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Discussion

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

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

Featured Replies

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!

Cystitis is a UTI. Go for it.

:)

  • Author

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?

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?

3+ Glucose could indicate diabetes as well.

3+ Glucose could indicate diabetes as well.

Oh! Good one!

You think that's it? Or the UTI?

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

  • Author

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. :)

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.

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.

  • Author

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.

  • Experts

color: dark amber [color is an indication of the concentration of urine]

character: cloudy [cloudy urine is due to the presence of pus, rbcs and/or bacteria]

usg 1.009 [this is a measure of the concentration of particles in the urine and this is on the low end of normal]

ph 6.9 [normal]

(+) protein [this is an abnormal finding and indicative of stress, excessive exercise, glomerulonephritis, nephropathy]

3+ glucose [a 3+ urine glucose is very abnormal - the blood glucose must be at 250 for glucose to start dumping into the urine - assume this urine sample is a from urine collected in the bladder over time so it is an averaged result--the glucose being dumped is most likely much higher than 3+ - this happens in diabetes mellitus, pregnancy and in the presence of the ingestion of nephrotoxic chemicals such as mercury, lead or carbon monoxide]

(+) wbc 1-3 [only present when there is acute uti, any form of nephritis, a fever and sometimes with strenuous exercise]

(+) bacteria (unspecified type)

(+) casts [indicative of nephropathy]

(+) crystals [renal stone formation is likely]

symptoms:

  • dysuria
    • dysuria is painful or difficult urination commonly accompanied by urinary frequency, urgency, or hesitancy. inflammation is the most frequent cause, but other pathology includes cystitis, urethritis, trigonoitis, carbuncles of the urethra, obstructions of the urinary tract, cancers, neurologic disorders, diabetic neuropathy or foreign bodies that have irritated the urinary tract such as catheters. it is most commonly due to lower urinary tract infection (uti) and is more common in women than men. it also frequently is the result of lower urinary tract irritation or inflammation which stimulates the nerve endings in the bladder and urethra that result in the typical symptoms of dysuria. (references: nurse's 5-minute consult: signs & symptoms, pages 196-7, signs & symptoms: a 2-1 reference for nurses, pages 236-239, differential diagnosis in primary care, pages 144-145)

    [*]frequent urination

    • assume the blood glucose is high and the kidneys are trying to dump glucose. this patient is at risk of becoming dehydrated.

    [*]malaise

    • "discomfort, uneasiness, or indisposition, often indicative of infection." (page 1153, taber's cyclopedic medical dictionary, 18th edition, 1997, f.a. davis company)

    [*]low grade fever

    • fever is related to infection. fever is one of the symptoms of infection.
      • (page 171, differential diagnosis in primary care, 4th edition, by r. douglas collins) "increased heat in the body is caused by increased production or decreased elimination or dysfunction of the thermoregulatory system in the brain. increased production of heat occurs in conditions with increased metabolic rate such as hyper thyroidism, pheochromocytomas, and malignant neoplasms. poor elimination of heat may occur in congestive heart failure (chf) (poor circulation through the skin) and conditions where sweat glands are absent (congenital) or poorly functioning (heat stroke). most cases of fever are caused by the effect of toxins on the thermoregulatory centers in the brain. these toxins may be exogenous from drugs, bacteria (endotoxins), parasites, fungi, rickettsiae, and virus particles, or they may be endogenous from tissue injury (trauma) and breakdown (carcinomas, leukemia, infarctions and autoimmune disease)."

        the hypothalamus of the body regulates body temperature. a fever is an elevation of the hypothalmic set point. this is caused by
        • central nervous system disease
        • malignant hyperthermia
        • strenuous exercise
        • stress
        • chills (produce more heat and, thus, raise the body temperature)
        • thyrotoxicosis
        • heatstroke
        • heart failure
        • congenital absence of sweat glands (sweating helps the body get rid of heat)
          drugs that impair sweating

what other hx is needed from the patient?

i want to know what the patient's medical diagnoses and other medical history is. has the patient had any recent injuries lately? what medications is the patient taking? how long has the dysuria been going on? how frequent is the urination? when did the fever start? what have the fevers been? what did the patient have to eat today?

what should be reported to the md?

the elevated glucose, the presence of wbcs, bacteria, protein, patient's complaints of dysuria, frequent urination, malaise and the low grade fever

what possible orders can be anticipated for this patient?

more labwork. a serum glucose, fasting blood sugar in the am, hb1ac, serum electrolytes, serum protein, bun, creatinine, serum adh, cbc, urine for culture and sensitivity,

what possible medical diagnoses are expected?

uti, dehydration, diabetes mellitus, nonketotoc hyperglycemic-hyperosmolar syndrome, glomerulonephritis

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