Introduction

The Urinary Tract Infection (UTI) is a general term used to describe infections that affect any section of the urinary tract. Research shows that women are the most affected when compared to men. Approximately a third of adult females have been diagnosed with symptomatic cystitis episode at least once and there are chances for recurrent episodes. The incidence of UTI in males below 50 years of age is low while the female adults being 30 times more vulnerable than men in UTI contraction (Tan & Chlebicki, 2016). The infection can result to complex effects like renal failure and kidney damage when not eliminated or identified in the system. Proper UTI classification into complicated and simple forms aids in the management. Diagnosis is founded on a patient’s history with applicable investigations depending on personal risk factors.

Patients Initials: R. L

Subjective Data:

The clients complained about frequent, painful and burning urination, vaginal discharge, and severe lower abdominal pain (Stothers et al., 2016).

Chief Compliant:

“The urge of frequent urination is out of my control. I barely cannot help but find myself in the bathroom from time to time.”

History of Present Illness:

The 28 year old lady, R.L., reports that for the past two days she has been constantly visiting the bathroom for urination. A painful burning sensation is experienced during the urination. The lady claims that she cannot control the urge for urinating and finds herself in bathroom often. The symptoms she claims are related to the previous UTI that she had suffered from. The lady experiences increased lower abdominal pain and also noticed brown fouls of smelling discharge after having unprotected sex with the former boyfriend. The tubal ligation performed on her could also contribute to the frequent cases of UTI as there are chances of infections after the ligation.

PMH/Medical/ Surgical History:

Past Medical History (PMH):

The patient was diagnosed with UTI infection three times in the same year. She was positive for gonorrhea twice and chlamydia once. The client has had a total of four pregnancies and three viable offspring birth (gravida 4, para 3). The client was prescribed sulfamethoxazole / trimethoprim for the as the antibiotic drugs.

Surgical History:

The client underwent surgical tubal ligation as a method of birth control to avoid unnecessary pregnancies that may initiate abortion.

Medical History:

The last pap conducted on her was negative and the client declined of any breast discharge. The dark urine is an indication of blood present in the urine (hematuria) which is associated with UTI as it is accompanied with urine odor. Currently the patient is under no medication.

 

 

Allergies:

The client claimed to be allergic to deodorants perfumes and items with scents in that she develops rashes when exposed to them. The client is also affected by mold, grass, and pollen during the fall and spring seasons. The seasonal allergies initiate itchy eyes, headaches, and running nose and as a result, she gets tired. The client is also allergic to Augmentin drug and eggs.

Significant family History:

The client R.L. is the eldest child in a family of four siblings. The patient has three children and still single. She has a history of numerous male sexual partners. At the moment, the client is staying with a new boyfriend. Their dad died while she was at a tender age of 10. The mother did odd jobs to earn a living as she was just a house wife by the time the husband died. After completion of school, R.L. decided to start living on her own while she hunts for a job where she later started to engage in relationships seeking financial support from her partners.  She was able to give birth to 3 children against her wish and decided to take them to her mother’s home. Her mother claims to have UTI at some point in her life but that should not be linked to hereditable infections as the mother also had cases of multiple sex partners. She was once taken for counseling sessions for abstinence but she did not complete the sessions and termed as tiresome.

Her siblings are all male and everyone is independent. The fact that she is the only female child could put pressure on her that may have resulted to the present character. The family does not hold meetings to help one other as everyone claim to be busy. Due to the family attitude of everyone minding their own business could be another contributing factor for R.L‘s behavior. In her own efforts of preventing unnecessary pregnancies, she opted for the use of contraceptives for birth control. Just like her mom, the client has also undergone tubal ligation two years ago.

Social History:

The client is single, living with a new boyfriend and she is presently not employed. She does not smoke neither does she use alcohol nor drug abuse. She is an atheist and believes in no religion, only managed to complete her A –level. No history of childhood violence though family negligence can be observed. She is more comfortable in male company than female friends.

Review of symptoms:

Physical exam:

On assessment, the client’s blood pressure was 100/80, heat rate was 80 rate of respiration was 16, and the temperature was 99.7F. She is 5 inch in height and weighs 120. She appears to be relatively distressed. Her HEENT was of normal limits and showed no abnormalities. The heart rate was normal with normal rhythm S1 and S2. The chest was clear within the normal limits. The abdomen indicated a soft, tender, and high suprapubic inflammation. She admits of adnexal and cervical motion inflammation, and smelling vaginal discharge. Her rectal is within the normal limits with no abnormalities. Normal pulse rates with normal working of the brain.

Laboratory and Diagnostic Testing results.

Leukocytes differential:

Results: Neutraphils 68%, Bands 7%, Lymphs 13%, Monos 8%, EOS 2%.

Interpretation: An increased level of leukocytes in in the blood stream or urine often indicates presence of an infection (Heytens et al., 2017). The leukocytes or white blood cells are immune cells that fight infection and diseases hence presence in the system. The neutrophils level is higher than the rest due to its function of phagocytosis and killing bacteria.

Urine analysis:

Results: Straw colored urine, Specific gravity of 1.015, PH 8.0, Protein-negative, ketone-negative, glucose-negative, bacteria –many, Leukocytes 10-15, RBC 0-1.

Interpretation: The urine analysis indicated that the specific gravity for the clients’ urine is 1.015 with a PH of 8.0. The UTIs is known to increase the pH level of urine. The specific gravity is within the normal range (Pagano et al., 2017). Lower specific gravity than that indicates high water intake or low minerals intake while a higher value than that indicates dehydration, insufficient water, and electrolyte stress.

Urine gram stain:

Results: Presence of gram negative rods

Interpretation: Escherichia coli is a gram-negative bacterium with a rod-like shape present in UTI infections (Pagano et al., 2017).

Culture of vaginal discharge:

Results: Presence of Neisseria gonorrhoeae, and gram negative diplococci

Interpretation: During gram stain, presence of gram negative bacteria helps in identifying appropriate medication for the infection; diplococcic and E. coli are common in UTI (Ismael et al., 2017). The presence of the bacteria in the UT is the main cause of the smelly vaginal discharge.

Chlamydia test:

Results: positive chlamydia monoclonal AB, wet preparation and VDRL negative, KOH preparation.

Interpretation: Lower GT infections with chlamydia are generally asymptomatic in both men and women unless the test is done. Since the chlamydia is labile, the viability can be sustained by keeping the specimen in wet conditions (Price et al., 2018).

A negative test for VDRL means that the sample is free from syphilis. The KOH preparation was for fungal infection test.

 

Conclusion and recommendation

Urinary Tract Infections are one of the most common clinical microbial infections in females. The recurrent UTIs are less frequent and mainly caused by reinfection of the same bacteria (Price et al., 2018). Proper urine assessment, urine cultures, and some radiological procedures are needed to cancel recurrence causes and to examine potential anatomical urinary tract anomalies. The anti-microbial therapy is the initial standard for UTI treatment although other alternatives like probiotics, methenamine salts reduce antibiotics exposure (Ailes et al, 2018). Postcoital prophylaxis, antibiotic prophylaxis, and acute individual-treatment are effective and cheaper treatment strategies aimed at decreasing the recurrent UTIs number.

 

 

 

 

 

 

 

 

 

 

 

References.

Ailes, E. C., Summers, A. D., Tran, E. L., Gilboa, S. M., Arnold, K. E., Meaney-Delman, D., & Reefhuis, J. (2018). Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections—United States, 2014. Morbidity and Mortality Weekly Report, 67(1), 18.

Heytens, S., De Sutter, A., Coorevits, L., Cools, P., Boelens, J., Van Simaey, L., … & Claeys, G. (2017). Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clinical Microbiology and Infection, 23(9), 647-652.

Ismail, M. D., Ali, I., Hatt, S., Salzman, E. A., Cronenwett, A. W., Marrs, C. F., … & Foxman, B. (2017). Association of Escherichia coli ST131 Lineage with risk of Urinary Tract Infection Recurrence among young women. Journal of global antimicrobial resistance.

Pagano, M. J., Barbalat, Y., Theofanides, M. C., Edokpolo, L., James, M. B., & Cooper, K. L. (2017). Diagnostic yield of cystoscopy in the evaluation of recurrent urinary tract infection in women. Neurourology and urodynamics, 36(3), 692-696.

Price, T. K., Hilt, E. E., Dune, T. J., Mueller, E. R., Wolfe, A. J., & Brubaker, L. (2018). Urine trouble: should we think differently about UTI? International urogynecology journal, 29(2), 205-210.

Stothers, L., Brown, P., Fenster, H., Levine, M., & Berkowitz, J. (2016). MP26-05 DOSE RESPONSE OF CRANBERRY IN THE TREATMENT OF LOWER URINARY TRACT INFECTIONS IN WOMEN. The Journal of Urology, 195(4), e355.

Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore medical journal, 57(9), 485.

 

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