OPIC: Urinary Tract Infection in Pregnancy
State the patient’s chief complaint, reason for visit and/or the problem for which you are providing follow-up.
The client is a married, 28-year-old Asian woman who is 37 weeks pregnant. This is her second pregnancy and her first child is alive and living at home with both parents and she has no history of miscarriage. The client’s chief complaint concerns her increasing problems with urination.
All symptoms related to the problem are described using the following cue descriptive categories:
Precipitating/alleviating factors (including prescribed and/or self-remedies and their effect on the problem).
The client presents with complaints of a constant need to urinate that causes a burning sensation. The client reports drinking cranberry juice in an effort to alleviate these symptoms but no other self remedies. The client denies tobacco, alcohol or illicit drug use.
Besides a burning sensation when urinating, the client also reports experienced pain in her pelvis and her urine appears cloudy.
3) Quality of all reported symptoms including the effect on the patient’s lifestyle
The client’s constant need to urinate has caused her to remain at home for the past several weeks. The client also reports trouble resting and sleeping due to her constant need to urinate.
4) Temporal factors (date of onset, frequency, duration, sequence of events)
The client reports having to urinate more than 20 times a day, and vomiting on occasion.
5) Location (localized or generalized? does it radiate?)
Besides pelvic pain, the client also reports experiencing occasional pain in her lower left back.
6) Sequelae (complications, impact on patient and/or significant other)
The client’s self-restriction to home has adversely affected her social life, including her previously regular weekly restaurant outings with friends.
7) Severity of the symptoms
The client reports increasing urgency in urination and severity of burning sensation in recent weeks.
b. Pertinent Past Medical History including Pregnancy, Prenatal. Postnatal, Immunizations, Tests, Dental Care, Allergies, Accidents, Childhood illnesses, Operations, Hospitalizations.
The client denies experiencing these symptoms during her first pregnancy which was uneventful. The client reports having been hospitalized last year to have a broken ankle surgically reduced with a plate after falling in the kitchen on a wet tile floor.
c. Family History includes family members, family health history, social history to include, residence, financial situation, outside assistance, family interrelationships, school experiences that are relevant to the problem are stated.
The client has an associate’s degree but is currently unemployed although she has worked as an administrative assistant in a law firm until having her first child 4 years previously. Her husband is employed full time as a stock broker, the family has full coverage health insurance and is financially secure. The client’s parents are dead but she has two siblings (brother and sister) living in China.
d. The Review of Systems relevant to the chief complaint/presenting problem is included.
General: (-) fever, easy fatigability, chills; (+) weight gain of 5 lbs. in previous week.
Skin: (-) pallor, diaphoresis; (-) rash
HEENT: (-) frontal headaches, dizziness, yellowish nasal discharge, post nasal drip, sore throat hoarseness; (-) earache, sinus pains, eye discharge, blurred vision
Breast: (-) lumps, masses or nipple discharge
Chest/Lungs (C/L): (-) pain on deep inhalation, shortness of breath, chest pain, exertional dyspnea, orthopnea, palpitations, hemoptysis, wheezing, edema, and claudication
Abdomen: (+) nausea, vomiting; (+) change in bowel habits
Genitourinary: (+) urgency; (-) dysuria, hematuria, post-menopausal bleeding
Musculoskeletal: (+) body malaise, joint stiffness and pains, weakness; (-) joint swelling
Neurologic: (-) confusion, blurred vision, anxiety; (-) paresthesia, slurring of speech, syncope, unsteady gait
e. Habits to include development and personality
The client reports eating little red meat but enjoys fish.
f. If appropriate, subjective date is obtained from or corroborated with parent or caregiver of child or other members of health care team
g. Interview pursues all cues presented by the patient/parent/caregiver.
The findings that emerged from the assessment of the client provide a valid basis for a diagnosis of a UTI which is not uncommon during pregnancies (Soster & Varma, 2008). A urinalysis can help rule out potential differential diagnoses of ectopic pregnancy or renal colic (Evans & Tippins, 2007) since the symptoms of these conditions can be similar to UTI (Ectopic pregnancy symptoms, 2016; Kidney pain causes, 2016).
a. Using inspection, palpation, percussion, and auscultation, the examiner evaluates all systems associated with the subjective complaint including all systems which may be causing the problem or which manifest or may potentially manifest complications and records positive and pertinent negative findings
Evaluation of the client confirms the classic symptoms of UTI which can affect the bladder and urethra as well as ureters and kidneys, and the condition is characterized by frequency and urgency of urination that produces a burning sensation termed dysuria (Feinbloom, 2009).
b. Performs appropriate diagnostic studies if equipment is available
Diagnosis requires a urinalysis and culture to evaluate the presence of white blood cells and bacteria which, combined with the foregoing symptoms, are the basis for a diagnosis of a UTI (Feinbloom, 2009).
c. Records results of pertinent, previously obtained diagnostic studies.
Diagnosis/es is (are) derived from the Subjective and Objective data
The results of the urinalysis and urine culture confirm the presence of white blood cells and bacteria.
4. Treatment plan
According to Delzell and Lefevre (2000), the conventional treatment for UTI in pregnant women that is safe for both the mother and the fetus has been ampicillin; however, this drug has become less effective against E. coli in recent years and clinicians are increasingly prescribing nitrofurantoin (Macrodantin) or cephalosporins which are well tolerated and treat the important organisms effectively (Delzell & Lefevre, 2000). The client should follow this course of treatment and be scheduled for a follow-up urinalysis and culture during her next examination.
Delzell, J. E. & Lefevre, M. L. (2000, February 1). Urinary tract infections during pregnancy. American Family Physician, 61(3), 713-720.
Ectopic pregnancy symptoms. (2016). Mayo Clinic. Retrieved from http://www.mayoclinic.org/ diseases-conditions/ectopic-pregnancy/basics/symptoms/con-20024262.
Evans, C. & Tippins, E. (2007). The foundations of emergency care. Maidenhead, England: Open University Press.
Feinbloom, R. I. (2009). Pregnancy, birth, and the early months: The thinking woman’s guide. Cambridge, MA: Perseus Publishing.
Kidney pain causes. (2016). Mayo Clinic. Retrieved from http://www.mayoclinic.org/symptoms/ kidney-pain/basics/causes/sym-20050902.
Sostre, S. O. & Varma, D. (2008, July). ‘Morning sickness’ in pregnancy loses psychogenic stigma; evidence refutes past beliefs, supports organic causes and psychological sequelae. Current Psychiatry, 7(7), 31-35.
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