Please respond to discussion below using current APA edition and 2 scholarly references. Must be at least 150 words.
A thorough prior medical history should be gathered in addition to the information already supplied. Further inquiries into the patient’s history of UTIs, such as how frequently they occurred, how long they lasted, and what kinds of antibiotics were prescribed, should be made. It is important to learn about the patient’s fluid consumption, particularly the type and number of fluids he drinks in addition to his coffee. A detailed history of the patient’s urine patterns, including any recent adjustments to frequency, urgency, or difficulties, should also be obtained. Questions about his sexual health because some urinary tract infections can be passed from sex to sex. Also to better comprehend the patient’s living circumstances, any recent changes in their routines, and any exposure to potentially infectious sources, it is also important to gather their social history. Relevant family history can offer important information, particularly when it comes to inherited diseases or dementia trends.
What additional objective data will you be assessing for?
The physical examination comprises an inspection, palpation of the suprapubic region, and percussion for costovertebral angle soreness, which, if positive, indicates pyelonephritis. To rule out prostatitis, examine the prostate gland for discomfort, enlargement, and bogginess (Kennedy-Malone et al. 2019). Individuals who have undergone hip surgery and later developed dementia should undergo a neurological assessment to assess changes in their mobility abilities and stability.
What are the differential diagnoses that you are considering?
Possible differential diagnoses include recurrent urinary tract infection (UTI), urine retention, benign prostatic hyperplasia (BPH), postoperative complications, delirium, and dehydration.
What laboratory tests will help you rule out some of the differential diagnoses?
Urinalysis can quickly detect parameters, such as leukocytes, nitrites, or bacteria, that suggest the probability of an infection.
A urine culture and sensitivity test allow for the identification of the exact microorganism causing the infection, which in turn helps in determining the most effective antibiotic treatment.
Complete blood count (CBC) with differential: used to evaluate indicators of infection, such as increased white blood cell count (WBC).
The Basic Metabolic Panel (BMP) allows for the calculation of kidney function type and stage, as well as the assessment of electrolyte levels.
Prostate-specific antigen (PSA) in males can help evaluate urine symptoms associated with the prostate.
What radiological examinations or additional diagnostic studies would you order?
Renal ultrasonography is used to evaluate structural abnormalities and identify any obstructions in the urinary system. A bladder scan to aid in determining the amount of urine left in the bladder after urination, which helps assess urinary retention. Cystoscopy is employed when other diagnostic tests yield inconclusive results, to directly observe the bladder and urethra and assess any abnormalities. If there is suspicion of a hip injury further hip x-rays are needed (Sutter & Blankenbaker, 2021).
What treatment and specific information about the prescription you will give this patient?
Treatment with antibiotics for urinary tract infection and management of fluid intake. Administer a 1-liter bolus of fluid and promote heightened fluid consumption besides coffee to facilitate the elimination of the infection. Physical therapy is utilized to facilitate the patient’s recuperation and enhance their ability to move after undergoing hip surgery. 5-alpha reductase inhibitors restrict the development or reduce the size of the prostate, hence enhancing urine flow. The concurrent use of a 5-alpha-reductase inhibitor and an alpha-blocker, such as finasteride and doxazosin or dutasteride and tamsulosin, may yield superior results compared to using either medication alone (Lokeshwar et al., 2019). Physical therapy is recommended to facilitate the patient’s recuperation and enhance his ability to move after undergoing hip surgery.
Potential Complications
Fluid Overload, Drug Interactions, and Antibiotic-Associated Diarrhea or Allergic Reactions.
What additional laboratory tests might you consider ordering?
The post-void residual volume test, electromyogram, a diagnostic test that assesses muscle activity, can provide insight into the engagement of muscles around the bladder. The C-reactive protein (CRP) is used to evaluate the presence of systemic inflammation. Procalcitonin is utilized as a diagnostic tool for bacterial infections.
What additional patient teaching may be needed?
It is crucial to reorient the patient to his living area as it might facilitate timely urination due to the increased stability of the environment (Kennedy-Malone et al., 2019). Instruct the patient and his family members about the need to maintain proper hydration by increasing water intake and decreasing coffee consumption. Offer comprehensive guidance on identifying indicators of infection that will aid both patients and caregivers in properly managing the disease.
Will you be looking for a consult?
The patient will need several consultations such as a urologist, infectious disease specialist, and physical therapy.
