What did you find interesting about their response?

Discussion Peer/Participation Prompt Due Sunday by 11:59 pm
Instructions:
Please respond to two peers’ posts regarding their differential diagnosis list and/or plan.

What did you find interesting about their response?
How did their differential diagnosis list or plan compare to yours?
Do you agree with their plan and recommendations?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Estimated time to complete: 2 hours

i will provide each peers repsonse please use updated refererences

peer#1

Peter Rayis
Jul 4, 2022Jul 4 at 3:04pm
Unit 9 Discussion – GI and GU Evaluation
Pertinent Positives

Subjective:

3-day hx of dysuria (i.e., burning upon urination), increased urinary urgency with reduced flow/inability to produce urine, and increased frequency (i.e., up to 6-8x/day).
1-day history of lower abdominal pain (began yesterday)
Pain is worst when she goes to the bathroom to urinate but cannot produce urine.
Pain decreases slightly between urinary urgency episodes.
Rates today’s pain level a 6 out of 10.
Tylenol provided some relief.
Pain has been worsening since onset 3 days ago.
Reports of fever, chills, nausea, and 1 episode of vomiting today.
Patient believes she has a UTI, as she experienced similar symptoms a few years ago.
Denies changes in mood
Objective:

Costovertebral angle (CVA) tenderness
Suprapubic tenderness.
Pertinent Negatives

Subjective:

Not currently sexually active
Denies incontinence
States she noticed some swelling to neck glands
Does not receive regular flu vaccine
Cooks frozen foods or eats out.
Denies constipation, diarrhea, bloating, loss of appetite, epigastric pain
Denies unexplained change in weight
Objective:

Normal vital signs (i.e., no presence of fever).
Negative for lymphadenopathy
Abdomen is nontender, no hepatosplenomegaly, active bowel sounds, and no bruits.
No scoliosis.
No change in functional status, ambulates without assistance.
Assessment (ICD10data.com, 2022):

N10 – Acute pyelonephritis

N39.0 – Urinary tract infection, site not specified

N30.00 – Acute cystitis without hematuria

R30.0 – Dysuria

Additional information:

When was the last dosage of Tylenol taken, and how much?
Ask about her energy levels, fatigue?
Have you noticed any blood tinged, or change in color of urination?
Is the urine cloudy in appearance or have a foul-smelling odor?
Have you been sexually active in the past, if so, when was the last time?
Any prior history of pregnancy?
Any recent trauma or illness?
Plan for Primary Diagnosis: N10 – Acute Pyelonephritis

Diagnostic: Obtain UA/culture; CBC, ESR, CRP, BUN, and creatinine; Imaging using renal ultrasound or CT scan to diagnosis (Maaks et al., 2020, pp. 826-828).

Therapeutic: Ciprofloxacin 1000 mg ER, PO, QD, 7 days (Hootan & Gupta, 2022).

Educational: Education provided to grandfather and patient about the various causes of acute pyelonephritis and UTI’s. Education provided regarding the goal of management, which includes the following (Maaks et al., 2020, p. 827): (1) determine the severity of infection; (2) eliminate the infection; (3) provide relief for current symptoms; (4) identify and correct any identified functional or anatomical abnormalities; and (5) prevent the reoccurrence and kidney damage. Education on proper hygiene, avoiding irritants (i.e., bubble baths, perfumed soaps, tight pants [spandex]), and wearing cotton underpants to prevent the reoccurrence of UTI’s (Maaks et al, 2020, p. 829). Additional guidance provided to patient including increasing fluid intake (water), avoiding bladder irritants (i.e., caffeine, carbonated drinks, chocolate, citrus, spicey foods), and voiding techniques such as scheduling voiding times, voiding with knees separated, and using double-voiding technique to ensure complete emptying of bladder. (Maaks et al, 2020, p. 829). Relating to prescribed antibiotics, patient instructed to take full course of antibiotics, even if symptoms improve in a few days. Lastly, instructed patient to seek emergen medical attention if fever is present for more than 48 hours (Maaks et al, 2020, p. 829).

Collaboration/consultation: If symptoms do not improve, refer to urologist for further evaluation and management with DMSA scan for suspicion of renal scarring and to confirm pyelonephritis (AUA, 2010/2017; as cited by Maak et al., 2020, p. 828).

References

Hooton, T.M., & Gupta, K. (2022). Acute complicated urinary tract infection (including pyelonephritis) in adults. UpToDate. https://www.uptodate.com/contents/acute-complicated-urinary-tract-infection-including-pyelonephritis-in-adults?topicRef=8063&source=see_link

ICD10data.com (2022). 2022 ICD-10-cm diagnosis code n10: Acute pyelonephritis. https://www.icd10data.com/ICD10CM/Codes/N00-N99/N10-N16/N10-/N10

ICD10data.com (2022). 2022 ICD-10-cm diagnosis code n30.00: Acute cystitis without hematuria. https://www.icd10data.com/ICD10CM/Codes/N00-N99/N30-N39/N30-/N30.00

ICD10data.com (2022). 2022 ICD-10-cm diagnosis code R30.0: Dysuria. https://www.icd10data.com/ICD10CM/Codes/R00-R99/R30-R39/R30-/R30.0

ICD10data.com (2022). 2022 ICD-10-cm diagnosis code n39.0: Urinary tract infection, site not specified. https://www.icd10data.com/ICD10CM/Codes/N00-N99/N30-N39/N39-/N39.0#:~:text=Urinary%20tract%20infection%2C%20site%20not%20specified,-2016%202017%202018&text=Billable%2FSpecific%20Code,N39.,effective%20on%20October%201%2C%202021.

Maaks, D.L. G., Starr, N., & Gaylord, N. (2020). Chapter 41: Genitourinary disorders. In A. Wetherington (Ed.), Burns’ Pediatric Primary Care (7th ed., pp. 819-850). Elsevier Health Sciences (US).

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peer#2

Nicholas Lounsberry
Jul 5, 2022Jul 5 at 12:26pm
Pertinent positives: burning with urination that she began three days ago; she was going to the bathroom more than normal; for the past three days she has felt the urge to go to the bathroom six to eight times daily and has not been able to produce urine every time; She has also experienced increased burning during urination when she is able to produce urine; Yesterday she started to have lower abdominal pain; She states that the pain is worse when she has the urge to go the bathroom and cannot produce any urine; patient rates the pain as a 6/10 today and is worse every day over the past three days; She also reports fever chills, today developed nausea with one episode of vomiting; she remembers having [a UTI] a few years ago that presented with the same symptoms; Urinary Tract Infection age 15; Developed nausea today with one episode of vomiting; States she has dysuria with urinary urgency and frequency x 3 days; CVA and suprapubic tenderness on exam;

Pertinent negatives: Patient does have a regular exercise routine; Patient denies drug(supposed to be tobacco?), ETOH or illicit drug use; denies reflux, pyrosis, loss of appetite, bloating, diarrhea, constipation, hematemesis, epigastric pain, hematochezia, food intolerance, flatulence, hemorrhoids or change in bowel habits; She denies heavy bleeding or incontinence; She is not currently sexually active; Temp 98.5; No acute distress noted; Abd: soft, flat, nontender without masses or hepatosplenomegaly

Further questioning: What is her wiping technique? What type of underwear does she use? What color is the urine? Is her urine clear or cloudy or turbid? Does the urine have a foul odor? How was her last UTI diagnosed and treated? Are her ears malformed?

Differentials: UTI – pain/burning with urination, fever, chills, nausea/vomiting, (Garzon Maaks et al., 2020). Pyelonephritis – costovertebral angle and suprapubic pain, vomiting, fever (Garzon Maaks et al., 2020). Dysfunctional voiding – Urinary frequency and urgency, abdominal pain (Garzon Maaks et al., 2020)

Priority diagnosis: Pyelonephritis

Plan: With the patient’s symptoms, it is important to quickly identify how bad the level of infection is, to get rid of the patient’s infection, and to prevent any kind of recurring issues that have led to the current problem. The most common cause of UTI, including pyelonephritis, is escheria coli (E. coli). All her symptoms point to UTI, but especially to pyelonephritis (Garzon Maaks et al., 2020). Because of this, she should undergo UA and urine culture and sensitivity. Because we are looking at pyelonephritis based on symptoms, she should also undergo ultrasound. Because she is experiencing dysuria, she can be prescribed phenazopyridine 200mg three times per day. The patient is allergic to penicillin, so she can be treated with ciprofloxacin 500mg 2 times daily (Garzon Maaks et al., 2020). She should also be educated on the following ways to prevent future infections: Increase fluid intake, especially water. It’s beneficial to void at predetermined intervals and void while spreading your knees apart. Maintain good hygiene like wiping front to back only and stay away from irritants like bubble baths, sitting in soapy water, and fragrant soaps. Pants should not be tight in the groin area, such as those made of spandex. Only use cotton undergarments. Steer clear of foods and beverages that irritate the bladder, including aspartame (NutraSweet), alcohol, spicy meals, and the “four Cs” (caffeine, carbonated beverages, chocolate, and citrus). If a fever returns or lasts more than 48 hours, seek immediate medical assistance (Garzon Maaks et al., 2020).

References

Garzon Maaks, D. L., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., & Duderstadt, K. G. (2020). Pediatric primary care. (7th Ed.). Louis, MO: Elsevier. ISBN: 978-0-323-58196-7

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Collapse SubdiscussionKayla Wisowaty
Kayla Wisowaty
Jul 10, 2022Jul 10 at 9:07am
Hello!

Thank you for your post this week! It could also be beneficial to ask this patient if she has a history of strep throat or if she has been diagnosed with strep throat recently because Streptococcus agalactiae can cause UTIs, including cystitis and asymptomatic bacteriuria. Although UTI was just one of your differential diagnoses, it could be a valid question to ask this patient. UTIs are a prevalent infectious disease that is commonly experienced by females and is mostly caused by gram-negative bacilli (Leclercq et al., 2016).

Reference:

Leclercq, S. Y., Sullivan, M. J., Ipe, D. S., Smith, J. P., Cripps, A. W., & Ulett, G. C. (2016). Pathogenesis of Streptococcus urinary tract infection depends on bacterial strain and β-hemolysin/cytolysin that mediates cytotoxicity, cytokine synthesis, inflammation and virulence. Scientific reports, 6, 29000. https://doi.org/10.1038/srep29000
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