MN568 Discussion 6 response 2

Learning Goal: I’m working on a nursing discussion question and need an explanation and answer to help me learn.

Please respond to discussion below using apa style edition 7 and 3 peer reviewed journal references. Please use one interactive question.
What are some appropriate questions to ask the patient?

Urinary tract infection is caused by bacterial infections that are present in the urinary system at any part such as the kidneys, ureters, bladder, and the urethra. The most common infections are in the bladder and urethra, the lower part of the urinary system (Mayoclinic, 2021). For this patient further questions are needed to have an idea of what might be causing this infection. I would ask the patient if he has had an issue like this before, ask him about any urinary tract abnormalities at birth, history of kidney stones, any history of enlarged prostate, history of diabetes or any condition that causes immunosuppression, recent catheter use or any urinary procedure recently. It is also important to ask him if he has had a new sexual partner and if he uses protection (Beahm et al., 2017). Additionally, back pain may suggest acute pyelonephritis and other symptoms to ask for would be the presence of fever, any nausea and vomiting, shaking or chills (Mayoclinic, 2021). Other questions would be to ask him if he has a weak urine stream, or if he has difficulty starting urination or if he is unable to empty his bladder completely, which would suspicion of Benign Prostate Hyperplasia (Lloyd et al., 2019)

What are three differential diagnoses for the patient?

Acute cystitis

Acute pyelonephritis

BPH

What physical examination would you perform?

If not obtain at arrival, I would obtain vital signs and most importantly a temperature. Assessment of abdomen and suprapubic area. Check for CVA tenderness for indication of kidney pathology. It is important to assess his genital area to check for any discharge, assess his testes and conduct a digital rectal exam to check for enlarged prostate.

What diagnostics would you include?

A urine dipstick has already been performed which had positive leukocytes and nitrites suggesting a urinary tract infection. The next step is to conduct a urine culture to determine the bacteria causing the infection (Chu & Lowder, 2018). A CBC will be needed to check his white blood count and blood cultures maybe collected if the patient has had a fever. In case of prostate enlargement, an ultrasound or prostate MRI will be needed to confirm the diagnosis.

Create an evidence-based plan of care. Include pharmacological and non-pharmacological treatments.

Bactrim is the first line treatment for uncomplicated UTIs, but our patient is allergic to it. This patient will need to be put on Ciprofloxacin 250 mg Q12H for three days and ibuprofen 400 mg Q6h as needed for pain (Epocrates, 2022). Maintain adequate fluid intake to flus bacteria out of the bladder. Avoid sexual intercourse until antibiotic treatment was completed (Cai & Ward, 2021). Call back the office if symptoms are not resolved within five days.

References

Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The assessment and management of urinary tract infections in adults: Guidelines for pharmacists. Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC150(5), 298–305. https://doi.org/10.1177/1715163517723036

Cai, T., Konstantinidis, C., & Ward, S. (2021). A non-pharmacological approach to the treatment of urinary tract infections: case reports with Utipro® Plus. Drugs in context10, 2021-2-2. https://doi.org/10.7573/dic.2021-2-2

Chu, C. M., & Lowder, J. L. (2018). Diagnosis and treatment of urinary tract infections across age groups. American journal of obstetrics and gynecology219(1), 40–51. https://doi.org/10.1016/j.ajog.2017.12.231

Epocrates. (2022). Interaction check: Ciprofloxacin. In Epocrates medical references (Version 18.12) [Mobile app]. Google Play Store. https://play.google.com/store/apps/details?id=com….

Lloyd, G. L., Marks, J. M., & Ricke, W. A. (2019). Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms: What Is the Role and Significance of Inflammation?. Current urology reports20(9), 54. https://doi.org/10.1007/s11934-019-0917-1

Mayo Foundation for Medical Education and Research. (2021). Urinary tract infection (UTI). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

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