Patient with Painful Urination - Essay Example

A Reflective Account Relating To a Patient With Painful Urination Reflective Account - Physical Exam A 15 year old female patient, accompanied by her mother walked in the clinic presented with a painful urination within the last 24 hours. The nurse tried to relax her and gave the impression that it will be alright. He told the mother and daughter that he will need to ask a few questions to establish the medical history. The nurse was focusing on open questions as they reveal any hidden concerns (Johnson & Smith, 2012). Advanced nursing practitioners are highly skilled nurses who can take comprehensive patient history and carry out physical examination (NMC, 2005). Accurate and thorough assessment, from health history to performing a physical exam, can help uncover facts that help clinicians develop the right care plan (Rushforth, 2009). The patient’s appearance was examined. There were some signs of worry on her face but she did not seem to be in immediate pain. The nurse asked general questions about urination such as ‘how often do you go?’ or ‘do you wet yourself involuntarily?’ (Bickley & Szilagyi, 2012, p. 445). When the author questioned her about the details she replied that it only hurt while urinating. Pain while urinating can be from the kidney (loin pain), ureteric colic or coming from the bladder (Douglas et al. 2009). In children over 2 years of age dysuria and suprapubic, and abdominal pain are the most common presentation of a UTI (patient.co.uk). Questioning her revealed that it was abdominal pain. A urinary complaint of this sort in children indicates dysuria, dysfunctional voiding, foul smelling urine, cloudy urine, enuresis or haematuria (Chiocca, 2010). Children with signs of and symptoms suggestive of UTI should have their urine tested (NICE, 2007). Initial management must include an accurate diagnosis of UTI from an appropriately obtained urine sample (Potts, 2012). The nurse explained to the patient that he will have to conduct an inspection and physical examination to diagnose the cause of urinary pain. Preparing for a physical examination includes a cosy and comfortable environment (Chiocca, 2010). Inspection consists of visual examination of the abdomen (Walker et al., 1990). The nurse explained that it is performed to look for skin abnormalities, abdominal masses and abdominal wall movement due to respiration (Walker et al., 1990). The child is undressed to examine the complete abdomen (Chiocca, 2010). Auscultation, percussion and palpation are the regular tests for abdominal assessment (Chiocca, 2010). The nurse explained to the patient that auscultation of abdomen is performed to detect altered bowl sounds, vascular bruits or rubs (Walker et al., 1990). Auscultation is performed on all four quadrants of abdomen (Wright, 2010). Palpation is examining the abdomen for crepitus, abdominal abnormalities or masses (Walker et al., 1990). Percussion can be helpful in defining the nature of the abdominal mass (Walker et al., 1990). It is very important that right after the inspection, the clinicians should conduct auscultation as palpation might interfere with the bowel sounds (Chiocca, 2010). The nurse caringly prepared the patient for the physical exam. Before starting the examination all vital signs must be obtained as a prerequisite (Chiocca, 2010). The nurse checked the pulse, temperature and breathing. A temperature of 36.8 degree Celsius, respiration rate of 26 breaths per minute and her pulse of 126 beats per minute, were well within the normal range (King & Henretig, 2008). The temperature of the child should always accompany the examination (patient.co.uk). The nurse examined the patient’s throat, abdomen, back and genitalia (patient.co.uk). Abdomen examination revealed no constipation or a tender kidney (patient.co.uk). Back examination did not reveal sacral agenesis (patient.co.uk). And genitalia examination did not reveal phimosis, labial adhesions epididymo-orchitis (patient.co.uk). The complete examination for a child presenting UTI symptoms include After checking for vitals a urinalysis was due. The mainstays of diagnosis are the urinalysis and urine culture, both require a clinician’s interpretation that is influenced by the method of collecting and processing (Fleisher & Ludwig, 2010). The severity of UTI symptoms dictates the degree of urgency for investigation (patient.co.uk). As the physical examination did not reveal any complications and the temperature was under 39 degrees Celsius, and no vomiting, there was no emergency or severe case of UTI (patient.co.uk). The nurse explained to the patient and her mother that they would need a urine sample. After collecting the sample it was sent to lab for testing. The urine was cloudy, which indicated a mild case of UTI ≤ 2 symptoms of UTI (Health Protection Agency, 2011). The results revealed a minor case of UTI which is very treatable with antibiotic dosage for 2-4 days (Health Protection Agency, 2011). The test showed leukocyte and nitrite positive for the urine sample (patient.co.uk). The patient was diagnosed with UTI only when the symptoms were suggestive plus urinalysis confirmed it (Hopcroft & Forte, 2010). The author explained to the patient that the UTI is perfectly manageable and she can expect a recovery very soon if it is a mild case. The nurse told the patient that lab results showed no serious illness, history of pelvic pain or complications, therefore antibiotic treatment should be the way forward (patient.co.uk). The patient was given amoxicillin (patient.co.uk) dosage for two days and the mother and daughter were advised to come straight to the clinic in case of any complications The patient was released to hear that it was a minor case of UTI and that only a small dosage of antibiotics would be sufficient. The complication of UTI in children include renal scarring and renal calculi (Schrier, 2007). The patient presented no other complications or a history of pelvic/abdominal pain. However, a follow-up was advised to rule out any doubts. When the results are normal a follow-up is not routinely required (NICE, 2007). However, the nurse wanted to make sure that all medical grounds were covered. The patient was asked to return on the third day for a check-up to make sure that she was perfectly cured. When the patient arrived again for a follow-up she said that she does not feel any pain. The patient responded well to treatment within 48 hours (patient.co.uk), which meant that there was no need for ultrasound testing for acute infection (patient.co.uk). The patient and her mother were briefed about management of UTI. They were told that the treatment aims to eliminate symptoms and eradicate bacteriuria, preventing renal scarring and recurrent UTIs and to correct any urological lesions (patient.co.uk). The patient was told that most children recover quickly and completely through antibiotic treatment (patient.co.uk). Upon hearing this the patient seemed relieved that she will probably be fully cured with management and probably she will not have a recurrent case of UTI. The patient was also explained very kindly about prevention measurements. For instance good hygiene, wiping from front to back after micturition, preventing constipation, avoiding bubble baths, chemical irritants and tight clothes are general precautionary measures to prevent UTI (patient.co.uk). The nurse explained that the patient should have ready access to clean toilets at all times and should not expect to delay voiding (NICE, 2007). The nurse was very kind in his explanation and recommendation of the management procedure to both the patient and her mother. Healthcare professional should ensure that old children’s parents are well informed about the need for treatment, the importance of completing any recommended medical course, prevention advice and long-term management (NICE, 2007). Healthcare professionals must also ensure that children and their parents are appropriately aware of the possibility of recurring UTI, hence they must understand the need for vigilance, they should seek prompt treatment from a healthcare professional for any suspected reinfection (NICE, 2007). The nurse was careful not to scare the patient and her mother. He told them that for the moment she has fully recovered but precautions and management are also necessary. The patient looked at ease and so did the nurse. The nurse seemed genuinely concerned about the patient and upon discovering that a mild case of UTI had been effectively treated with antibiotics he seemed genuinely happy. The nurse covered all medical grounds in getting medical history, physical examination, diagnosing and managing the problem. The nurse made good judgement call about the UTI and confirmed it in time through lab tests. The author handled the case expertly and it is expected of him to continue to handle medical cases professionally and diligently. References 1. Bickley L. & Szilagyi, P. G., 2012. Bate’s guide to physical examination and history-taking. Lippincott Williams & Wilkins 2. Chiocca, E. M. 2010. Advanced paediatric assessment. Lippincott Williams & Wilkins. 3. Douglas et al. 2009. Macleod clinical exam. Elsevier Health Sciences. 4. Fleisher, G. R. & Ludwig, S. 2010. Textbook of paediatric emergency medicine. Lippincott Williams & Wilkins. 5. Health Protection Agency, 2011. Diagnosis of UTI- Quick reference guide for primary care. British Infection Association. [Accessed online] 6 July 2014 http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947404720 6. Hopcroft K. & Forte, V. Symptom sorter. Radcliffe Publishing. 7. Johnson, G. & Smith, I., 2012. The minor illness manual. Radcliffe Publishing. 8. King, C. & Henretig, F. M. 2008. Textbook of paediatric emergency procedures. Lippincott Williams and Wilkins. 9. NICE. 2007. Urinary tract infection in children: Diagnosis treatment and long term management. National Institute for Healthcare and Excellence. [Accessed online] 6 July 2014 http://www.nice.org.uk/guidance/CG54 10. NMC, 2005. The proposed framework for the standard of post-registration nursing – February 2005. Nursing and Midwifery Council. [Accessed online] 8 July 2014 http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/The-proposed-framework-for-the-standard-for-post-registration-nursing---February-2005/ 11. Patient.co.uk. n.d. Childhood urinary tract infection. Patient.Co.UK. [Accessed online] 8 July 2014 http://www.patient.co.uk/doctor/childhood-urinary-tract-infection 12. Potts, J. M. 2012. Essential urology: A guide to clinical practice. Springer Science & Business Media. 13. Rushforth, H. 2009. Assessment made incredibly easy. Lippincott Williams and Wilkins. 14. Schrier, R. W. 2007. Diseases of kidney and urinary tract. Lippincott Williams and Wilkins. 15. Walker et al. 1990. Clinical methods: The history, physical and laboratory examinations.[Accessed online] 9 July 2014 http://www.ncbi.nlm.nih.gov/books/NBK420/ 16. Wright, M. 2010. Acute abdomen. Patient.co.uk. [Accessed online] 9 July 2014 http://www.patient.co.uk/doctor/Acute-Abdomen.htm Read More