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

Daytonite, BSN, RN · Oct 13, 2008

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

loricatus · Oct 13, 2008

Good job, Daytonite. But, I think the OP ...wanted a simplistic answer. Hope that other students reading this can find value in your hard work,

CapNurse09 · Oct 13, 2008

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

I'd say UTI + DM

driving85 · Oct 13, 2008

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.

That's all good and well, but a lab value book or website will tell you that glycosuria is an indication of elevated blood sugar. Which, in turn, leads you to diabetes. If you google diabetes and UTI, which is your first hunch, you get several websites which support that theory. However, you need to then figure out what additional labs you would run to determine if the patient is in DKA and has a UTI, or if they're just a poorly controlled diabetic with a UTI. This can also come from google. Use your Google-fu, grasshopper.

SugarNSpiceX2 · Oct 13, 2008

Um, well...if that insult was directed at me...

I do very much want to learn and I appreciate Daytonite's information...it was VERY helpful!

It's not that I didn't want to learn, I just didn't want to make the assignment more complicated than it has to be.

She specifically told us in class to do this on our own and not to be putting a bunch of info in the assignment that we aren't supposed to know yet, b/c then she'll know that we got help and didn't do it on our own like we are supposed to.

I am in my 2nd month of LPN school. Right now we are going over A&P of body systems. We haven't even started Med-Surg yet. This assignment is about the urinary system. In my 2nd month of LPN school, there's no way I would know all of that information. Even in doing research, I just haven't learned enough in class yet to form that conclusion that Daytonite posted.

I very much appreciate the information, though, and it helped so much. Very helpful post.

I DO want to learn...I just didn't want to complicate the assignment...you see?

I don't see the need for a smart-assy reply or an insult. Just trying to complete the assignment based on what I have been taught in class thus far.

loricatus · Oct 13, 2008

Um, well...if that insult was directed at me...
I do very much want to learn and I appreciate Daytonite's information...it was VERY helpful!
It's not that I didn't want to learn, I just didn't want to make the assignment more complicated than it has to be.
She specifically told us in class to do this on our own and not to be putting a bunch of info in the assignment that we aren't supposed to know yet, b/c then she'll know that we got help and didn't do it on our own like we are supposed to.
I am in my 2nd month of LPN school. Right now we are going over A&P of body systems. We haven't even started Med-Surg yet. This assignment is about the urinary system. In my 2nd month of LPN school, there's no way I would know all of that information. Even in doing research, I just haven't learned enough in class yet to form that conclusion that Daytonite posted.
I very much appreciate the information, though, and it helped so much. Very helpful post.
I DO want to learn...I just didn't want to complicate the assignment...you see?
I don't see the need for a smart-assy reply or an insult. Just trying to complete the assignment based on what I have been taught in class thus far.

You said, after my post, that you did not want complicated answers. That is why I acknowledge Daytonite's hard work as being beneficial for someone else.

I do have to question why you posted here if you were supposed to do this on your own? Also, please keep what you write on this board clean.

SugarNSpiceX2 · Oct 13, 2008

You said, after my post, that you did not want complicated answers. That is why I acknowledge Daytonite's hard work as being beneficial for someone else.
I do have to question why you posted here if you were supposed to do this on your own? Also, please keep what you write on this board clean.

I wasn't aware that my reply was "dirty"....but I'll try to keep that in mind. :confused:

I posted here because I know that there are a lot of people on here with much more experience than I have and I wanted to make sure I was on the right track.

As you could tell from my original post, I had already formed my own conclusion that this patient's diagnosis was likely Cystitis...based on my interpretation of the lab results and complaints.

So I had already down my own work, my own researching....all I wanted was some input from someone more experienced to let me know whether or not I was on the right track.

I wasn't looking for someone to give me the answer or do the work for me. Just a little guidance. I thought that was kind of the point of this forum???

Daytonite, BSN, RN · Oct 13, 2008

I spent a great deal of time putting together an answer to this question to give the critical thinking that went into determining a diagnosis. Students need this.

I don't appreciate getting criticized for my efforts. I didn't need to be told that I gave too much information. To complete the assignment based on what has been taught in class so far, just use the information that is felt is needed and forget about the rest. There was no reason for anyone to criticize how I chose to answer this post, especially since I answered it by copying it and breaking it down piece by piece.

Daytonite, BSN, RN · Oct 13, 2008

You said, after my post, that you did not want complicated answers. That is why I acknowledge Daytonite's hard work as being beneficial for someone else.
I do have to question why you posted here if you were supposed to do this on your own? Also, please keep what you write on this board clean.

This is a student forum and this kind of question is perfectly legitimate for a student to ask.

Home Health Columnist / Guide · Oct 13, 2008

:eek: :eek: :eek: Please remember that this is a student discussion area.

:typing

Posters can be in PN, AD/ASN or BSN program anywhere from first week, second month to last month in program----and we do not always know that info when posting.

Please allow leaway here and avoid sarcastic/unhelpful comments as per the bb Terms Of Service. We desire this section to be a welcoming nurturing area. Let those who enjoy guiding students provide info as they desire. No reason to flame any poster in this AN area.

NRSKarenRN

of behalf of AN Mod Team

txnursingqt · Oct 13, 2008

I spent a great deal of time putting together an answer to this question to give the critical thinking that went into determining a diagnosis. Students need this.
I don't appreciate getting criticized for my efforts. I didn't need to be told that I gave too much information. To complete the assignment based on what has been taught in class so far, just use the information that is felt is needed and forget about the rest. There was no reason for anyone to criticize how I chose to answer this post, especially since I answered it by copying it and breaking it down piece by piece.

Daytonite you are AMAZING and I always appreciate your responses to the posts. I am not in NS yet but I like to read all of these posts because they do give me insight. And I especially appreciate the fact that you give you the reasons behind your answers. I have learned so much already just from your explanations!

THANK YOU!!!!! :yeah: :bow:

nightmare, RN · Oct 13, 2008

Well I for one appreciated Daytonites efforts!!I'm certainly not a student but then we are never too old to learn!