A 40-year-old Hindu married male complaining of sudden high fever for the last two days. He is also complaining of right flank pain with some burning on urination. Past medical history includes diabetes and hypertension. Current medications include metformin 500mg bid and lisinopril 10mg daily.
Workup would include ordering a kidney, ureter, and bladder (KUB) film, it can visualize calcium oxalate stones, however a CT scan can be ordered if the KUB does not show any stones (Haewook, Segal, Seifter, & Dwyer, 2015). A urinalysis and urine culture and sensitivity should be obtained. A 24-hour urine can be ordered on someone with recurrent kidney stones. Ketorolac, which an NSAID, may be given for pain. Iv nausea medication may need to be given. IV fluids would be necessary. If it is found that the patient is going to be unable to pass the kidney stone, then the patient would set up for lithotripsy. If the kidney stone is too big and causing complications then the patient should be admitted to the floor for IV hydration, antiemetics, and pain management. This patient should probably be admitted to the hospital for observation and referred to urologist.
At home management would include increasing fluid intake, strain all urine, and keep stones and bring them back into the office to be tested, and eat a diet that that is either oxalate free or very low. Most patients do not require any type of surgical intervention, and they are able to pass the kidney stone on their own. The patient should be instructed to strain their urine. The patient would need to follow up in the clinic as soon as the stone passes and then have repeat scans to ensure that the whole stone has passed, or if he has trouble urinating. Cipro 400mg po should be given twice daily for 7 days. The patient can take Tylenol for fevers and pain, or some sort of mild opioid. Pyridium 200mg po three times a day for two days for dysuria.
Differential Diagnosis
1. Urinary Tract Infection: Urinary tract infections are the most common bacterial infection encountered in the ambulatory care setting. Patients present with symptoms such as urinary frequency, urgency, dysuria, suprapubic pain, and gross or microscopic hematuria (Grabe et al., 2015). Diagnosis confirmed after thorough history and physical exam, urinalysis, urine culture, and based on symptoms. Treatment would be aimed at having the patient increase their water consumption and then they should take Cipro 400mg po twice daily for 7 days. The patient can take Tylenol for fevers and pain. Pyridium 200mg po three times a day for two days dysuria.
2. Pyelonephritis: Pyelonephritis is an ascending infection of a bacterial pathogen infection the renal pelvis and kidney that primary presents as a UTI characterized by dysuria with flank pain, nausea, vomiting, and/or fever (Bae et al., 2015). A thorough history and physical will be important to help accurately diagnose the patient. Urinalysis should be ordered as well as a urine culture. Since the patient has a fever blood cultures should be ordered in the patient that is suspected to have pyelonephritis. KUB can be ordered or retrograde or antegrade pyelography in severe obstruction cases (Bae et al., 2015). This patient should be admitted to the hospital and given an initial dose of ciprofloxacin 400mg IV and then the patient should be given cipro 500mg po twice daily for 7 days. The patient should be instructed to push fluids and strain urine if the cause of obstruction is a kidney stone.
3. Interstitial Cystitis: Interstitial cystitis is a clinical syndrome consisting of suprapubic pain related to bladder filling and relieved by emptying bladder, accompanied by other symptoms such as increased daytimes and nighttime frequency, insidious onset, exercise, sexual activity, foods high in acid make the pain worse, lower abdominal tenderness, and tenderness in prostate exam (Hanno, Erickson, Moldwin, & Faraday, 2015). After thorough history and physical exam diagnosis could be made with symptoms. There is not a definitive test for interstitial cystitis. Having the patient keep a voiding diary can show voiding patterns. Cystoscopy can be done to confirm diagnosis. Urinalysis and urine culture should be ordered. The patient should avoid foods and activities that aggravate the bladder. Elmiron 100mg orally three times a day should be taken to help with bladder pain and irritation.
References
Bae, M., Park, C., Cho, Y., Joo, K., Kwon, C., & Park, H. (2015, April 2010). Effects of Diabetes Mellitus and HbA1c on Treatment Prognosis in Uncomplicated Acute Pyelonephritis. The Korean Journal of Urogenital Tract Infection and Inflammation, 10(1), 41-48. https://doi.org/https://doi.org/10.14777/kjutii.2015.10.1.41
Grabe, M., Bartoletti, R., Bjerklund, T., Cek, M., Koves, B., Naber, K., … Wagenlehner, F. (2015, March). GUIDELINES ON UROLOGICAL INFECTIONS. Urological Infections. Retrieved from https://uroweb.org/wp-content/uploads/18-Urological-Infections_LR.pdf
Haewook, H., Segal, A., Seifter, J., & Dwyer, J. (2015, July 31). Nutritional Management of Kidney Stones (Nephrolithiasis). Clinical Nutrition Research, 4(3), 137-152. https://doi.org/https://doi.org/10.7762/cnr.2015.4.3.137
Hanno, P., Erickson, D., Moldwin, R., & Faraday, M. (2015, May). Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome: AUA Guideline Amendment. Journal of Urology, 193(5), 1545-1553. https://doi.org/https://doi.org/10.1016/j.juro.2015.01.086
Nalini, S., Manickavasakam, K., & Walter, T. (2016, March). PREVALENCE AND RISK FACTORS OF KIDNEY STONE. Global Journal for Research Analysis, 5(3), 183-187. Retrieved from https://www.researchgate.net/profile/HNalini_Sofia/publication/299543144_PREVALENCE_AND_RISK_FACTORS_OF_KIDNEY_STONE/links/56fe82a108ae650a64f71f53/PREVALENCE-AND-RISK-FACTORS-OF-KIDNEY-STONE.pdf
Prochaska, M., Taylor, E., & Curhan, G. (2016, August 10). Insights Into Nephrolithiasis From the Nurses’ Health Studies. American Journal of Public Health. Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303319
Reply Quote Email Author
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
Ace Writing Center has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.
Essays
At Ace Writing Center, Nowadays, students normally have extremely busy schedules. You will note that some of them have to take on some evening or weekend jobs in order to get some income that can help them to sustain in college or in the university. This can deny them a chance to write all the essays given. Others usually get bombarded with a lot of work by their lecturers. This can still delay such students from working on all their essays. However, some of them usually try to work on all these essays but end up delivering their work late. This can prevent them from graduating since most lecturers are strict on deadlines. If you want to write a business essay, the wise way is to hire an outstanding essay writing service like us, so that you can get the best results. If you are keen, you will note that many companies usually overcharge their customers. Some of them are there only to make money. And in reality, they really don’t care to build a long term commitment with students. You should not choose such companies. You should take your time and choose a reliable company to work with. Ace Writing Center is the ultimate solution for you. We have been offering our writing service for more than 7 years. This is a clear indication that you will get quality essay writing service. We have a wide range of writers who can work on any business essay that you might have. We believe in doing extensive research so that we can provide quality work to all our clients. .
Admissions
Admission and Business Papers
Have you ever had to write an admission essay for college? The majority of students face the same issues when applying to a university or college and many in such situations decide they need professional help to cope with this matter. They get in a situation when the deadline keeps coming closer but lack motivation to start because they are just not sure if their writing skills are strong enough. We have a solution for you! Ace Writing Center is the best admission essay writing service with a large professional team and years of experience in providing high-quality papers to students of all levels and faculties. The mission of our team is to help students make their dreams of entering a good college come true and that’s what we offer!.
Editing
Editing and Proofreading
Sometimes all the words for your paper just flow out of your mind and into your fingers. You type quickly at your keyboard and there they are, your beautiful words right there on the screen. But you have no idea how to polish it up. You may be wishing there was a paper writing service that offered this type of writing service. Look no more! Here at Ace Writing Center, we offer you an editing and proofreading option that you can't find anywhere else..
Coursework
College Essay Writing
In case you are familiar Ace Writing Center, you know the way to distinguish a better company from a cheap one exactly. First of all, poor service website does not have a sufficient support. We think support team is an essential part of success; it has to answer all clients’ questions and be a connecting link between clients and their writers. On our web-service you will get answers about anything you need and your writer will receive all your instructions, assignments and requirements exactly and swiftly. A writing service that we run has got a flexible pricing system that will save you from senseless wastes and many bonus systems that let you sparing money for something important for you.