Question

A nurse in the emergency department is caring for a 23-year-old female who is on vacation for her honeymoon. Two days ago, she began experiencing burning while voiding and a tactile fever. The patient reports she has been treating the symptoms with cranberry tablets and increased fluid intake. Her symptoms have not improved, and now she is experiencing a frequent urge to void and lower abdominal pain. Upon assessment, the nurse finds the patient has a low-grade fever. Based on the patient's clinical presentation, which of the following diagnoses is most likely? A. Cystitis B. General urinary tract infection C. Pyelonephritis D. Urethritis

Answer 1

The most likely diagnosis for the 23-year-old female with symptoms of burning during urination, lower abdominal pain, and a low-grade fever is Cystitis, a bacterial infection of the bladder.

Step-by-step explanation:

Based on the clinical presentation of burning while voiding, a tactile fever, a frequent urge to void, lower abdominal pain, and a low-grade fever, the diagnosis that is most likely for the 23-year-old female patient is A. Cystitis. Cystitis, which is characterized by inflammation of the bladder typically due to a bacterial infection, often presents with symptoms such as painful urination (dysuria), feeling the need to urinate frequently, and discomfort in the lower abdomen. Treatment of cystitis usually involves antibiotics such as fluoroquinolones, nitrofurantoin, or a combination of trimethoprim and sulfamethoxazole, along with pain medication to alleviate dysuria.

While general urinary tract infections, urethritis, and pyelonephritis are other possibilities, the specific symptoms and absence of upper urinary tract symptoms such as flank pain, which would be more indicative of pyelonephritis, lean towards a bladder-focused infection, which is consistent with cystitis.

Answer 2

Based on the patient's clinical presentation, the most likely diagnosis is C. Pyelonephritis.

Step-by-step explanation:

Pyelonephritis is the inflammation of the kidneys, often caused by a bacterial infection that ascends from the lower urinary tract. The patient's symptoms of burning while voiding, tactile fever, and now lower abdominal pain, along with a low-grade fever, suggest an ascending urinary tract infection involving the kidneys. While cystitis (option A) and general urinary tract infection (option B) involve the lower urinary tract, the presence of systemic symptoms and lower abdominal pain is more indicative of pyelonephritis. Urethritis (option D) typically presents with symptoms localized to the urethra and does not involve the kidneys.

The patient's attempt to self-treat with cranberry tablets and increased fluid intake may have contributed to a delay in seeking medical attention, allowing the infection to progress. Pyelonephritis is a serious condition that requires prompt medical intervention, usually with antibiotics, to prevent complications and ensure a full recovery. The nurse should prioritize initiating appropriate diagnostic tests, such as a urine culture, and coordinating treatment to address the underlying infection and alleviate the patient's symptoms.

In the context of emergency care, accurately identifying the likely diagnosis guides healthcare professionals in providing targeted and timely interventions. Pyelonephritis, if left untreated, can lead to severe complications, including kidney damage. Therefore, swift and appropriate medical management is essential to ensure the well-being of the patient, particularly considering the potential impact on her honeymoon experience.