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Discussion 9-Gi and Gu evaluation

Discussion 9-Gi and Gu evaluation

Sample Answer 

Discussion 9-Gi and Gu evaluation

Pertinent positive and negative information

The positive information garnered from the patient is that she is not sexually active, which rules out the possibility of an STI or pregnancy. She does not experience heavy menstrual bleeding, which possibly eliminates ovarian cysts. On the downside, the patient has a family history of diabetes; her mother, father, and maternal grandmother have diabetes.

Additional information required

I would ask the patient whether she passes urine that is cloudy or has a stronger-than-usual smell and if there is blood in the urine (hematuria). If the patient has started a new food type (spicy or hot foods) that could cause painful urination can be useful in determining whether she is experiencing the pain due to the same. I would also examine the patient’s breasts for tenderness as well as her lower back to find out if she is experiencing dull pain (ovarian cysts). The patient’s body should also be checked for any bruises that have taken longer than usual to heal (diabetes)

Differential diagnosis

Based on the findings, three differential diagnoses can be determined: Cystitis, Kidney stones, and Ovarian cysts.

Plan utilizing clinical practice guidelines for Cystitis.

The patient will undergo imaging to rule out kidney stones. The patient is diagnosed with uncomplicated Cystitis. She has a history of UTI. The urination frequency is persistent, and small amounts of urine are passed. She reported not having irregular vaginal bleeding, which rules out ovarian cysts (Colgan & Williams, 2011). The evidence rating is C, which means consensus; the evidence is disease-oriented (AAFP, n.d). There are a number of first-line agents that the IDSA recommends according to the 2010 guidelines. Evidence is in support of the use of fosfomycin (monaural) and nitrofurantoin (macrocrystals). The nitrofurantoin will be administered at 100mg twice a day for five days. Fosfomycin may be less effective (Gupta et al., 2011).


References

American Family Physician (AAFP, n.d). SORT: The Strength of Recommendation Taxonomy. https://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf

Colgan, R., & Williams, M. (2011). Diagnosis and treatment of acute uncomplicated Cystitis. American family physician84(7), 771.

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., … & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated Cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases52(5), e103-e120.

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Question 


Discussion 9-Gi and Gu evaluation

Discussion Prompt (250 -300 words):

  • Evaluate the subjective and objective information provided to you in the file below. 
  • First, identify all pertinent positive and negative information. 
  • Is there any other information you would want to obtain? 
  • Create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
  • Next, create a plan utilizing clinical practice guidelines for the priority diagnosis. 
  • Include APA in-text 2 scholarly citations and provide full reference citation at the end of the discussion.

*** FILE BELOW

Discussion 9 – GI and GU Evaluation

Discussion 9 – GI and GU Evaluation

NU632 Unit 9 Discussion Case

C.C. Burning with urination, fever, N/V

HPI: 16 y.o. F presented to Clinic with grandfather for burning with urination that she began three days ago. She noticed that she was going to the bathroom more than normal. She recalls normal urinary frequency as four times daily, but 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, which worried her so her mother called the office to make an appointment for today but only her grandfather could bring her. She states that the pain is worse when she has the urge to go the bathroom and cannot produce any urine. The pain decreases a little between the urgency episodes. The patient rates the pain as a 6/10 today. She says that it has gotten worse every day over the past three days. She tried Tylenol with some relief.  She also reports fever and chills, today developed nausea with one episode of vomiting.  The patient believes that she has a urinary tract infection because she remembers having one a few years ago that presented with the same symptoms. Allergies: Penicillin (rash) Current Mediation: MVI 1 tab PO daily. Childhood Illnesses. Chicken Pox. Asthma. Urinary Tract Infection at age 15. Immunizations: The patient does not receive regular flu vaccines. Screening tests: The patient does not go to the eye doctor and states that she does not have any trouble with her vision. Family History: Mother -Lung cancer, heart disease, hypertension, diabetes. Father -Diabetes. Maternal grandfather deceased at 61 due to a heart attack and maternal grandmother has diabetes and HTN. Paternal grandfather has PMH seizures and paternal grandmother deceased at age 51 due to breast cancer Social History: Patient denies drug, ETOH, or illicit drug use. She is a high school senior who plans to go into the military after graduation. She is unemployed. She is not sexually active.

Exercise & Diet: Patient does have a regular exercise routine. Patient states that she cooks a lot of prepared frozen food for her or she just eats out.

Safety Measures: Wears seat belt. HEENT: Denies headaches, sinus problems, epistaxis, hoarseness, and dental problems, oral lesions, hearing loss or changes, nasal congestion. Denies blurred vision, difficulty focusing, ocular pain, diplopia, scotoma, peripheral visual changes, and dry eyes. Patient states she does not wear glasses or contacts. Patient has never seen an eye doctor Neck: No neck pain or stiffness. She denies any limitation of motion or any lumps. She states she has noticed some swelling to her glands.CV: Patient states she exercises 2 to 3 times a week. She denies any history of a heart murmur, chest pain, palpitations, dyspnea, activity intolerance, varicose veins, or edema. Lungs: Patient denies cough, SOB on exertion, difficulty breathing, wheezing, pain on inspiration, history of respiratory infections, exposure to TB, hemoptysis. Patient states she has not had a chest x-rays in the past. Her last TB skin test was done in September 2019 for volunteer work and it was negative.GI: Denies, nausea, vomiting, dysphagia, reflux, pyrosis, loss of appetite, bloating, diarrhea, constipation, hematemesis, epigastric pain, hematochezia, food intolerance, flatulence, hemorrhoids or change in

Bowel habits.GU: She denies heavy bleeding or incontinence. She had her first period at the age of 12. She is not currently sexually active. States she has dysuria with urinary urgency and frequency x 3 days. PV: She denies deep leg pain, cold hands/feet, varicose veins, thrombophlebitis, or leg cramps. Patient denies bruising or bleeds easily or history of any blood transfusions. MSK: Patient denies joint pain, swelling, muscle pain or cramps, neck pain or stiffness, or changes in ROM. Neuro: Patient denies transient weakness, numbness, muscular weakness, tingling, memory difficulties, involuntary movements or tremors, syncope, stroke, seizures, or paresthesia. Endo: Patient denies thyroid problems, cold or heat intolerance, polydipsia, polyphagia, polyuria, changes in skin, hair or nail texture, unexplained change in weight, changes in facial or body hair, changes in hat or glove size, or use of hormonal therapy. Psych: Patient denies nightmares, mood changes, anxiety, depression, nervousness, insomnia, suicidal thoughts, and exposure to violence, or excessive anger. Objective: Physical Examination (PE): VS: BP: 102/60, HR: 76, RR: 18, Temp 98.5, weight: 129, height: 63 inches, BMI: 22.7.Gen: Patient well-nourished and appears stated age. No acute distress noted. Ambulating without assistance. Skin:  No lesions present. HEENT: Normocephalic. Eyes Sclera white. Conjunctivae pink. Pupils are PERRL, 3 mm bilaterally. Extraocular movements intact. Hearing is intact. Nose normal with no mucous, inflammation or lesions present. Nares patent. Septum is midline. Pink, moist mucous membranes. No missing or decayed teeth. Throat: no inflammation or lesions present. Neck: Had a supple and with no pain, patient was negative for lymphadenopathy CV: S1, S2. Regular rate and rhythm, no murmurs, gallops, or rubs. Carotid Arteries: normal pulses bilaterally, no bruits present. Pedal Pulses: 2+ bilaterally. Extremities: no cyanosis, clubbing, or edema, less than 2-second refill noted Lungs: Even and unlabored. Clear to auscultation bilaterally without wheezes, rales, or rhonchi. Abd: soft, flat, non-tender without masses or hepatosplenomegaly. Bowel sounds active. No bruits.GU: CVA and suprapubic tenderness on exam. PV: Carotids -Regular, no bruits. Upper extremities warm, symmetrical in size, no lesions, no edema. Capillary refill < 2 sec bilaterally. Lower extremities warm, symmetrical in size, even hair distribution, no lesions, no edema, no varicosities, and faint superficial vessels, toenails clear and pink. Pulses +2, regular, equal. No lymphadenopathy. MSK: Normal ROM, joint stability normal in all extremities, no tenderness to palpation. No scoliosis noted. Neuro: Grossly alert and oriented x3, communication ability within normal limits, attention and concentration normal. Psych: Judgment and insight intact, rate of thoughts normal and logical. Pleasant, calm, and cooperative. Patient appears to be happy/content.

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