Diagnosis and Anamnesis
Given the symptoms and the results of the initial urine test, the most likely diagnosis is acute bilateral pyelonephritis. What typically causes this condition is a bacterial infection of the renal parenchyma. The bacteria usually ascend from the urinary tract and the bladder, later invading the kidneys. The examination of the patient showed that she was likely to have been neglecting hygiene and self-care for quite some time. Moreover, the onset of pyelonephritis is rapid, with first symptoms manifesting themselves in under one or two days (Castner, 2013). As the patient reported, she has been suffering from the inability to urinate and painful sensations for eight hours which also speaks in support of the suggested diagnosis.
It is advised to ask more questions to be sure about diagnosing the patient with pyelonephritis and elaborate on the most beneficial treatment plan. For instance, a health practitioner might ask if it has ever happened to the girl before, what her urination patterns have been like recently, and if she had been urinating more frequently before the onset. Further, the patient might describe her current state: if she had a fever and if she has been feeling weak. It is crucial to locate the pain, for instance, it would be typical to experience painful sensations in the lower back. Lastly, a health practitioner might ask if the patient has been exposed to a cold lately.
The primary treatment goal for this case is to eliminate the pathogen. It should be done promptly so that the condition does not escalate to chronic kidney disease. Since the patient is underage, her parents should be notified, for depending on the gravity of the situation, hospitalization could be necessary. Blood tests should be done, and after obtaining the results, the contents of creatinine, urea, sodium electrolytes, potassium, calcium, and chlorine should be taken into account.
It is reasonable to assign the patient to a urologist and do an ultrasound. The patient should stay in bed and take antibiotics such as Amoxicillin. However, one should be cautious and make sure the patient would not have an idiosyncratic drug reaction to the prescribed medication. The treatment might look as follows:
- antibiotics for the renal infection in the first week (Amoxicillin 500 mg three times a day);
- antibiotics for the bladder infection in the second week (Macrobid 100 mg two times a day);
- cranberry juice in the next two weeks.
After one month, blood and urine tests should be done again.
In the present case, it is crucial to warn the patient about possible complications of her condition. A health practitioner might be confronted with a pushback since the treatment is likely to take at least one month, and teenagers might not be intentional and committed. Choosing simple words, showing pictures, and being sympathetic and non-judgmental might help. Further, a health practitioner should give recommendations for the future.
For instance, one should not underestimate the importance of drinking enough water. It is recommended to drink six to eight 8-ounce glasses per day; however, the volume should be adjusted to the patient’s weight and activity level (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Lastly, the patient should change her attitude towards personal hygiene and make improvements. A health practitioner might advise her to wipe from front to back, go to WC as soon as an urge occurs, and urinate after sex if the patient is sexually active.
Castner, D. (2013). A closer look at pyelonephritis. Nursing2013, 43(10), 63.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). . Web.