Case Study of a Patient Presenting with Urinary Frequency Essay

In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?

Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. Case Study of a Patient Presenting with Urinary Frequency Essay.  In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient? Case Study 1 A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only. Case Study 2 This is a 40-year-old Hindu married male complaining of sudden high-grade fever for the last 2 days. He is complaining of right flank pain with some burning on urination. PMH: diabetes, HTN. Current meds: metformin 500mg bid, Lisinopril 10mg QD Case Study 3 A 52-year-old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s a loss at least “10 pounds”. For the past week and a half, she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20-year history of Crohn’s disease. She also tells you that she is a practicing vegan. To prepare: Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources. You will either select or be assigned to a patient case study for this Discussion. Review the patient case study and reflect on the information provided about the patient. Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation. Consider types of physical exams and diagnostics that might be appropriate for the evaluation of the patient in the study. Reflect on a possible diagnosis for the patient. Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy. Case Study of a Patient Presenting with Urinary Frequency Essay.  Think about potential treatment options for the patient. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

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A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank haematuria. He had no significant past medical history and no history of STIs.

Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily.

His symptoms improved over the week and the urine microscopy report revealed no growth but large quantities of white and red blood cells.

Review
The patient was reviewed at 10 days and was asymptomatic. A repeat urine microscopy was normal. At the review appointment, digital rectal examination revealed a non-tender benign prostatic enlargement. Case Study of a Patient Presenting with Urinary Frequency Essay.

Biochemical tests including a PSA, glomerular filtration rate and U+Es were normal.

Three weeks later he presented with frank haematuria and incontinence with lower abdominal and left-sided loin pain. He had a palpable bladder and a large stone trapped at the urethral entrance. He was admitted as a surgical emergency and underwent a meatotomy and stone removal under anaesthetic. A cystoscopy was normal and there was no evidence of further calculi in the renal tract.

The stone was calcium oxalate and thought to have originated from the ureter. A coexistent UTI had caused urethral impaction secondary to epithelial slough and an element of BPH.

He has been well since.

Renal calculi
The overall prevalence of renal calculi in the UK is 3 per cent. Males are more affected with peak age incidences in the mid-twenties and mid-fifties.

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The majority arise in the upper urinary tract and most are radio opaque. Smaller stones are more likely to migrate causing pain while larger stones may remain within the kidney.

Many calculi form in the absence of obvious precipitating factors but recognised causative factors include:

• An excess of a normal constituent in blood or urine, for example hypercalcaemia or hyperuricaemia.
• Impaired drainage causing chronic urethral obstruction, for example, benign prostatic hypertrophy.
• The presence of abnormal constituents, for example coexistent urinary infection.

Clinical features
Kidney stones cause flank pain that spreads around the abdomen as the stone migrates.

There is often associated microor macroscopic haematuria.

There may be an associated UTI with pyrexia and septicaemia. An acute pyelonephritis associated with urinary obstruction requires emergency urological review. Case Study of a Patient Presenting with Urinary Frequency Essay.

Ureteric stones present with colicky pain radiating from the flank into the scrotum or the labia majora. There is commonly associated haematuria and symptoms of urinary infection. Abdominal examination may elicit tenderness along the course of the ureter but this is usually milder than the pain reported.

In the lower urinary tract stones may cause pain in the lower abdomen or genitalia.

This may be worse on standing or at the end of micturition if the stone is lying on the trigone.

Management
Around 90 per cent of stones will pass spontaneously. The patient should be kept hydrated and appropriate analgesia given.

If the patient is unwell, febrile or in severe pain, hospital admission is indicated with consideration of IV fluids and antibiotics to treat associated infection.

When the stone is passed, it is important to retain it for further histological examination.

Larger stones may require surgical management. Open surgery has now been largely replaced by endoscopic and percutaneous techniques to remove stones. Lithotripsy is also readily used.

Once the acute phase has passed, the patient should remain under urological follow-up to ensure there are no further residual stones. Case Study of a Patient Presenting with Urinary Frequency Essay.