Dysuria: Diagnosis and Treatment – Endocrine System Example

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"Dysuria: Diagnosis and Treatment" is a great example of a paper on the endocrine system. Dysuria is the disorder that presents difficulty in urination, burning sensation, pain during, and after urinating (Merseburger, Kuczyk & Moul, 2014). This paper will analyze a case of a 51-year old female complaining of dysuria for two days. She has a temperature of 100o, lower abdominal pain, no back pain, and nausea without vomiting. The appropriate physical assessment and laboratory tests will be highlighted together with the treatment plan. From the complaints and information provided by the patient, it can be concluded that she suffers from Acute Pyelonephritis.

Acute pyelonephritis is a severe inflammatory procedure of the renal parenchyma that results after a bacterial infection. The illness is classified by the complication of the symptoms (Wright, 2013).   The physical examination carried out will emphasize the abdominal area. The abdominal assessment is carried out to look for any discomfort on percussion or palpation of the lower abdominal area. For example suprapubic zone that may happen with cystitis. Although cystitis has no defined physical findings, murphy’ s sign is the only physical outcome.

Murphy’ s sign is also referred to as costovertebral angle tenderness and is the only finding that can explain the possibility of urinary tract infection indicating pyelonephritis. The suitable laboratory tests include CBC that is requested to indicate the severe condition of the illness and the reaction to treatment. In addition, the BMP that assists in determining the renal function. Moreover, CRP and ESR tests are critical to experiment with the level of serum where in most cases they are normally high but non-specific. Likewise, the urinalysis test is paramount. In most cases, pyuria is present that is determined by the existence of leukocyte nitrite or esterase on urine dipstick at 75% sensitivity.

In addition, the test has a specificity of 82%. Nevertheless, a negative result does not rule out infection in a patient with a strong history of urinary tract infection. The microscopic assessment of urine that reveals ten white blood cells per cubic millimeter is judged as a signal of pyuria. The existence of urinary white blood in relation to the signs is strong evidence of pyelonephritis.

Blood in the urine (Hematuria) is linked to pyelonephritis and cystitis. In addition, the illness can be determined through a DSMA scan, ultrasound, and IVP that recognize kidneys with ‘ clubbing’ of the calyces. In some cases, chronic pyelonephritis is ruled out through kidney biopsy (Dunphy, Winland-Brown, Porter & Thomas, 2015). The treatment plan of pyelonephritis starts with the incentive management for pyelonephritis that is founded on the need for hospitalization for about 2 to 4 weeks (Bope,   Rakel, Kellerman & Conn, 2011). Most of the patients can be managed with oral antimicrobial therapy in an outpatient environment.

According to Wright (2013), the necessity for hospital admission is triggered by unreliable social support, complex infection, advanced age, and persistent signs after suitable outpatient treatment (p. 194). All in all, the drug used for the treatment of acute pyelonephritis is antibiotic and hence the need to recognize the infecting organism. Oral treatment with norfloxacin, ciprofloxacin, and ofloxacin are the most suitable choices. The alternatives can be trimethoprim-sulphamethoxazole and trimethoprim if the local rate of resistance among uropathogens is low. It is not advisable to utilize ß -lactam antibiotics although it is fully sensitive in vitro because it is linked to a high rate of recurrence than other agents (Bope, Rakel, Kellerman & Conn, 2011).

References

Bope, E. T., Rakel, R. E., Kellerman, R. D., & Conn, H. F. (2011). Conn's current therapy in 2011. Philadelphia, Pa: Saunders/Elsevier.

Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015).Primary care: The art and science of advanced practice nursing. FA Davis.

Merseburger, A. S., Kuczyk, M. A., & Moul, J. W. (Eds.). (2014). Urology at a Glance. Springer Berlin Heidelberg.

Wright, W. F. (2013). Essentials of clinical infectious diseases. New York: Demos Medical.

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