Oct 8, 2020 in Medicine

Urinary tract infections

Urinary tract infections are a common health problem in both the United States and other countries. These infections primarily affect urinary tract that comprises of the urethra, ureters, kidneys, and the urinary bladder. In 2007, about 10.5 million ambulatory visits were reported in the USA regarding UTIs, of which 21.3% were to emergency departments in hospitals (Foxman, 2014). Women are the most affected part of population suffering from these infections. The prevalence of UTIs is high in inpatients. Foxman (2014) reiterates that in one of the 2004 surveys on UTIs that covered 49 Swiss hospitals, UTI was found in 3.7% of all the individuals who had been catheterized for more than 24 hours during their hospital stay as compared to 0.9% who had not been catheterized. This shows that catheterization is a risk factor for these conditions since catheters are capable of introducing microbial pathogens to the urinary tract. According to Behzadi et al. (2010), many authors have explained that gram-negative bacteria, especially E. coli as well as Klebsiella spp., are the most common causes of UTIs. In fact, E. coli is responsible for more than 70% to 95% of all the upper and lower UTIs reported in the world (Behzadi et al., 2010). This paper describes and analyses a UTI case study in addition to providing the plan on how to manage the case scenario.

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Subjective Information

Lisa Rodgers, a 36-year-old female, visits the hospital with chief complaints of increased urination frequency, burning sensation while urinating, and the urgency to urinate for the past five days. She says, I feel a painful burning sensation in my genitals when urinating. Lisa explains that the burning sensation has only worsened every time she urinates since the beginning of the symptoms. Additionally, she explains that her urine has a strong foul odor. She wonders whether the infection has been caused by the intrauterine device inserted two weeks ago. She says that she opted to use this family planning method after her husband had advised her to seek the best family planning option because they wanted to stop having more children and enjoy their sexual life without worries of Lisa getting pregnant. Lisa further reports that she has been drinking cranberry juice following the advice from her neighbor. She says, I have been using cranberry juice, which showed some relief at first, but the symptoms are now unresponsive. I am very anxious about how this condition will end.

On further probing, Lisa denies having fever, vaginal discharge, chills, and nausea, but says that she had mild flank pains one day ago. Lisa is sexually active and in a monogamous relationship with her loving husband. Her last sexual intercourse was four days ago. She reports that she had a similar problem three years ago during the delivery of her only daughter. According to Lisa, the doctor had explained the cause of her previous condition as the introduction of bacteria into her urinary system through either the catheter she had during the delivery or poor hygiene following the delivery. During this time, she was treated with a course of antibiotics, which she does not remember. She reports of symptom disappearance even before she finished the antibiotics. Lisa does not have any known food or drug allergies.

Objective Information

Lisa Rodgers is an anxious communicative woman. She reports of having general body fatigue attributed to inadequate sleep and early morning awakening because of anxiety. On physical examination, her vitals are as follows. Her blood pressure is 128/80 with a heart rate of 85 beats per minute, respiration of 18 breaths per minute, and axillary body temperature of 36.7oC. She is alert and anxious with a sense of humor. Her facial skin looks healthy and supple. She demonstrates a broad range of motions concerning her walking, standing, and bending ability. However, straining of the abdomen is associated with pain in the flanks. Abdominal examination reveals a normal liver size and no unusual bowel sounds. Slight palpations show mild tenderness in the flanks. Her body reflexes and muscle strength appear to be in reasonable limits. The examination of genitalia reveals her increased sensitivity to touch. Additionally, the genitals are characterized by a foul smell. No vaginal discharge is noted. Laboratory results are absent because it is her first visit to the hospital facility due to her current condition. However, midstream urine should be collected for laboratory culture, sensitivity, and urinalysis. Urine dipstick testing is positive for both nitrates and leukocyte esterase.

Assessment

Lisa is a 36-year-old female who presents with complaints of increased urgency and frequency of urination as well as burning painful sensation during urination for the past five days. Based on the history of her presenting illness and the examination done, she suffers from a urinary tract infection. According to Hooton (2012), individuals who suffer from UTIs mostly present with dysuria increased as well as the frequency of urination. These symptoms in addition to foul smelling urine have made her anxious. Her complaints began five days ago, following the insertion of an intrauterine device that she opted for as a family planning method. Furthermore, she had a UTI in the past that occurred secondary to catheterization or unhygienic conditions that followed the delivery of her only daughter.

These indications further explain the diagnosis of a UTI. Some of the risk factors for UTIs comprise of frequent sexual intercourse, the use of family planning devices that include diaphragms and intrauterine devices, and the use of instruments such as catheterization (Behzadi et al., 2010). Furthermore, having a positive history of UTIs in the past increases the likelihood of developing the condition in the future (Hooton, 2012). It is clear that her previous condition may have occurred because of catheterization, and the present illness is caused by the introduction of microbial pathogens when inserting the intrauterine device. Cranberry juice can prevent the invasion of pathogens to the urinary system, although the amount and duration of taking the juice to realize its impact is unknown (Maki et al., 2016; Rutter & Newby, 2015). Therefore, her use of cranberry juice is justified.

Several disease conditions symptomatically mimic UTIs. These conditions should be ruled out before settling on the definitive UTI diagnosis. Conditions like vaginitis, bladder cancer, and kidney stones symptomatically mimic UTIs in one way or another (Rutter & Newby, 2015). They should be ruled out based on the available findings from both the history and examination. Vaginitis is caused by Candida albicans or bacteria and it presents with frequent urination (Rutter & Newby, 2015). Bladder cancer and kidney stones can also present with painful urination, which mimics the UTI. In addition, interstitial cystitis has symptoms similar to UTIs because it manifests itself with painful sexual intercourse and urination as well as increased urination frequency (Rutter & Newby, 2015). However, the history of flank pains, foul-smelling urine, the presence of nitrates and leukocyte esterase rules out all these conditions.

Plan

The plan on how to address this disease involves trying to carry out further investigations and manage the UTI appropriately. The first thing is to refer the patient to the laboratory for the collection of midstream urine that will help in carrying out culture and sensitivity tests as well as a urinalysis. Culture and sensitivity tests help in identifying the causative microbial pathogen for the UTI and the appropriate pharmacological drug, for which the organism responds (Hooton, 2012). Such a thing is important for the physician to know the precise microbe before instituting the right medication, for which the pathogen is responsive.

On the other hand, the plan involves pharmacological care. In the treatment of this UTI, trimethoprim will be the drug of choice. This is supported by Hootons (2012) assertions that trimethoprim and nitrofurantoin are the current drugs of choice for treating a UTI. Furthermore, the primary causative organisms for this condition are E. coli and Klebsiella spp. Lisa will need to take 200mg of trimethoprim orally once a day for ten days. This drug affects the metabolism of nucleoprotein through dihydrofolate reductase inhibition (Hooton, 2012). Analgesics are also necessary because of the painful urination. In this case, Lisa shall take oral phenazopyridine. The dosage for this drug is two tablets of 100 milligrams every eight hours after meals for two days (Lane & Takhar, 2011). The use of these two medications will clear the microbial pathogen and relieve pain respectively. This treatment regimen will be reviewed after two days of treatment or when symptoms persist.

Conclusion

Lisa suffers from a UTI that has such symptoms as foul smelling urine and painful and frequent urination as well as increased urination urgency. The development of this condition is attributed to the introduction of microbial pathogens to the genitourinary system during the recent insertion of an intrauterine device as a family planning method. Frequent sexual intercourse and the history of having a similar condition in the past are the risk factors that have enhanced the recurrence of this devastating condition. The intensive history and examination that capture UTI-specific symptoms and a dipstick test that has found positive results for urine nitrates and leucocyte esterase confirm the disease diagnosis. The plan involves taking a urine sample for laboratory urinalysis and culture and sensitivity. Lisa is also to take 200mg of oral trimethoprim once for ten days and two tablets (100mg each) of oral phenazopyridine every 8 hours for two days to clear the causative pathogen and relieve pain respectively.
 
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