I am upset that mom's PCP did not suspect this possibility instead of dementia. Her meds for HPB have never been adjusted despite her extreme weight loss in the last 4 years. I took her to ER after reading an article about UTI's and dehydration causing confusion and memory issues. I feel terrible !
What should I do next ??
It is good to remember that all nurses and Dr's are not necessarily trained in all the areas they are practicing in. A very good PCG may have absolutely no experience with dementia and not know what to look for. A nurse with an acute care background is used to infections presenting with high fevers. yes she should know if she is working with hospice patients but anyone new to hospice has a very steep learning curve to climb and there is no special training. Another thing to consider is whether you want to put your loved one through the discomfort of antibiotics when they will feel nausious, off their food and have diarrhea.
Anyone who feels their loved on has a lot of quality of life ahead of them and wants agressive treatment for things like UTI should take the patient to see a specialist. Some Drs will treat frequent UTIs with various combinations of continuous antibiotics. Maybe 2 weeks on drug A then 2 weeks off and two weeks of drug B. the caregivers do have to do their part though keeping the patient really clean and changed as soon as they are wet. a warm wet depends is an ideal breeding ground for nasty bugs. You changed your babies every few hours and washed their nether regions so it is just as important to do the same with the elders. As we age weare less concerned with personal hygiene and consider a quick swipe with a wet wipe is good enough. It isn't, the genital area needs to cleaned with warm water and possibly soap at least twice daily with someone who gets frequent UTIs. use good quality paper towels for this Handwashing must also be supervised. yes you may have a fight on your hands but that may be better than three nights of hallucinations and wandering till the antibiotic kicks in.
It is also very very important for the correct antibiotic to be prescribed and this means a specimen has to be sent to the lab for what are called culture and sensitivities. The urine is spread on an agar plate and discs of common antibiotics are spread around. the pathologist looks at the bugs that have grown and can identify them and sees which areas are clear around the antibiotic discs. that way he knows which antibiotic shouls be prescribed. That may be the test the Dr said would not be covered frequently by Medicare as it is probably quite expensive.
Would of, should of, could of...... Hindsight is twenty twenty I guess. :(