- QUESTION
Discussion Question 2
LN is a twenty-six-year-old married woman who presents at the clinic with symptoms of dysuria, frequency, and urgency. Further history yields two days of these symptoms but no fever, chills, or flank pain. She describes a burning discomfort during and immediately following urination and feeling the need to void every half hour. There is no vaginal discharge, itching, or odor. She is not using birth control at this time. She requests “a urine culture and some sulfa pills.†When asked to explain, she says she has had many “bladder infections†over the past three years and “sulfa pills usually work.†She was evaluated approximately five years ago with an IV pyelography and cystogram, and “nothing was wrong.†All her vital signs are normal. Answer the following questions:
•What additional information would you like to collect?
•What is your working diagnosis?
•What are the contributing factors to this potential diagnosis?
•What treatment would you implement and why?
•What type of follow-up would you recommend?
Provide information for each that specifically answers each above. Pages from text attached. Use any other reference necessary.
TEXT: Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for nurse practitioner prescribers (3rd ed.). Philadelphia, PA: F. A. Davis.
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| Subject | Nursing | Pages | 4 | Style | APA |
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Answer
Introduction
Urinary tract infections (UTIs) occur frequently and cause up to 6.86 million office visits by women per year (Hooton et. al., 2000). Enteric bacteria especially Escherichia coli remains the most frequent cause of UTIs. More essential is the increase in resistance to some antimicrobial agents, in particular, the resistance to trimethoprim-sulfamethoxazole seen in E. coli. UTIs are distinguished from other ailments by use of several tests none of which, if used individually, have adequate sensitivity and specificity (Hooton et. al., 2000). Among the diagnostic tests, urinalysis is useful mainly for excluding bacteria in urine culture, but it is still recommended that all patients who are experiencing recurrent UTIs, failures in treatment and even complicated UTIs to have this procedure.
Additional Information to Collect
History
The history of the patient will enable identification of risk factors, for instance, sexual habits, previous Urinary Tract Infections (UTIs), sexually transmitted diseases and urethral instrumentation (Hooton et. al., 2000). The question of adherence and sensitivity to medication can also be addressed.
Physical Examination
A comprehensive physical examination can often reveal the cause of symptoms presented. Physical examination includes pelvic examinations, checking for suprapubic and costovertebral angle tenderness to rule out upper UTI (Hooton et. al., 2000).
Urinalysis
Urinalysis is indicated in all patients. It can help determine the presence of infection and confirm a suspected diagnosis, in this context it will aid in knowing the history of internal dysuria (Hooton et. al., 2000).
Urine Culture
Positive urinalysis calls for a urine culture to help identify sites of infection and causative agents. However, women with uncomplicated symptoms who are not pregnant do not usually require a urine culture.
Working Diagnosis
Cystitis
This is among the many bacterial infections affecting women. 30% of women experience this condition once a year. Of this number, approximately 20% will have a recurrence of the illness (Hooton et. al., 2000).
Contributing Factors to the Diagnosis
Anatomy of the female urinary tract contributes since women are at higher risk of infection due to the shortness of the female urethra. Bacteria from the anal opening can be easily transferred to the opening of the urethra (Hooton et. al., 2000). Therefore, it is very likely that she is suffering from a bacterial infection.
Sexual behavior is yet another contributor as almost 80 percent of UTIs in premenopausal women occurs within a day of engaging in intercourse, thus making frequent sexual activity the most significant risk factor for UTI in young women (Woo & Wynne, 2012).
The frequent antibiotic use has also been identified as a contributing factor since research has linked the intake of antibiotics with increased risk of infection because certain antibiotics also target protective bacteria lactobacilli (Woo & Wynne, 2012). This may result in an overgrowth of E. coli in the vagina hence leading to infections (Hooton et. al., 2000)
The Treatment to Implement
First, I would implement a drug therapy of Nitrofurantoin 50mg-100mg four times in a day for ten days so as to control the bacteria formation. In a recent study where Nitrofurantoin 50mg-100mg was compared to TMP/SMZ, Ciprofloxacin and Levofloxacin, Nitrofurantoin had a low resistant rate of 2.1 % (Woo & Wynne, 2012) thus the most effective treatment of UTIs. Second, I would recommend safety procedures, such as engaging in safe intercourse, maintaining a proper hygiene, and avoiding too much sugar. This is because these are some of the major factors contributing to the development of overgrown bacteria in the genitals.
Follow Up
After the dose is finished, the patient should come back to get tested once again. If she is still symptomatic after the ten days drug therapy an examination for upper UTI should be done, followed by treatment for 14 more days followed by post treatment urinalysis and urine culture.
References
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Hooton et. al. (2000). Pathogenesis of Urinary Tract Infections: An Update. J Antimicrob Chemother. 46 ( Suppl. Sl): 1-7.
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