Health Medical
NUR 505 Chamberlain University GU Case Study

NUR 505

chamberlain university

NUR

Question Description

Can you help me understand this Health & Medical question?

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A 28 year old G0 calls the office with complaints of lower abdominal pressure and urinary frequency. She has been in the office four times over this past year for dysuria and has been treated for UTI. She is sexually active on Apri for contraception. She has a negative GYN history. She feels her UTI symptoms seem to be occurring within 12 hours of intercourse.

PMH – PCOS
Medications – Loestrin 1/20, Mvi, Omega 3
Allergies – Ciprofloxacin

Vitals: T=98.4, B/P=118/72, Pulse = 84

Color, Urineyellow
Clarity, UrineTurbid
pH, Urine5.5
Glucose, UrineNegative
Protein, Urine100 mgdL
Ketones, UrineNegative
Blood, UrineLarge
NitritePositive
Leukocytes UrineLarge
Specific Gravity, Urine1.020
White Blood Cells, Urine818
Red Blood Cells, Urine>900
Bacteria, UrineMany
Hyaline Casts<=10

Culture results with >100,000 CFU/ML Escherichia coli

Escherichia coli Not Specified
Ampicillin<=8 ug/ml Sensitive
Ampicillin + Sulbactam<=1/.5 ug/ml Sensitive
Cefazolin<=2 ug/ml Sensitive
Cefepime<=2 ug/ml Sensitive
Ceftriaxone<=1 ug/ml Sensitive
Ciprofloxacin<=1 ug/ml Sensitive
Gentamicin<=1 ug/ml Sensitive
Nitrofurantoin<=32 ug/ml Sensitive
Tobramycin<=1 ug/ml Sensitive
Trimethoprim + Sulfamethoxazole<=2/38 ug/ml Sensitive
  1. What would you include in your focused physical exam?
  2. What diagnostic tests would you include today?
  3. What is your interpretation of these results?
  4. Would you select to treat this patient?
  5. What does MIC mean? How does it influence choosing a treatment?
  6. Explain your reasoning for selecting the treatment you chose.
  7. What would your choice be if she was pregnant?
  8. Explain why women are at higher risk for urinary tract infections.
  9. As you finish your visit she asks, “What can I do to prevent this from happening?” How do you answer this question, and what can she do to prevent them from happening in conjunction with sexual relations?

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Final Answer

Attached.

Running Head: GU CASE STUDY

1

GU Case Study
Name
Institutional Affiliation
Date

GU CASE STUDY

2

Question 1: In this case study, it is evident that the patient has a recurrent urinary tract
infection, possibly acute pyelonephritis. Therefore the concern is to find more information
regarding the urinary tract infection and be able to rule out other possible conditions. Often
women presenting with urinary tract infections have suprapubic and costovertebral angle
tenderness (key finding); it is necessary to examine these areas as it will help rule out vaginitis,
cervicitis, or possible pelvic tenderness which may suggest pelvic inflammatory disease
(American College of Obstetricians and Gynecologists, 2008).
Similarly, while culture results show the presence of E. coli, it is appropriate to examine
extremities for clamminess or orthostatic as this may show poor vascular tone, which is often
linked to gram-negative bacteremia and will rule out uncomplicated cystitis (Simerville, Maxted
& Pahira, 2005). History about vomiting, nausea, chills, and fever above 38 degrees Celsius is
essential since they may suggest pyelonephritis instead of cystitis. It is vital to know about the
pain, its location, and its severity. Often acute pyelonephritis presents with moderate to severe or
flank pain mostly in the abdominal region while cystitis tends to the around the suprapubic area
and is mild to moderate. The patient is sexually active and seemingly has recurrent urinary tract
infection; thus, it is appropriate to enquire about the sexual partner, whether she has new sexual
partners or one partner. Lastly, it is crucial to check the urine amount, smell, and whether cloudy.
Question 2: The patient has a hyaline cast, which may lead to possible blockage in the
flow of urine, causing the urgency with a reduced amount of urine (Simerville, Maxted & Pahira,
2005). Also, she has a history of urinary tract infection for sometimes, and it seems there is
underlying causing. Thus voiding cystourethrogram is crucial to examine how the bladder and
urethra empties, fills and identify a possible defective bladder emptying...

Chancellor_Ivy (21999)
Carnegie Mellon University

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