Women’s Health Case Study Judy Pham's case for 2022/2023 COMPLETED A

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Student’s Name Institutional AffiliationSynopsis of Judy Pham's case  18 years old female.  CC: Urination frequency , urgency, pain, presence of blood in urine.  Acute onset of symptom ... s.  fever, chills and vomiting are denied.  Social: movies, basket ball and partying .  Sexually active, one sexual; partner, unprotected sex.  Diagnosis: acute uncomplicated Cystitis, chlamydia.  Prescription: Nitrofurantoin and azithromycin.  Education: Abstain for one week after medication.HPI  18 years old.  Previously healthy.  Acute onset of urinary disorders.  Increased frequency, urgency (Alidjanov at al., 2016).  Painful urination and blood in urine.  Sexually active, admits unprotected sex.  Fever, vomiting, chills not reported.Medical History  Currently under no medication.  No history of major traumas and chronic disorders.  No allergies reported.  No medical intolerances.  No history of surgeries and hospitalization.Family History  Mother: No history chronic or acute disease.  Father: No history chronic or acute disease.  Sister: No history chronic or acute disease.Social History  Has taken marijuana once.  Admits alcohol but less frequently.  Denies tobacco and drug abuse.  Watches movies, basket ball and likes partying.  College student.  Stays in school dormitory.  Currently home for thanksgiving.  No safety concerns.ROS  General:  No chills and fever reported.  Skin:  No lesions, bruising and rushes.  HEENT:  No abnormalities reported.  Cardiovascular:  No chest pain, edema and palpitation reported.  Respiratory:  No wheezes, coughs and breathing difficulties reported.ROS cont…  Gastrointestinal: Non nausea, vomiting reported.  Musculoskeletal: Back pain denied.  Gynecological/genitourinary: Reports:  urination frequency, urgency, pain  presence blood in the urine  white vaginal discharge  Denies menstrual abnormalities  Reports recent unprotected sex.  Denies pain during sexual intercourse.Examination  Vital sign:  P: 88 b/min, BP: 92/55 mmHg, T: 97.2 F, R: 16 b/min.  H: 160 cm, W: 105 llbs, BMI: 18.6 kg/m2.  General:  Healthy, no acute distress.  Cardiovascular:  No murmurs.  Respiratory:  Lungs clear to auscultation.  Skin:  No lesions.Examination cont…  Back:  No costovertebral angle tenderness.  Gastrointestinal:  Stomach soft on touch,  normal active bowel sounds,  mild midline suprapubic tenderness,  Non-distended bladder.  Pelvic:  No redness, ulceration,  No skin, labia and introitus, abnormalities.  Small amount of white discharge.  Normal looking cervix.Labs  Pregnancy Test:  Negative  Pelvic exam:  Whiff-amine test : negative  Two to five white cells per high-power field  Vaginal discharge: Hp is 4.0.  Urine deep stick (Alidjanov at al., 2020):  Positive for nitrites, leukocyte esterase and hemoglobinDiagnosis  Primary Diagnosis:  Acute uncomplicated Cystitis:  Acute onset of symptoms (Alidjanov at al., 2016).  Urination frequency, urgency, blood in urine.  Dysuria and hematuria.  Physical exam and lab findings supported diagnosis.  Differential Diagnosis:  Cervicitis with urethritis.  Pelvic inflammatory disease.  Pyelonephritis.Treatment Plan  Medication:  Nitrofurantoin. Dose intervals: 100 mg q 12 hours. Duration: 5 days (Aliaga at al., 2017)  azithromycin  Non-medication treatment: None given.  Tests ordered:  Pelvic exam, urine deep stick, pregnancy test.  Education:  Abstain from sex from one week after medication.  Ask boy friend to get treated for Chlamydia.  Follow-up:  Collect azithromycin from the pharmacy and collect HIV test results.  Referral: None.Evidence-based Articles  Prevention of Recurrent Acute Uncomplicated Cystitis by Increasing Daily Water in Premenopausal Women by Hooton and collegues 2017.  This article was written following a study to assess how increased daily water intake can help prevent reoccurrence of acute uncomplicated Cystitis.  The results of the study revealed that increase in the intake of water was efficient in preventing recurrent acute uncomplicated cystitis by 48% and antimicrobial regimens by 47%.  Ms Pham should have been advised to increase daily water intake to prevent recurrent of Acute Uncomplicated Cystitis.Evidence-based Articles cont…  Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System by Pedela and colleagues 2017.  This article evaluates changes in the n fluoroquinolone and nitrofurantoin in patients with acute uncomplicated cystitis.  It also evaluates changes in resistance among E. coli isolates after institutional guidance recommended use of nitrofurantoin over fluoroquinolone in patients with acute uncomplicated cystitis.  The authors concluded that reduction in the use of Fluoroquinolones caused the change in institutional guidance for acute uncomplicated cystitis resulting in stabilization in FQ-resistant E. coli.  They also concluded that increases use of Nitrofurantoin was not associated with changes in Nitrofurantoin resistance.Evidence-based Articles cont…  MP71-10 THE DIAGNOSTIC VALUES OF SYMPTOMS FOR ACUTE UNCOMPLICATED CYSTITIS – EVALUATION OF THE PROPOSED UPDATED FDA GUIDELINES by Alidjanov and colleagues 2019.  This article reevaluates the diagnostic values of the symptoms of acute uncomplicated cystitis using ACSS score.  After the evaluation, the authors concluded that: s  Severity of symptom rather than their presence is essential for accurate diagnosis of acute cystitis.  Dysuria has the highest diagnostic value of the symptoms and  Incomplete bladder empting should also be added to the symptoms.  ACSS is a useful tool in the diagnosis of acute cystitis.  This article is applicable in Ms Pham’s case since she was diagnosed with acute uncomplicated cystitis.Evidence-based Articles cont…  Green tea as an adjunctive therapy for treatment of acute uncomplicated cystitis in women by Kheirabadi and colleagues 2019.  This article evaluate the efficacy of green tea as an adjunctive therapy to standard treatment of women with acute uncomplicated cystitis.  A study was conducted and the results revealed:  Significant decrease in symptoms of cystitis  Significant improvement in the urinalysis results  No improvement for hematuria.  Authors concluded that green tea is an effective suppliment when used with trimethoprim–sulfamethoxazole to treat acute uncomplicated cystitis.  If trimethoprim–sulfamethoxazole was prescribed in Pham’sd case, green tea suppliment could have been recommended.Evidence-based Articles cont…  Screening for genital Chlamydia infection by Low and colleagues 2016.  This article examines the effects and safety Chlamydia screening versus standard care on Chlamydia infection.  It follows a study whose results revealed that:  Detection and treatment of Chlamydia infection can reduce the risk of PID.  This article related to Pham’s case since she was also diagnosed with Chlamydia.References  Aliaga, L., Moreno, M., Aomar, I., Moya, S., & Ceballos, Á. (2017). Treatment of Acute Uncomplicated Cystitis. A Clinical Review. Int J Fam Commun Med, 1(2), 00009.  Alidjanov, J. F., Abdufattaev, U. A., Makhsudov, S. A., Pilatz, A., Akilov, F. A., Naber, K. G., & Wagenlehner, F. M. (2016). The acute cystitis symptom score for patient-reported outcome assessment. Urologia internationalis, 97(4), 402-409.  Alidjanov, J. F., Naber, K. G., Pilatz, A., Radzhabov, A., Zamuddinov, M., Magyar, A., ... & Wagenlehner, F. M. (2020). Evaluation of the draft guidelines proposed by EMA and FDA for the clinical diagnosis of acute uncomplicated cystitis in women. World journal of urology, 38(1), 63-72.  Hooton, T. M., Vecchio, M., Iroz, A., Tack, I., Dornic, Q., Seksek, I., & Lotan, Y. (2017). Prevention of recurrent acute uncomplicated cystitis by increasing daily water in premenopausal women: A prospective, randomized, controlled study. In Open forum infectious diseases (Vol. 4, No. suppl_1, pp. S736-S736). US: Oxford University Press.  Kheirabadi, Z., Mehrabani, M., Sarafzadeh, F., Dabaghzadeh, F., & Ahmadinia, N. (2019). Green tea as an adjunctive therapy for treatment of acute uncomplicated cystitis in women: A randomized clinical trial. Complementary therapies in clinical practice, 34, 13- 16.  Low, N., Redmond, S., Uusküla, A., van Bergen, J., Ward, H., Andersen, B., & Götz, H. (2016). Screening for genital chlamydia infection. Cochrane Database of Systematic Reviews, (9).  Pedela, R. L., Shihadeh, K. C., Knepper, B. C., Haas, M. K., Burman, W. J., & Jenkins, T. C. (2017). Preferential use of nitrofurantoin over fluoroquinolones for acute uncomplicated cystitis and outpatient Escherichia coli resistance in an integrated healthcare system. infection control & hospital epidemiology, 38(4), 461-468. [Show More]

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