Pathophysiologic Diagnosis Responses(2)

10463Discussion Peer/Participation Prompt [Due Sunday]
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least three of these prompts:

Look at your course colleagues’ PDSA model schemata.

Review the ‘P’ and the ‘S’ of your course colleagues’ schemata from your advanced practice nursing role perspective – educator, leader or practitioner. From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their schemata.

Post a response individually to each of them that expresses your advanced practice nursing role perspective of the data represented in their schemata.

Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about their ability to follow task instructions for constructing the assignment, etc.?; if you a nurse leader what are your thoughts about the success of their application of a process improvement model, etc.?; if you are a nurse practitioner what are your observations about the non-conventional modality presented in the schemata, can you locate any evidence or the foundational basic sciences that support the modality, etc.?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Respond to post 1:
Amy Jones
TuesdayAug 23 at 1:18am
Case #1

What is the definition of bacteriuria?

Bacteriuria is the presence of bacteria in urine without evidence of infection. Bacteriuria develops during catheterization, contaminated urine from the drainage bag reflux back into the bladder, and microorganisms are introduced in a break in the closed system (McCance & Huether, 2018).

What additional history do you need to make a diagnosis?

History for this patient would be past medical history, alcohol use, new diagnosis, surgeries, and any kidney problems in the past. Knowing if this patient has gone through menopause or when was her last menstrual cycle. I would want to know if the blood was noticed before the dysuria or if the dysuria made her notice the blood. The patient’s medication history and if she recently started any medication. The patient’s current diet, if that has changed, and what she eats most. Food and medication can change urine color: red beets, blackberries, rhubarb, food coloring, ibuprofen, chloroquine, metronidazole, deferoxamine, nitrofurantoin, phenytoin, rifampicin, phenolphthalein, and phenothiazines (Queremel Milani & Jialal, 2022). Being newly married would be when she became sexually active with her new husband or anyone else. Those who test positive for sexually transmitted diseases and who are sexually active and have pelvic or lower abdomen pain meet the presumed pelvic inflammatory disease criteria. (Latimer et al., 2019).

What diagnostic studies would you order and why?

Urinalysis with culture for bacteria and screen and STI testing. Sexually transmitted infections (STIs) can manifest as urethritis (Cavanagh & White, 2022). Complete blood count, complete metabolic panel, hematocrit & hemoglobin. A pregnancy test will be ordered if the patient has not gone through menopause. Due to the dilation of the renal system and slower peristalsis of the ureters and bladder during pregnancy, which facilitates bacterial colonization and ascending infection, pregnant women are more likely to suffer urinary tract infections (Kumar Shrestha et al., 2022). Pending on test results, a CT will be ordered.

Case #2

What are the possible reasons for this woman’s pain? List possible differential diagnoses and explain each.

The suspect is that the patient has a UTI with dysuria, increased frequency, and urgency. This complaint is categorized as an “irritative” symptom—other such symptoms include urinary urgency, frequency, and nocturia (Fried, 2018). Acute pyelonephritis means inflammation of the kidney. This condition can be caused by infection or obstruction of the urinary tract. Acute pyelonephritis symptoms usually include fever, flank pain, nausea, vomiting, burning on urination, increased frequency, and urgency (Belyayeva & Jeong, 2021).

What diagnostic tests should you order to confirm the diagnosis?

Urinalysis with culture for bacteria and screen to tell what and if bacteria are present. This will lead to possible treatment. Blood work would consist of CBC, CMP, and H&H. Women are far more likely to get cystitis than men, and blood work will provide results (Wilson & Wilson, 2021). If needed, an ultrasound and X-ray will help determine or find any bladder inflammation. Complications in the lower urinary tract can be seen on imaging (Wyndaele et al., 2022).

What are the possible causes of recurrent lower UTIs?

The lack of knowledge of how to wipe being front to back, if not done that way, can cause UTIs. Excessive diarrhea can cause infections. Urinating before and after intercourse, avoiding intercourse while being treated for a UTI, after urinating, keeping the genital area clean, and avoiding using strong soaps, antiseptic creams, feminine hygiene sprays, and powders (Sequera & Chacko, 2022). Being sexually active can cause UTIs due to not being sexually active.

What are the differences when comparing prerenal acute renal failure, intrarenal acute renal failure, and postrenal acute renal failure? Give examples of each.

Acute kidney injury occurs when the kidneys fail to function correctly over a short period. Postrenal acute renal failure occurs when blood flow to the kidneys decreases due to decreased perfusion pressure from other organs such as the heart or brain. Intrarenal acute renal failure occurs within the kidney itself, usually due to urinary tract obstruction. The kidney filters the blood and is directly linked to every other organ system. Renal failure, whether acute or chronic, is a life-threatening condition. The BUN value rises in states of dehydration and acute and chronic renal failure when fluid passage through the tubules is slowed (McCance & Huether, 2018).

References

Belyayeva, M., & Jeong, J. M. (2021). Acute pyelonephritis. Europe PMC, 2(6). https://doi.org/10.47407/dd2021.6.0057

Cavanagh, N., & White, J. (2022). Sexually transmitted causes of urethritis, proctitis, pharyngitis, vaginitis and cervicitis. Medicine, 50(5), 247–253. https://doi.org/10.1016/j.mpmed.2022.02.001

Fried, M. (2018). Dysuria. Handbook of Outpatient Medicine, 451–464. https://doi.org/10.1007/978-3-319-68379-9_28

Kumar Shrestha, B., Tumbahangphe, M., Shakya, J., & Chauhan, S. (2022). Uropathogenic escherichia coli in urinary tract infections: A review on epidemiology, pathogenesis, clinical manifestation, diagnosis, treatments and prevention. Novel Research in Microbiology Journal, 6(4), 1614–1634. https://doi.org/10.21608/nrmj.2022.251024

Latimer, R. L., Read, T. R., Vodstrcil, L. A., Goller, J. L., Ong, J. J., Fairley, C. K., Hocking, J. S., & Bradshaw, C. S. (2019). Clinical features and therapeutic response in women meeting criteria for presumptive treatment for pelvic inflammatory disease associated with mycoplasma genitalium. Sexually Transmitted Diseases, 46(2), 73–79. https://doi.org/10.1097/olq.0000000000000924

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.) [E-book]. Mosby.

Queremel Milani, D. A. & Jialal I. (2022). Urinalysis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557685/

Sequera, S. K. L., & Chacko, L. K. (2022). Effectiveness of structured counseling and preventive strategies in promoting awareness and expressed habitual practices toward prevention of urinary tract infection among women of reproductive age group: A pilot study. Journal of Health and Allied Sciences NU, 12(03), 286–295. https://doi.org/10.1055/s-0041-1740332

Wilson, M., & Wilson, P. J. K. (2021). Cystitis. Close Encounters of the Microbial Kind, 347–360. https://doi.org/10.1007/978-3-030-56978-5_25

Wyndaele, J. J., Wyndaele, M., Rapidi, C. A., & Krassioukov, A. (2022). What do x-ray images of the bladder during video urodynamics show us in patients with spinal cord injury? Spinal Cord, 60(5), 408–413. https://doi.org/10.1038/s41393-022-00771-4

Respond to post 2:
Tara Dozier
TuesdayAug 23 at 11:20am
Bacteriuria is essentially an UTI that has not been treated and has spread into the upper portion of the urinary tract (Henderson et l., 2019).

What additional history do you need to make a diagnosis? Assessment questions should include: Onset of Sx, are you experiencing flank pain, how many times a day are you urinating, do you use catheters, could you be pregnant, and has there been any vaginal discharge with the symptoms (Mayo Clinic, 2021).

What diagnostic studies would you order and why? History should include renal panel, urinalysis w/ C and S, and possibly a CBC to assess elevated WBC. Renal panel would be useful in assessing damgae to the kidnyes as well as to rule out nephrolithiasis. Urinlysis with C and S will let me know what particular bacteria is present and what antibiotic it is sensitive to. The CBC will reveal the presence of elevated white blood cells in the bloodstream, indicating the severity of the infection. WBC greater than 10,000 indicates infection within the bloodstream. Broad spectrum antibiotics may be initiated based on this number for symptom relief until the UA with C and S provides a more specific antiobiotic needed. Cranberry tablets and water should be intiated and continued also.

Reference

Henderson, J. T., Webber, E. M., & Bean, S. I. (2019). Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US preventive services Task force. Jama, 322(12), 1195-1205.

Mayo Clinic. (2021, April 23). Urinary tract infection (UTI) – Diagnosis and treatment – Mayo Clinic. Mayo Clinic – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453

RESOURCES:
McCance, K. & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children. 7th Edition. Elsevier Mosby: St. Louis, MO. ISBN: 978-0323088541.
Chapter 38 – Structure and Function of the Renal and Urologic Systems
Chapter 39 – Alterations of Renal and Urinary Tract Function

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