Week 6 Advance FNP Clinical IV Discussions Replies

All replies must be constructive and include at least two references.

• Ferlanda Pierrelus 

Weekly Clinical Experience 6

• This week of clinical experience primarily assisted me in developing clinical abilities and integrating theory and practice into practice. This clinical experience has improved my capacity to care for patients and has given me confidence in making essential and independent decisions in the nursing process.

Before becoming a nurse practitioner, students must have academic skills and fulfill interpersonal encounters in a suitable clinical setting. I can comprehend the special aspects of treatment delivered in gerontology through clinical practice and have voiced good thoughts about the privilege of learning through observing various clinical circumstances.

This week, I saw a 66-year-old Hispanic female who appeared at the clinic complaining of frequent urination with the desire to urinate several times during the day and night with a tiny amount of urine accompanied by a sensation of urgency to void without relief. The patient claims that the urinary symptoms began about three days ago and are related to discomfort in the suprapubic area, but he denies having flank pain. The patient claims she hasn’t observed any changes in her urine, such as a terrible odor or the presence of blood. The patient denied having a fever, chills, nausea, or vomiting. The patient denied a vaginal discharge.

Her vital signs were as follows: BP 115/80 mmHg, Pulse Rate: 68bpm, Respiration Rate: 18 per min, Temp-Tympanic: 97.6 F., Height   67 in, Weight: 150 lbs., Body Mass Index: 23.5, Oxygen Saturation: 98 % on room air, and Pain Scale/Rate: 0/10.

The patient was sensitive to CVA percussion (bilaterally). The patient has declined a genital examination. Dipstick urinalysis was performed in the office and revealed the presence of blood, which Buttaro (2017) claims is particularly beneficial in predicting the existence of UTI. Before beginning antibiotic treatment, urine c/s were acquired to rule out the likelihood of pathogen resistance to the empirical treatment (Domino, F., Baldor, R., Golding, J., and Stephens, M., 2020).

The patient was diagnosed with a urinary tract infection based on his clinical presentation and dipstick urinalysis. Urinary tract infection (UTI) refers to an acute or chronic infection and/or inflammation of the bladder (cystitis), urethra, prostate, ureter, or kidney (Pyelonephritis) caused by microbial colonization of the urine (Buttaro, 2017). This infection is one of the most common primary care diagnoses. Reduced fluid intake, irregular bladder emptying, fecal contamination, menopause, and sexual intercourse are risk factors ( Buttaro, 2017). E. coli is responsible for most illnesses (Buttaro, 2017). UTIs are common in diabetics, and uncomplicated UTIs are characterized by signs and symptoms of bladder irritation, such as increased frequency, urgency, dysuria, suprapubic discomfort, odorous urine, and, in rare cases, hematuria (Buttaro, 2017).

The differential diagnosis is acute Pyelonephritis, Acute urethral syndrome, and Interstitial cystitis (Domino et al., 2020).

Trimethoprim-sulfamethoxazole (160 mg TMP/800mg SMX) 1 Tab by mouth twice a day x 3 days ordered. That is the first line of treatment for uncomplicated UTIs where the chance of E. coli resistance is less than 20% (Domino et al., 2020).

Phenazopyridine (200mg) 1 Tab by mouth ordered two times a day x 2 days as needed for rapid relief of symptoms of dysuria(Domino et al., 2020).

The patient was instructed on general precautions to avoid future UTIs:

Drinking lots of fluids (64 to 80 ounces daily) and practicing excellent hygiene, such as frequently urinating (at least every 4 hours) and wiping from front to back, are important (Buttaro, 2017). Do not use feminine hygiene sprays or douches (Domino et al., 2020).

The patient was educated to monitor for  s/s of Pyelonephritis, the most prevalent complication of UTI, which includes fever, chills, or worsening urinary symptoms such as flank discomfort (Buttaro, 2017).

A three-day follow-up was planned in case the antibiotic needed to be changed based on the urine culture/sensitivity results (Domino et al., 2020).

In addition, the patient was told to return if her symptoms worsened.

References

Buttaro, T. M. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, Mo.:Mosby/Elsevier.

Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5-Minute Clinical Consult 2017 (28th ed.). Print (The 5-Minute Consult Series).