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Week 10 - Assignment Example

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Over the counter drugs reduced the symptoms temporarily, but they recurred after completion of the dose.
Past medical history: The patient has had three cases of urinary tract…
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Pediatric Urinary Tract Infection due: ive Data Chief complaint: The patient wasadmitted to the hospital with complaints of abdominal pains. She also reports frequent vomiting, polyuria, and bladder incontinence.
History of present illness: The child developed a fever one week ago and is lethargic ever since. Over the counter drugs reduced the symptoms temporarily, but they recurred after completion of the dose.
Past medical history: The patient has had three cases of urinary tract infections in the past six months. She was treated in all cases, but the infection recurs shortly after completion of the prescription.
Family history: Other family members have no history of recurrent urinary tract infections.
Current medication: The child is receiving 400mg of acetaminophen tablets after every six hours to control the fever.
Immunizations: The child is fully immunized.
Social history: The child comes from a family of six. She shares the bedroom with her three siblings who are younger than her.
Review of systems: Genitourinary as per the patient include pain around the suprapubic region and increased frequency of urination. Gastrointestinal symptoms reported by the patient include vomiting and loss of appetite.
Objective Data
• Temperature – 39 degrees Celsius
• Lethargy
• Dehydrated
• Weight – 59.5 pounds (27kg)
• Suprapubical tenderness
Urinary tract infections are the most common illnesses among children. The condition causes distress to the child owing to the negative symptoms. If not treated, urinary tract infections can result to permanent kidney damage (Fisher et al., 2015). Normally, urinary tract infections develop when the pathogens present in the urine, and those which have colonized the periurethral region ascend into the bladder through the urethra. From the bladder, the pathogens can spread further up into the kidneys and sometimes into the bloodstream. Some of the factors that may facilitate entry of bacteria into the bladder include voiding dysfunction, catheterization, sexual intercourse and genital manipulation (Fisher et al., 2015). Poor hygiene can also predispose one to urinary tract infections.
Based on the case study, the patient may be having the recurrent infections due to poor hygiene. She uses the same bedroom with her younger siblings, and hygiene may be questionable in such a situation. More information should be gathered on her sexual experiences to determine if she was molested or sexually abused. The fact that she has had three consequent infections in the past six months also raises the need to investigate the situation further. The recurrent infection may also point to mis-diagnosis by the health professionals who previously evaluated her. As a result, she will be required to present documentation on her past illness to enable the physicians determine the correct plan of action. Also, it has been shown that uropathogenic Escherichia coli is linked to recurrent and persistent urinary tract infections (Tapiainen et al., 2011).
Lab tests: Urine samples will be required for lab testing to determine the pathogen causing the infection, and the appropriate choice of medication. Escherichia coli is a causative agent, accounting for a large majority of urinary tract infections in children (Albert et al., 2014).
Medication: The child should be given Nitrofurantoin Tablets at 7mg/kg/day administered six-hourly. The second line medication includes trimethoprim 8mg/ml – sulfamethoxazole 40mg/ml. Dosing should be based on trimethoprim, at 6-12kg/day (Williams & Craig, 2011; Fitzgerald, Mori, Lakhanpaul & Tullus, 2012).
Nonpharmacological: The child should ensure they are clean and wear clean clothes to minimize the risk of re-infection. Also, the child should increase her intake of fruits and vegetables or take multivitamins to boost her immunity.
Education: The caregivers should be advised on ways to manage the symptoms of the illness. Such measures include increasing fluid intake, taking warm baths and when and how to administer the medication.
Follow-up: in case the symptoms do not subside in two days, the caregiver is advised to return the child to the clinic for further investigation.
Alberici, I., Bayazit, A. K., Drozdz, D., Emre, S., Fischbach, M., Harambat, J., ... & Montini, G. (2014). Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group. European journal of pediatrics, 174(6), 783-790.
Fisher, D. J. (2015). Pediatric Urinary Tract Infection. June 28, 2015, from
Fitzgerald, A., Mori, R., Lakhanpaul, M., & Tullus, K. (2012). Antibiotics for treating lower urinary tract infection in children. The Cochrane Library.
Tapiainen, T., Hanni, A. M., Salo, J., Ikäheimo, I., & Uhari, M. (2014). Escherichia coli biofilm formation and recurrences of urinary tract infections in children. European journal of clinical microbiology & infectious diseases, 33(1), 111-115.
Williams, G., & Craig, J. C. (2011). Long‐term antibiotics for preventing recurrent urinary tract infection in children. The Cochrane Library. Read More
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