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- What is (are) the most likely diagnosis (diagnoses)? What were the clinical findings that confirmed the diagnosis (diagnoses)?
Cystitis N30. 90. Inflammation of the bladder caused by a bacterial infection. Acute onset with urinary frequency and discomfort (dysuria), suprapubic pain and hematuria. The lack of fever, chills, costal vertebral angle tenderness and vaginal discharge eliminates the likelihood of Pyelonephritis (Burns, Dunn, Brady, Starr & Blosser, 2017). Wet mount results of vaginal pH of 4.0 and no yeast, trichomonads or clue cells helps to confirm the diagnosis of cystitis. Pyuria, white cells on microscopy, also lead to cystitis as a diagnosis (Kovach, 2020).
- How is it (are they) treated according to the most recent clinical guidelines? Cite the guidelines.
Guidelines for treatment of cystitis include antibiotic treatment and follow up urinalysis in 2 weeks if needed or patient has hematuria. Once a complicated condition such as Pyelonephritis is excluded, treatment for cystitis is initiated based on the symptoms presented. Urinalysis and cultures help to identify organisms present to determine antibiotic course (Burns, Dunn, Brady, Starr & Blosser, 2017).
- Describe a plan of care for the patient, including patient education, and additional tests.
Ms. Pham is an 18 year -old college student complaining of pain, hematuria and burning with urination for the past two days. She denies fever, back pain and vaginal discharge. She is sexually active with one male partner, and denies pain with intercourse. She is not using any birth control and inconsistently uses condoms during coitus. Her LMP was 7 days ago and consistent with past periods. Plan of care includes: Nitrofurantoin monohydrate 100mg twice a day for five days and proper hydration. Review of safer sexual practices and teaching of the importance of consistent condom use during intercourse. Additional testing for blood and urine cultures to be done if problem persists, worsens or returns despite antibiotic treatment (Chiocca, 2014).
What is the most likely diagnoses? What were the clinical findings that confirmed the diagnoses?
The primary diagnosis is Chlamydial cystitis/urethritis. The urethritis is secondary to the sexually transmitted disease which also lead to the urinary tract infection or cystitis. The clinical findings to confirm this diagnosis is her vaginal swabs was positive for chlamydia. Her urine dipstick was positive for leukocyte esterase, nitrates and hemoglobin. The patient admitted to only intermittently using condoms with one sexual partner. Her signs and symptoms include urinary urgency, frequency, retention, and burning, blood in urine, suprapubic pain, and white vaginal discharge.
How are they treated according to the most recent clinical guidelines? Cite the guidelines.
The cystitis and urinary tract infection Nitrofurantoin 100 mg po twice daily for five days. here are several first-line agents recommended by the IDSA for the treatment of acute uncomplicated cystitis. New evidence supports the use of nitrofurantoin and fosfomycin as first-line therapy.The following antimicrobials represent the first tier: (1) nitrofurantoin at a dosage of 100 mg twice per day for five days; (2) trimethoprim/sulfamethoxazole (Bactrim, Septra) at a dosage of one double-strength tablet (160/800 mg) twice per day for three days in regions where the prevalence of resistance of community uropathogens does not exceed 20 percent; and (3) fosfomycin at a single dose of 3 g. Note that the duration of therapy for nitrofurantoin has been reduced to five days compared with the previous IDSA guidelines of seven days, based on research showing effectiveness with a shorter duration of therapy (Colgan & Williams, 2015). Chlamydia is treated Azithromycin 1 gram orally as one-time dose. The current recommendation of the CDC for treatment for uncomplicated genital infections in nonpregnant adolescents and adults is doxycycline for 7 days or azithromycin in a single dose. Azithromycin is the recommended first choice for treatment of pregnant women, with amoxicillin as alternative (O’Connell & Ferone, 2016).
Describe a plan of care for the patient, including patient education, and additional tests.
She may have to have a urine culture if she has recurrent infections. Behavioral and lifestyle modifications can help reduce infections. Sexual activity is associated with recurrent infections, it recommend that females void before and after sexual intercourse. Use condoms, they help prevent UTIs caused by sexually transmitted bacteria. Don’t use spermicides during sex. Wipe front to back, increase fluid intake, and avoid full bladder. Drinking cranberry juice is helpful (CDC, 2020).
You advise her to have blood tests to check for HIV and syphilis. She should also be tested for gonorrhea because it is common for gonorrhea and chlamydia to cause coinfection. Encourage her to talk with her boyfriend and explain that he should also be treated for chlamydia. Explain that they should not not have sex a week after they finish the medication, if they do not wait then they can be reinfected again. He should also be tested for gonorrhea and HIV as well. They should always use a condom each and every time they have sex to be safe (Ford, Barnes, Rompalo, & Hook, 2016).