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Case Study Of Patient Complaining Of Urinary Tract Infection

Case Study Of Patient Complaining Of Urinary Tract Infection

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Patient B is a 64-year-old Pacific Islander woman who has come in with symptoms of urinary tract infection (UTI) and fatigue due to nighttime frequent urination. Her height is 5 feet 1 inch., 170 pounds is her weight (BMI of 32. 2 kg/m²) and has put on weight in the last month for no specific reason. An example of finger stick blood glucose testing is as follows: The patient’s blood glucose level is 207 mg/dL. Her blood pressure is raised at 150/99 mmHg, while her pulse and respiratory rates are within the normal range. No recent febrile states or pain with urination, which points to the fact that the conditions may be chronic Case Study Of Patient Complaining Of Urinary Tract Infection.

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The first, second, and third differentials are T2DM, UTI, hypothyroidism, and metabolic syndrome. Additional history and review of systems should inquire about polyuria, polydipsia, polyphagia, vision change, recurrent infections, presence of thyroid dysfunction symptoms such as dry skin, hair loss, and cold intolerance, and whether there is any family history of metabolic disorders.

Urine analysis shows UTI presence with positive nitrate and leukocyte esterase and highly increased glucose level (>200 mg/dL) that may be due to diabetes mellitus. The fasting blood work includes HbA1c, which is 10. 8%, fasting glucose at 200 mg/dL triglycerides at 500 mg/dL HDL at 32 mg/dL and TSH at 20. 09, which shows that the patient has uncontrolled diabetes, hyperlipidemia, and hypothyroidism.

Patient B has T2DM, hypothyroidism, and UTI as the diagnoses. T2DM is diagnosed by an increased HbA1c and fasting blood sugar, which demonstrates the body’s constant high blood sugar levels. The TSH is high, which implies hypothyroidism, and the urine findings are positive for a UTI. These conditions are frequently comorbid and interdependent, which makes their treatment multimodal.

ADA guidelines for treating T2DM involve using metformin as the initial pharmacologic therapy and possibly insulin or another antidiabetic agent, depending on glycemic control. Other changes include diet, which entails a low carbohydrate, high fiber diet, exercise, physical activity, and weight loss. In hypothyroidism, according to ATA, the initial treatment is levothyroxine and dose modification should be based on TSH levels. According to IDSA recommendations, UTI management includes using antibiotics such as trimethoprim/sulfamethoxazole or nitrofurantoin, drinking fluids, and cleanliness (Foster, 2022)Case Study Of Patient Complaining Of Urinary Tract Infection.

Patient education is critical. For T2DM, Patient B should understand the necessity of self-GLM, signs of hypoglycemia and hyperglycemia, changes in diet, and exercise (Szmuda et al., 2020). For hypothyroidism, education must include the nature of the disease, how to take the medications and the signs that will indicate over or under-treatment. To ensure that the UTI does not recur, UTI education should focus on the need to complete the antibiotic course, take enough water, and practice hygiene.

After three months, a follow-up should be made to check HbA1c, fasting glucose, and lipid profile. If such changes are observed, maintain the existing therapy and remind the patient about the necessary lifestyle modifications. If there is no improvement, one should consider increasing the dose of the medications or using new ones (Adam et al., 2020)Case Study Of Patient Complaining Of Urinary Tract Infection. For hypothyroidism, TSH should be rechecked in 6-8 weeks, and the dose of levothyroxine should be adjusted accordingly and yearly after that when on a stable dose. For UTI, review in 1-2 weeks if the patient’s symptoms have not resolved or have recurred, and revise the treatment plan as appropriate.

Patient B’s case illustrates the challenges of multi-morbidity in chronic diseases. Treatment should follow clinical guidelines, patient and family education, and follow-up can significantly enhance the patient’s quality of life. Combining pharmacologic and nonpharmacologic treatments with lifestyle changes will address her health problems, improving her T2DM, hypothyroidism, and UTI (Samson et al., 2023)Case Study Of Patient Complaining Of Urinary Tract Infection.

References

Adam, G., Rampášek, L., Safikhani, Z., Smirnov, P., Haibe-Kains, B., & Goldenberg, A. (2020). Machine learning approaches to drug response prediction: challenges and recent progress. NPJ precision oncology4(1), 19. https://www.nature.com/articles/s41698-020-0122-1

Foster, K. Y. (2022). Treatment of inpatient urinary tract infections and patterns of the pathogens that cause urinary tract infections (Doctoral dissertation, The University of Iowa). https://search.proquest.com/openview/c8d82712466132be1c5d19fef0c78584/1?pq-origsite=gscholar&cbl=18750&diss=y

Samson, S. L., Vellanki, P., Blonde, L., Christofides, E. A., Galindo, R. J., Hirsch, I. B., … & Valencia, W. M. (2023). American Association of Clinical Endocrinology Consensus Statement: comprehensive type 2 diabetes management algorithm–2023 update. Endocrine Practice29(5), 305-340. https://www.sciencedirect.com/science/article/pii/S1530891X23000344

Szmuda, T., Özdemir, C., Ali, S., Singh, A., Syed, M. T., & Słoniewski, P. (2020). Readability of online patient education material for the novel coronavirus disease (COVID-19): a cross-sectional health literacy study. Public health185, 21-25. https://www.sciencedirect.com/science/article/pii/S0033350620302031 Case Study Of Patient Complaining Of Urinary Tract Infection

Complete the Case Study below:

Case Study:

Patient B is a Pacific Islander woman, 64 years of age, presenting to the primary care physician with complaints of a urinary tract infection (UTI) and fatigue. She attributes the fatigue to waking frequently at night due to the UTI. The patient denies any recent history of febrile states or pain with urination. She is 5 feet 1 inch tall and weighs 170 pounds, with a calculated BMI of 32.2 kg/m2.She is also concerned about recent weight gain w/o much change in her eating habits. A random finger stick reveals a blood glucose level of 207 mg/dL. Vitals Signs: BP 150/99, HR; 87, RR, 18, Oxygen Saturation: 99%, Pain: 0

What are your initial differentials?
What additional HPI and ROS findings are your seeking or ruling in or ruling out?
What are common symptoms (what the patient says) (per system) for the differentials you are considering?

Patient B’s urine sample is below: Case Study Of Patient Complaining Of Urinary Tract Infection

Blood: negative

Protein: <150 mg /d

Nitrates: Positive

Leukocyte esterase: Positive

Glucose >200 mg/d

Ketones: positive

Color: amber and cloudy

To gain additional information, Patient B is referred for fasting blood work. The results of this blood work indicate:

HbA1c: 10.8%
Fasting blood glucose: 200 mg/dL
Triglycerides: 500 mg/dL
LDL: Unable to calculate due to elevated triglycerides
HDL: 32 mg/dL
TSH: 20.09
Hep C antibody: negative
HIV test: negative

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3. What is your actual diagnosis(es) (Most pertinent)?

4. What assessment data/signs are common with this type of patient/diagnosis

5. What guideline will you use to assist in your planning?

6. What is your initial treatment plan for each diagnosis (pharmacologic, nonpharmacologic, etc)?

7. What is your initial education for each diagnosis?

8. When do you recommend follow up? What is your plan upon follow up? (if improvement/ If no improvement)Case Study Of Patient Complaining Of Urinary Tract Infection

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