Weekly discussion 3
Did you face any challenges, any success? If so, what were they?
The transition from registered nurse (RN) to nurse practitioner (NP) is a significant career role transition. It is often difficult and can be stressful across various settings. During this time, there is a shift from an experienced, often expert status in the RN role to an inexperienced, novice status in the NP role. This can result in an alteration in professional identity, loss of confidence, and impaired NP role development. (Barnes, 2015)
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.
25-year-old woman comes to the clinic complaining of pain and a burning sensation on urination. She also reports urgency and frequency. Patient reports the pain is across her pubic area. Reports that urine is cloudy. Denies flank pain, fever, blood in urine.
Examination:
Physical Examination
On physical examination patient noted with noted with no suprapubic tenderness or costovertebral angle tenderness. Urinalysis was performed to look for evidence of infection, such as bacteria and white blood cells in a sample of urine. A positive leukocyte esterase test and the presence of nitrite in the urine was positive which supported the diagnosis of UTI.
BP: 130/78, Temp: 36.9, HR 80: RR 18, Pain:3
Differential diagnosis:
Acute pyelonephritis
Bladder cancer
Cystitis
Pelvic inflammatory disease
Urethritis
Plan of Care: Urinary tract infection
Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. They are classified as upper UTIs (pyelonephritis) and lower UTIs (cystitis, prostatitis) depending on the site of infection and as uncomplicated or complicated according to underlying diseases and anatomical or functional abnormalities of the urinary tract. Clinical manifestations of UTIs vary from asymptomatic bacteriuria to septic shock. (Jennifer Anger, Una Lee, 2019)
Management/Education
Wipe from front to back when you go to the toilet.
Keep the genital area clean and dry.
Drink plenty of fluids, particularly water so that you regularly pee during the day and do not feel thirsty.
Wash the skin around the vagina with water before and after sex.
Urinate as soon as possible after sex.
Therapeutic: Nitrofurantoin: 100mg capsule. 1 cap every 12 hours for 7 days
Follow up in 2 weeks
Support your plan of care with the current peer-reviewed research guidelines.
Urinary tract infections are the most common bacterial infections in women. Most urinary tract infections are acute uncomplicated cystitis. Identifiers of acute uncomplicated cystitis are frequency and dysuria in an immunocompetent woman of childbearing age who has no comorbidities or urologic abnormalities First-line treatment options for acute uncomplicated cystitis include nitrofurantoin (microcrystals; 100 mg twice per day for five days), trimethoprim/sulfamethoxazole (Guideline, 2019)
References
Barnes, H. (2015). Exploring the factors that influence Nurse Practitioner Role Transition. Journal of Nurse Practitioner, 11(2):178-183.
Guideline, L. E. (2019). Clinical Practice Guideline for the management of asymptomatic Bacteriua. Clinical infectious disease, Volume 68, issue 10,pages e83-e110.
Jennifer Anger, Una Lee. (2019). Recurrent uncomplicated Urinary Tract Infection in Women. Official Journal of the American Urological Association, https://doi.org/10.1097/JU.0000000000000296.
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