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Table 1 Signs and symptoms of UTI expressed by different agents; the patient, her daughter and the health-care system

From: Complicated versus complexity: when an old woman and her daughter meet the health care system

The encounters between agents is enacted through expressions of signs and symptoms

Daughter

Esther

RETTS

National guideline

ICD 10

Medical record

Mother was not her usual self, was not feeling well, was not OK, never been in such a condition, seemed to be feeling down, hysterical, sweating, crying, wailing, hyperventilating, seemed confused, picking with her fingers, seemed to disappear mentally, did not know where she is, not aware of what is happening. Her personality had completely changed, like she was demented.

I thought I was dead, I had no sense of time, I could not speak. It was like a cramp, I felt I was crazy

Green: Regularly checkups by nursing assistant, temperature 35 °C - 38.5 °C. Examination by physician within 240 min [13]

In women > 15 years of age

New inconvenience of two of the following symptoms; smart, urgency and increased frequency of urination.

Note: Non-specific symptoms, such as tiredness and confusion, should not be considered as UTI [29], SKR 2011 [26], STRAMA 2017 [28], Folkhälsomyndigheten 2019 [27].

F419P

Unspecified anxiety

R699

Unknown and unspecified causes of morbidity

R410

Disorientated, unspecified confusion

Excludes

Psychogenic confusion (F44.8) [30]

Physical status: Normal, delayed reflex responses, good sleep.

Cognitive status: Anxiety, confusion, picking with her hands, shaking, hyperventilate, disoriented, difficulty in finding words, babbles, do not follow instructions, cannot be alone.

Biochemical markers: Normal, urine dipstick strong indication of UTI, CRP 69.

Diagnosis: F419P. R 410 Confusion Unspecified anxiety, R 699, Hyponatremia, UTI [30]

  1. UTI Urinary tract infection. The patient: 90-year-old Esther; the daughter; National guidelines; (International Classification of Diseases (ICD 10); Rapid emergency triage and treatment system (RETTS). Condensed extracts from data in the case is not time-dependent [13, 26,27,28,29,30]