The purpose of this discussion is to respond to topic one regarding a 24-year-old woman with symptoms such as a sudden urgency to urinate, back pain, frequent urination, and pain during urination. Relevant questions to ask the patient, three possible differential diagnoses, pertinent physical examination, and diagnostics are given. An appropriate evidence-based plan of care is also explained.
Appropriate Questions to Ask the Patient
The medical practitioner should ask the patient whether she has had similar experiences in the past, whether she experiences pain, and the characteristics of the pain in terms of location, severity, and type (dull or sharp). The patient should also be asked whether she has vaginal irritation. A third important question is whether the patient has multiple sexual partners and if she practices safe sex to rule out the likelihood of a sexually transmitted infection. Pregnancy also increases the risk of cystitis. Therefore, the patient should be asked if she is pregnant. Any current medications that the patient is taking should be revealed.
The first differential diagnosis is a urinary tract infection (UTI), which occurs when bacteria access the urinary tract via the urethra and start to proliferate in the bladder (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). The distinguishing symptoms include a burning sensation when passing urine, a strong urge to pass urine frequently, pain in the lower abdomen and back, cloudy urine with a foul odor, and fatigue. Fever and chills may be present if the infection reaches the kidneys. The patient has most of these symptoms. Furthermore, the urine dipstick is positive for leukocytes and nitrates, which indicate an infection. Therefore, this is the most likely diagnosis.
The second differential diagnosis is noninfectious urethritis. This disorder is marked by dysuria with negative findings in urine dipstick, urine culture, and microscopic examination. The patient’s dipstick was positive for leukoesterase and nitrates, which rule out this diagnosis.
The third differential diagnosis is an overactive bladder, which is typified by increased urinary urgency and frequency. However, urine dipstick, culture, and microscopic urinalysis are negative. The patient’s urinalysis was positive for white blood cells and nitrates, which eliminates this diagnosis.
Appropriate physical examination should include measuring vital signs to identify fever, tachypnea, and tachycardia. Deep abdominal percussion should be conducted to diagnose suprapubic tenderness or flank pain. The patient’s hydration status should be determined by checking skin turgor, assessing fluid intake and urine output. Any abnormalities in the urine should also be determined.
The most common method of diagnosing urinal tract infections is doing a urinalysis to determine the presence of causative bacteria, white blood cells, and red blood cells. The availability of white blood cells in urine is an indication of infection and is the main finding in patients with UTIs. A urine culture should be done to facilitate the precise identification of infectious bacteria and determine the most effective antibiotic that should be used for treatment. Imaging tests such as ultrasound, magnetic resonance imaging, and computerized tomography can be done to observe the structure of the urinary tract, particularly in patients with recurrent UTIs. Cystoscopy can also be done to visualize the inner anatomy of the bladder.
Evidence-Based Plan of Care
The first-line pharmacological treatment of UTIs is antibiotics such as Bactrim (trimethoprim/sulfamethoxazole). However, Bactrim cannot be administered because the patient is allergic to it. Therefore, other suitable antibiotics include cephalexin, nitrofurantoin, fosfomycin, and ceftriaxone (Grabe et al., 2015). The patient should be given 50 mg oral nitrofurantoin capsules four times a day for seven days. Pain medication such as 500 mg paracetamol every six to eight hours can be given to relieve pain (Türk et al., 2016).
Non-pharmacological interventions include using a heating pad to alleviate pain and taking a lot of water to flush out bacteria from the system. The patient should be educated about ways of preventing the recurrence of the infection. She should be reminded to finish the prescribed antibiotics even if the symptoms subside. She should be encouraged to empty her bladder frequently as soon as she feels the urge and ensure complete voiding. She should also wipe from front to back to avoid introducing fecal bacteria to the urethra. She should also prevent harmful practices like douching and stay away from scented feminine hygiene products. She should also avoid using birth control methods such as spermicidal jelly, unlubricated condoms, and diaphragms because they can cause irritation, promote bacterial growth, and increase susceptibility to UTIs (Mauck et al., 2017). She should also wear loose-fitting cotton underwear and urinate after sexual intercourse to minimize the likelihood of infection.
UTI is a common problem of the renal system, which affects men and women. Its main symptoms include pain when passing urine, which can lead to suspicions about sexually transmitted diseases. A detailed medical history by asking pertinent questions is essential to obtain a proper context of the patient’s symptoms. Additionally, various diagnostic tests are necessary to facilitate an accurate diagnosis of the disease. Positive urine dipstick tests, particularly for white blood cells and nitrates, are crucial indicators of UTIs. Untreated UTIs increase the risk of more severe conditions such as pyelonephritis. Therefore, patients should take the prescribed methods correctly.
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284.
Grabe, M., Bjerklund-Johansen, T. E., Botto, H., Çek, M., Naber, K. G., Tenke, P., & Wagenlehner, F. (2015). Guidelines on urological infections. European Association of Urology, 182, 237-257.
Mauck, C. K., Brache, V., Kimble, T., Thurman, A., Cochon, L., Littlefield, S.,… Schwartz, J. L. (2017). A phase I randomized postcoital testing and safety study of the Caya diaphragm used with 3% Nonoxynol-9 gel, ContraGel, or no gel. Contraception, 96(2), 124-130.
Türk, C., Petřík, A., Sarica, K., Seitz, C., Skolarikos, A., Straub, M., & Knoll, T. (2016). EAU guidelines on interventional treatment for urolithiasis. European Urology, 69(3), 475-482.