A 92-year-old patient with mild dementia, chronic kidney dis…
A 92-year-old patient with mild dementia, chronic kidney disease stage 4 (GFR = 25ml/min), and arthritis is seen for two days of new-onset urinary incontinence. She has had increased urinary frequency and inability to get to the bathroom in time due to her severe arthritis. This is the first time she has had these symptoms in the past several years. She also has some worsening confusion from her baseline and has been more sleepy. On exam, she is a thin, frail female with a BMI of 14 and a weight of 47 kg (103.6 lbs). She is not as attentive as is typical. Her vital signs and physical exam are normal other than vaginal atrophy. Urinalysis is done and shows > 100 WBC, leukocyte esterase, nitrites, many bacteria, with no squamous cells. Specific gravity is 1.004. Culture is pending. She only takes a multivitamin and calcium and is on no other medications and has no allergies. What is the best next step?
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