URIN TRAC INFEC

ARY T TION
UNCOMPLICATED: ACUTE
PATIENT DATA

• Married
• Malagutay,
Zamboanga
City A.G.
• Housewife 31 years old
• Roman Catholic Female
CHIEF COMPLAINT

SUPRAPUBIC PAIN
SUPRAPUBIC PAIN
 HISTORY OF PRESENT ILLNESS
4 Days PTA • Suprapubic pain 2 Days PTA
• Pain upon • Fever • Consult at a
Urination • Chills Private Hospital
• Paracetamol and
• Dark Yellow • Sweating at Antibiotic Given
Urine Night • Advised Admission
• Decreased • Vomiting • Refused

Urination Hours PTA

• Temporary • Loss of appetite
Relief from • Dizziness
Paracetamol • Consult at
500mg ZCMC
PAST MEDICAL HISTORY

No history of similar symptoms

No renal, urogenital or gynecological

disease or disorders

No diabetes mellitus or hypertension.

Has no known allergies to food or drugs

No medications or supplements taken
OB-GYNE HISTORY

Menarche: 10 years old

Menstrual cycle is regular
Last Menstrual Period:
February 20, 2020.

OB Score of G4P4 (4003).

3 children via NSVD. 4th via cesarean section

No Complications
FAMILY HISTORY

No family members have the same

symptoms
No family history of any renal, genito-
urinary illnesses.
No History of Hypertension or Diabetes
Mellitus.
PERSONAL-SOCIAL
HISTORY
Diet usually includes salty foods
(dried fish).
Fluid intake: 3 liters of water + 8 ounces
of soda per day

Urinates at least 5 times a day

Wipes perineal area from the back to

the front
 REVIEW OF
SYSTEMS
No difficulty of breathing
No Changes in Weight
No paroxysmal nocturnal dyspnea
No orthostatic hypotension

No Urethral Discharges No changes in bowel

No itchiness movement
PHYSICAL EXAMINATION
PR: 65 bpm SpO2: 98%
RR: 19 bpm Temp.: 36.3°C
BP: 130/80 mmHg
Weight: 63 Kg

Non-tender Abdomen
(+) costovertebral angle tenderness right
(+) kidney Punch Right
 CLINICAL
DIAGNOSIS

Urinary Tract Infection (Uncomplicated):

Urinary Tract Infection (Uncomplicated):
Acute Pyelonephritis
Acute Pyelonephritis Right
Right
CONCEPT
MAP

Legend
Symptoms of Patient
Management for the
Patient
 CERTAINTY
Diagnosis Certainty Basis for Certainty Treatment
Modality
Acute 95% History of: Medical
Uncomplicated  Dysuria Management
Pyelonephritis  Suprapubic pain, radiating to the right for the infection
flank with the use of
 Fever (undocumented) antibiotics with
 Vomiting supportive
 Loss of appetite treatment of
Physical examination finding of: other symptoms
 (+) right costovertebral angle tenderness
 (+) kidney punch right
 PARACLINICALS
Diagnostic Benefit Cost Availability
Procedure
Urinalysis Provides clear picture of urinary tract 130Php Laboratory
infection. Presence of pyuria and Department,
bacteriuria supports the diagnosis ZCMC
Urine As recommended by the Clinical Laboratory
Gram Stain / Practice Guidelines 2013, this 70Php Department,
Culture and facilitates cost-effective use of 1,500Php ZCMC
Sensitivity antimicrobial agents
PARACLINICALS
URINALYSIS RESULTS
Color: Dark Yellow
Transparency: Cloudy
Specific Gravity: 1.014
Glucose: Negative
Protein: Positive
Nitrite: Negative
Leukocytes: Negative
WBC: to many to count
RBC: 2-4
Bacteria: 2-4
 MANAGEMENT
Treatment Modality Benefit Risk
Non-Operative: Antibiotic of choice as first Allergic reactions
Ciprofloxacin 500mg BID line for Acute Pyelonephritis Increased risk of tendinitis and
x 7-10 days tendon rupture
Non-Operative: Supportive treatment (for Risk for hepatotoxicity
Paracetamol PRN for fever)
fever
Non-Operative: Supportive treatment Adverse reactions (dystonic
Metoclopramide PRN for (prevent frequent vomiting) reactions, bronchospasm,
vomiting arrhythmias)
 HEALTH EDUCATION AND
PREVENTION
 Proper Hygiene
o When wiping the perineal area, wipe from front to back
o Use dry tissue
o Avoid using strongly scented or products with alcohol as
feminine wash, use mild soap or appropriate feminine wash
with clean water
o Wash every after voiding and after sexual activity
 Decrease or minimize intake of salty foods and of soda
 Have enough water intake (about 6-8 glasses per day)