FNP NR511 Week 2 Snapps Cheryl PDF

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SNAPPS assignment...

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SNAPPS ORAL PRESENTATION TEMPLATE This template should only be used to organize your oral presentation, IT SHOULD NOT BE SUBMITTED. SUMMARIZE Using a patient seen in the practicum setting, summarize the H&P into an organized and concise format. CC

Pain in bladder

HPI statement using OLDCARTS data

CC: M.B. is a female who presents to clinic with c/o pain in bladder. Onset: 4 days ago Location: suprapubic area, Left flank pain Duration: constant, lasting from a few to fifteen min, but has been increasing in frequency and severity in the past few days. Characteristics: dysuria, of pain is described as a burning sensation at the urinary meatus upon urination which is aggravated during urination and reported as severity of 8/10 but relieved within minutes of cessation of urinary stream. Character of abd pain in suprapubic area is described as pressure and dull ache with severity of 6/10 which is aggravated by bladder distention and external abd pressure and relieved by bladder emptying. Aggravation: movement, walking Relieving: Ibuprofen 600 mg as needed Treatment: Took Cipro 250 mg twice daily for 3 days, no relief

Pertinent ROS

Constitutional: Denies fever, chills, or body aches. Denies night sweats Respiratory & Cardiovascular: Denies SOB, cough, wheezing, palpitations, CP, murmur present Gastrointestinal: Pos for abd pain, denies nausea/vomiting, denies upper quadrant pain, pos left flank pain, denies back pain, denies anorexia, denies diarrhea or constipation. Genitourinary: Pos pain upon urination; Reports urgency, frequency. Denies vaginal discharge, odor, itching,. Hematology/Lymphatics: No swollen lymph glands Neurologic: Denies HA, vertigo, syncope, confusion, Endocrine: fatigue

Pertinent PE

T: 98.2 F HR: 74 RR: 19 BP: 122/78 SpO2: 100% (RA) BMI: 24.39 GEN: A/O x 4 PULM: Vesicular sounds noted to all lung fields, Neg retractions, Neg wheezing, crackles, ronchi. CARDIOVASCULAR: Regular Rate Rhythm, no Carotid Bruits, PP equal 2+ bilat, normal capillary refill. ABD: Pos abd tenderness, Pos guarding noted upon palpation of suprapubic area. Neg for rebound tenderness. Neg for distention. Neg Blumburg. Neg Murphy’s sign. Neg costovertebral angle tenderness. Neg abd bruit. NEURO/PSYCH: Normal mood and affect Lab: UA: Neg. leukocytes, Neg. Nitrates, Urobilirubin: 0.2 Bilirubin:neg, pH: 5.0, Blood: neg, Ketone: neg

NARROW Based on the H&P key findings, identify an appropriate differential.

N-ephr ol i t hi as i s -Pylonephritis -Pelvic Inflammatory Disease

ANALYZE Analyze the differential by comparing and contrasting the possibilities. Use pertinent positive and negative findings to argue for or against each diagnosis in your differential. Rank your diagnoses in order of most likely to least likely.

Nephr ol i t hi as i s-Renal calculi are a common cause of blood in the urine (hematuria) which was negative finding in this patient and pain in the abdomen or flank. Occurs more in women than men. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity. Renal calculi present with excruciating pain.

Cystitis Most likely Diagnosis for this patient's condition is cystitis. Pertinent positives for this condition are dysuria, suprapubic abdominal pain, frequency, urgency, and of course lab

results showing large amounts of leukocytes, nitrites, moderate blood, and elevated pH. There are no identified pertinent negatives. Furthermore, the patient has a history of UTI’s Pylonephritis Pylonephritis is an infection of the kidney and/or upper urinary tract. Pertinent positives for this condition which are present in this patient include: abdominal pain, urgency, frequency, dysuria, hematuria, and cloudy urine. Although pyelonephritis has many of the same symptoms as cyctitis, pertinent negatives include: afebrile, lack of N/V, lack of flank/back pain, lack of fatigue, and the appearance of being otherwise unwell. People with pyelonephritis generally look sick and have a constant feeling of illness. This patient appeared in NAD and was talkative and engaging in conversation. This state, combined with the other pertinent positive and negative symptoms lead me to believe that pyelonephritis, though a possibility, is not the condition in this cas

PROBE Verbalize any knowledge gaps, points of confusion or dilemmas that you have regarding your understanding of the case by identifying questions that you would (or did) ask your preceptor.

I asked my preceptor how she would decide which antibiotic to start the patient on while awaiting culture results, or what she would do in cases where she did not obtain a culture. She stated that since Bactrim is no longer considered first line treatment due to increased resistance, Macrobid is her treatment of choice in patients as long as they are not on a multitude of other medications or otherwise have contraindications.

PLAN At a novice level, propose an appropriate plan to confirm and/or manage the problem.

Urine Culture -Ultrasound of kidneys - Macrobid 100mg PO Q12H x 5 days -Take with food -Do not take within 2 hours of PPI -Do not take antacids with magnesium trisilicate -IBP 800mg PO Q8H PRN pain x 10 days, heating pad as needed for cramping -Call if symptoms do not improve or if they worsen -Complete entire AB course -Wipe front to back; urinate after intercourse; increase H2O intake, no bubble baths, no scented tampons, no douching -Call if symptoms do not improve or if they worsen within 48 hours, otherwise follow up in 1

week

SELF-DIRECTED LEARNING Identify one issue for self-directed learning. What are some non-hygiene related causes of cystitis and how might they be avoided or treated?

In the written portion of this assignment, you will present your findings....