility. If at the facility, I would question it. Did they do a culture to find out what bacteria is causing the problem? Is he on IV antibiotics? I don't think a pill will clear up a septic infection. IMO, and Alva will chime in, if Dad was not taken to a hospital, he should have been. NHs are limited in the kind of care they can give. I would make sure he is tested regularly for any signs of a UTI. Just because he has been on antibiotics and the UTI seems to have cleared up, it can come back. Your Dad may not bounce back right away. He needs to drink plenty of water. I would ask if he can have probiotic (should have been given this while on antibiotics) and cranberry tablets. This may help to keep the UTI at bay.

Having sepsis is serious. If Dad was not taken to the hospital, if he doesn't show signs of improvement tell the DON you want him sent to the hospital. If he contracts a UTI again, hospital. Anytime you feel Dad needs hospitalization and the facility doesn't send him you are within your rights to call an ambulance.

Why the low B/P. If he is on B/P medication, they need to lower the dosage or take him off. If not, what do they say the problem is?

Changing Dads room will not give him better care. He just may not have shown any signs. To be honest, he could have had this infection at the other facility. We r pretty sure my MIL had a UTI when we visited one Thanksgiving. SIL visiting at Christmas felt MIL didn't look or act well. Was complaining about her her back but Dr never checked for UTI. The very end of January she was found laying on her living room floor delirious. She was taken to the hospital and found it was a UTI. We think she had it for 2 months.
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Bryant2016 Apr 2, 2022
Hi JoAnn.

I am looking at his Medicare. They billed for labs the 28th, the 29th, and the 30th from the nursing home. They never communicated to me anything about the 28th or the 29th.

The 30th was when he was admitted to the hospital in septic shock.

Would this indicate that they were trying to keep it in house the 28th and the 29th? There had to be some reasoning that they were running tests, right? The woman on the phone from the nursing homs told me it was out of their realm of care so they sent him to the hospital when she called me on the 30th. She also told me his white blood cell count was low (it was high) His b.u.n. was low (it was high) and his creatine (sp?) Was low (it was high)

So I have no idea who this woman was. I just got my butt to the hospital.

No one has made communication to me from the nursing home since. I have reached out to his social worker on Wednesday for more details via phone and email. I think she's avoiding me.
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In any nursing home the nurses do almost zero care of the patients. It is almost all done by aids with the RN doing paperwork and sometimes medications, and an initial assessment or two. Sepsis of any kind is not going to be found until quite late. My brother died of Sepsis from a small untreated ulcer, non healing, he ignored and self treated on his shin. It killed quickly enough when the antibiotics IV were not effective as they so often are not today.
Urinary tract infections in an incontinent male are not caught as often as in females because they are more common in females, more looked for. They don't affect intake and output and sepsis WORK VERY FAST to start shutting down bodily systems; your Dad was very lucky to survive it. My brother thought he had the "you know, flu I get every year" until he went really wonky one night and was transported to hospital where it was found.
I think it ALMOST as likely to have happened had Dad been in your own home, though I can't compare how the aids would cleanse and how quickly after incontinence.
Urinary infections are extremely common in elders. It is thought to be very underestimated how many die of sepsis and these infections. It is quite common. I am so glad your Dad seems to be recovering and know he is one lucky man.
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Bryant2016 Apr 2, 2022
Hi Alva, thanks for your reply. JoAnn mentioned you might be further help.

I noticed just now on my dad's Medicare that they did labs on him the 28th and 29th as well as the 30th which was when he was admitted to the hospital in septic shock.

Would this mean that they were possibly monitoring the situation in house instead of sending him to the hospital in the first place? Maybe his levels weren't horrible?
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I wouldn't raise the issue of moving "just in case", but would ask for a quick meeting with the DNO to discuss the issue, and what if any changes can be made to avoid another UTI.    Do you in fact know which nurse(s) might have been attending him?  If not, I certainly wouldn't infer that the then attending nurse (if it was a nurse and not a CNA) was in part at fault.

Since this apparently is a new facility, give them a chance to work with you by making suggestions as opposed to accusing.
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Sendhelp Apr 2, 2022
Director of Nursing?
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