Doing an assignment...can someone help me??

[SugarNSpiceX2]

Hey all. :)

I am doing an assignment for school that is due tomorrow.

Basically here's what I have to do...

I have a set of lab values from a urinalysis. I have to take those lab values, analyze them, and then try to use those lab values along with the patient's complaints to figure out the following:

- What should be reported to the MD

- What other Hx is needed from the patient?

- What possible orders can be anticipated for this patient?

- What possible medical diagnoses are expected.

So.....Here's the info that I have from the urinalysis...

Color: Dark Amber

Character: Cloudy

USG 1.009

pH 6.9

(+) Protein

3+ Glucose

(+) WBC 1-3

(+) Bacteria (unspecified type)

(+) Casts

(+) Crystals

Pt. complains of dysuria, frequent urination with malaise, low grade fever.

So...I have to take that info and try to determine the 4 things above.

I am thinking along the lines of a diagnosis of Cystitis. Does that sound about right? What do you think?

If I can just figure out the right diagnosis, I can figure out the other stuff easily.

I'd appreciate the help. Thanks

[RN2B123]

Sounds like a bladder infection to me (UTI) or maybe some kind of infection (kidney infection)? due to protein in the urine

Let us know what the right answer is!

[SuesquatchRN, BSN, RN]

Cystitis is a UTI. Go for it.

:)

[SugarNSpiceX2]

Yeah that's what I was thinking too...

Bladder Infection/UTI/Cystits...something along those lines.

Does anyone know of any website I could go to to verify? Or check lab values that would be expected w/ those diagnoses?

[SuesquatchRN, BSN, RN]

Your text should have them, no?

Go non-specific, sugar. Without a C&S - culture and sensitivity - you can't diagnose which UTI and, as a nurse, you aren't expected to, anyway. Does your instructor expect that much specificity?

[nightmare, RN]

3+ Glucose could indicate diabetes as well.

[SuesquatchRN, BSN, RN]

3+ Glucose could indicate diabetes as well.

Oh! Good one!

You think that's it? Or the UTI?

[nightmare, RN]

Difficult could be either.Could be dehydrated because of diabetes but There's also protein.No mention of Nitrites in there though.

[SugarNSpiceX2]

I'm not really sure how specific she wants us to get.

The 3+ glucose COULD be an indicator of diabetes...BUT, a diet high in sugar will also increase the risk of a UTI...right?? So it would be important to know the patient's dietary practices when taking history, right??

I am thinking the Dx is UTI/Cystits based on the information that I have. Especially given the fact that the patient is complaining of malaise, low grade fever, frequent urination and dysuria. Those are all classic symptoms of Cystits.

Plus, the casts and crystals in the UA point to that as well...and the bacteria.

I don't think this assignment is for a grade, but she did say that if we do well on it we might get a couple points added to our next test...so I do want to do good on it.

I'm pretty sure the Dx is Cystitis. I will just be sure to mention that one of the possible orders will be a C&S to determine Dx.

Thanks for the help. :)

[loricatus]

Diabetics are prone to infections.

So, what things do you think you need to report? Some things to consider:

If the pt has a spillover of glucose in the urine, look up how high there blood glucose would need to be? So, would a fingerstick &/or blood glucose level by needed. DKA, maybe?

What vital signs would indicate a systemic infection? What is a complication for an infection prone person (diabetic) that has a urinary tract infection. Look up urosepsis/sepsis. Some tests for could be lactate levels and blood cultures.

If it is chronic kidney infection, is erythropoeitin production altered & would a CBC be indicated?

Just trying to get you thinking so you can handle what is yet to come in school. Be glad to help further if you respond with some thought process of why you came to your conclusion and what you feel needs to be done.

[loricatus]

I'm not really sure how specific she wants us to get.

The 3+ glucose COULD be an indicator of diabetes...BUT, a diet high in sugar will also increase the risk of a UTI...right?? So it would be important to know the patient's dietary practices when taking history, right??

I am thinking the Dx is UTI/Cystits based on the information that I have. Especially given the fact that the patient is complaining of malaise, low grade fever, frequent urination and dysuria. Those are all classic symptoms of Cystits.

Plus, the casts and crystals in the UA point to that as well...and the bacteria.

I don't think this assignment is for a grade, but she did say that if we do well on it we might get a couple points added to our next test...so I do want to do good on it.

I'm pretty sure the Dx is Cystitis. I will just be sure to mention that one of the possible orders will be a C&S to determine Dx.

Thanks for the help. :)

OOOPS, must have been writing my post while you were writing this one.

A diet high in sugar will not have a spillover into the urine. There is a certain blood glucose count that there needs to be to have the spillover. The body will manufacture enough insulin to prevent the spillover, if the patient isn't diabetic.

The sxs you describe can also fit a chronic kidney infection. Diabetics, are, by nature, prone to various infections; but, especially of the urinary tract. So, the c/o of low grade fever, etc, needs to have an objective assessment. Yes, the UA does indicate an infection of the urinary tract, somewhere. Also, the amber urine could be from traces of blood. Is the urine concentrated, by way of the results of the specific gravity? That should tell you if it is blood or dehydration or a combination.

[SugarNSpiceX2]

I really don't think she wants us to go THAT in depth. I mean, there's only so much info we can know at this point in the nursing program and we haven't even touched on Diabetes yet.