Management of Pyelonephritis in a 33-Year-Old Female

A 33-year-old female presents with a history of recurrent urinary tract infections (UTIs), the most recent episode occurring two months ago. She states she had dysuria two days prior to this admission, increased frequency, and urgency in urination, with progressively worsening pain in her right flank. Further, she has had chills, a temperature of 100.2°F for a single day, nausea, and vomiting only once. The patient does not state hematuria, dyspareunia, or menstrual changes. She remains weak and fatigued but is ambulatory; her temperature is 100.2°F; she has mild suprapubic pain, and her right CVA is tender. According to these complaints, the main diagnosis is expected to be pyelonephritis.

Differential Diagnoses

Pyelonephritis

This is the best diagnosis, taking into account the patient’s history, age, and sex as well as presenting symptoms, including flank pain, fever, chills, and costovertebral angle tenderness, possibly pointing towards upper renal tract involvement in this patient (Sabih & Leslie, 2023).

Urolithiasis

This condition has similar flank pain and urinary complaints, but patients usually have bloody urine, which is not described by the patient.

Ectopic Pregnancy

As this diagnosis has been contemplated, the lack of acute lower abdominal pain and the existence of non-regular bleeding, as the normal find last menstrual period is about one month before, reduces the probability of this diagnosis. If the pregnancy test were negative, this condition would also be excluded as a diagnosis.

Management Plan

The primary management goal is to treat the suspected pyelonephritis while preventing complications.

Pharmacological Treatment

Antibiotic therapy is essential. The recommended oral regimen for pyelonephritis syndrome is ciprofloxacin, 500 mg orally twice a day for 7-14 days because it targets most of the frequent pathogens. The patient needs to be taught the importance of taking all the drugs in the course as prescribed, as failure could lead to a backup of infection. Moreover, an option is a medication that can help, when needed, to reduce fever and pain; in this case, acetaminophen 500 mg every 6 hours if needed.

Non-Pharmacological Interventions

Adjuvant treatments for the patient include plenty of fluids, which will assist in rinsing the urinary system and decrease the chances of complications. It is also advised to take some form of rest in order to enhance the body’s healing mechanism.

Ancillary Testing and Referrals

In addition, a urine culture should be carried out in order to determine the specific pathogen, and treatment should be modified based on the antibiotic regimen if required. The symptoms can also be evaluated for complications such as an abscess or obstruction. If they deteriorate or become severe, a renal ultrasound may be required (Vernice et al., 2023). All other diagnostics, including complete blood count and basic metabolic panels, can also help determine the severity of infection.

Addressing Social Determinants of Health (SDOH)

Individual factors affecting the patient’s health have a strong correlation to the health of the patient and their willingness to heed doctors’ advice. Questions arise when it comes to the general well-being of patients. These include: 1) Is the patient able to access health care? What mode of transport is preferred while going for treatment? and 2) Is the patient in a position to get assistance from close friends and relatives? Further, to enhance the patient’s outcomes, it is important to resolve any obstacles to adherence to prescribed medications and subsequent therapy (Chelak & Chakole, 2023).

Patient Education

Comprehensive education is essential. The patient should be informed about pyelonephritis, the prescribed treatment, and the importance of adherence to medication. Lifestyle recommendations, such as avoiding bladder irritants like caffeine and alcohol, can help support urinary health (Belyayeva & Jeong, 2022). The patient should be advised to seek medical attention if symptoms worsen, such as increased pain, persistent fever, or difficulty urinating.

Follow-Up Instructions

A follow-up visit should be scheduled in two weeks to monitor the patient’s response to treatment. The patient should be educated about pyelonephritis, the prescribed medication, and the necessity of taking it at the mentioned time. UV health can also be maintained by avoiding food and beverages that have an irritating effect on the bladder, such as caffeine and alcohol. The patient should be urged to visit a clinician if the side effects worsen, for example, if the pain severity increases and when they experience a high fever or develop a problem in passing urine.

References

Belyayeva, M., & Jeong, J. M. (2022). Acute pyelonephritis. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519537/

Chelak, K., & Chakole, S. (2023). The role of social determinants of health in promoting health equality: A narrative review. Cureus, 15(1), 1–8. https://doi.org/10.7759/cureus.33425

Sabih, A., & Leslie, S. W. (2023). Complicated urinary tract infections. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK436013/

Vernice, Heller, D. R., Berger, E. R., Capozza, S., Greenup, R. A., & Sanft, T. B. (2023). Ancillary treatment referrals and visits after breast cancer surgery in a sociodemographically diverse population. Annals of Surgical Oncology, 30(9), 5637–5648. https://doi.org/10.1245/s10434-023-13431-5

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Case

The patient is a 33 years old female with a history of recurrent UTIs (most recently two months ago) who presents with 2 days f dysuria, increased frequency of urination, urgency and progressively worsening right flank pain. She has had chills and an elevated temperature of 100.2 F for 1 day, nausea, and 1 episode of vomiting with nonbloody emesis and denies hematuria or dyspareunia. She is sexually active with 1 partner, her spouse. She denies changes in menstrual cycle with the last menstrual period nearly 4 weeks ago. Physical exam is significant for T 100.2F, otherwise stable vitals, mild suprapubic tenderness and right costovertebral angle (CVA) tenderness.

Management of Pyelonephritis in a 33-Year-Old Female

Diagnosis

• Pyelonephritis

3-5 Differential Diagnoses, and Coding: What were the key clinical presentations in this patient that led you to choose these differentials; then how did you rule them out to reach your primary diagnosis? 15 points

1. Pyelonephritis
2. Urolithiasis
3. Ectopic Pregnancy

Outcome Management Plan: 20 points

• Medications ordered (including over the counter) are appropriate, evidence based, written as a complete prescription, and includes appropriate medication education.
• Nonpharmacological treatment, additional ancillary testing and referrals ordered are appropriate.

Social Determinants of Health (SDOH), health promotion and risk factors are addressed. 10 pints

Patient Education: Comprehensive patient education is included related to current health visit. 10 points

Follow Up Instructions: Follow up instructions are complete and include time to next visit and specific symptoms to prompt a return visit sooner. 10 points

Scholarly References and Clinical Practice Guidelines: The assignment includes a minimum of 3 scholarly references that are not older than 5 years. Most recent clinical practice guidelines are included if applicable. 5 points