reply to this discussion 3 references needed sha
What are some appropriate questions to ask the patient?
- How long have you been experiencing these symptoms?
- Is there pain anywhere specifically in your back, a certain side, etc.?
- Is the pain constant or does it come a go?
- How would you describe the pain, burning, aching, and throbbing? How would you describe your urine, dark, amber, or light yellow? Is there any blood that you notice? Any mucus at all?
- What makes your symptoms worse?
- Have you had a fever at all within this time?
- What have you used to ease these symptoms?
- Did those interventions help ease your symptoms at all?
(Arnold, 2016).
What are three differential diagnoses for the patient?
- Cystitis
- Bacterial Vaginitis
- Urinary tract infection
(Up To Date, 2020).
What physical examination would you perform?
After introducing myself and washing my hands, I would first get a thorough HPI with the questions listed above. Then I would observe ears, nose throat, heart tones and lung sounds, abdominal sounds. Palpate abdominal cavity. Percuss lower lumbar regions over the kidneys (bilateral) to assess for a dull sound.
What diagnostics would you include?
- Urine analysis with culture and sensitivity (Price et. al., 2018).
- Computed tomography of the abdomen and pelvis (Price et. al., 2018).
- Vaginal pH testing (Onderdonk et. al., 2016).
Create an evidenced-based plan of care. Include pharmacological and non-pharmacological treatments.
|
Antimicrobials |
|
|
Medication |
Dose |
|
Nitrofurantoin (Macrobid) |
Take 100 mg by mouth daily for 5 days |
|
Fosfomycin |
3 Grams of Powder mixed in water as a single oral dose |
|
Pivmecillinam |
400 mg by mouth twice a day for 5-7 days |
(Up To Date, 2020).
|
NSAID |
|
|
Ibuprofen |
Take 400mg three times a day by mouth as needed for pain for three days |
(Up To Date, 2020).
|
Urinary Analgesic |
|
|
Phenazopyridine (pyridium) |
Take two (190 mg) tabs three times a day with meals for up to 2 days. |
(Up To Date, 2020).
References
Arnold, J. J., Hehn, L. E., & Klein, D. A. (2016). Common questions about recurrent
urinary tract infections in women. American family physician, 93(7), 560-569.
Onderdonk, A. B., Delaney, M. L., & Fichorova, R. N. (2016). The human microbiome
during bacterial vaginosis. Clinical microbiology reviews, 29(2), 223-238.
Price, T. K., Hilt, E. E., Dune, T. J., Mueller, E. R., Wolfe, A. J., & Brubaker, L. (2018).
Urine trouble: should we think differently about UTI?. International urogynecology journal, 29(2), 205-210.
Up To Date. (2020). Acute simple cystitis in women. Retrieved from
https://www.uptodate.com/contents/acute-simple-cys… on 14 March 2020.
