You must complete both case studies.
Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources, within 5 years
Each question must be answered individually. Not in an essay format.
Example: Question 1 (write out question), followed by the answer to question 1; Question 2, followed by the answer to question 2; etc. No Quotes.
Discussion 4
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Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
- The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
- Create a list of risk factors the patient might have and explain why.
- Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
- According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
- Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
- Name the criteria you would use to recommend hospitalization for this patient
Discussion 4
Student’s Name:
Institutional Affiliations:
Date:
Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
- The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Based on Mr. J.R.’s symptoms, the possible type of acute kidney injury (AKI) is the prerenal type. Patient evaluation or history findings for a patient with prerenal AKI usually include volume/fluid loss due to vomiting, diarrhea, sweating, or hemorrhage. Other symptoms that occur in patients with this type of AKI include nausea, fatigue, dizziness, weakness, and a metallic-like taste in the mouth (American Academy of Family Physicians, 2020). Mr. J.R.’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. He is also sweaty and pale. The fluid loss is quite severe evidenced by the fact that he had 5-6 watery bowel movements in the past 24 hours. It is unlikely that Mr. J.R. has intrinsic renal AKI because he does not have recent exposure to nephrotic medications and denies a recent use of antibiotics, laxatives, or excessive caffeine. It is also unlikely that he has postrenal AKI because he does not report gross hematuria, urinary hesitancy or urgency, kidney stones, polyuria, or a history of cancer (American Academy of Family Physicians, 2020). Therefore, since the patient’s history and symptoms are close to those of prerenal AKI, the physician should perform diagnostic tests that will help to confirm the presence of this suspected condition.
- Create a list of risk factors the patient might have and explain why.
Identifying risk factors can help the healthcare professional to establish the possible causes of Mr. J.R.’s prerenal AKI. The possible risk factor that Mr. J.R. might have is the consumption of contaminated food which triggered severe vomiting and diarrhea leading to fluid/volume loss. Prerenal AKI commonly occurs in patients with a recent history of fluid/volume loss due to severe diarrhea or vomiting (American Academy of Family Physicians, 2020). As described in the case study, Mr. J.R. had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. This was followed by severe vomiting and diarrhea. The patient’s wife has denied the possibility of her husband having an eating disorder. Therefore, his current symptoms could have been triggered by the possibly contaminated burritos that he ate for supper.
- Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Chronic kidney disease usually causes several other complications in the body of the affected patient leading to poor quality of life. The complications that the patient might have on his hematologic system are coagulopathy and anemia. Coagulopathy is a medical condition in which the blood clot formation is delayed (Nunns et al., 2017). The strength of the final clot is usually increased but its rate of breakdown is usually decreased. The pathophysiologic mechanism of coagulopathy in patients with chronic kidney disease entails the production of supra-normal fibrinogen levels (Nunns et al., 2017). Anemia is a medical condition in which hemoglobin concentration in the blood reduce to severely low levels of less than 13.0 g/dL in males and less than 12.0 g/dL in premenopausal females (Shaikh & Aeddula, 2022). In patients with chronic kidney disease, the pathophysiologic mechanism of anemia entails a reduction in the production of erythropoietin by the renal cells. This hinders the production of red blood cells leading to anemia (Shaikh & Aeddula, 2022).
References
American Academy of Family Physicians. (2020). Acute kidney injury: A guide to diagnosis and management. https://www.aafp.org/afp/2012/1001/p631.html#:~:text=The%20causes%20of%20acute%20kidney,urine%20distal%20to%20the%20kidneys).
Nunns, G. R., Moore, E. E., Chapman, M. P., Moore, H. B., Stettler, G. R., Peltz, E., Burlew, C. C., Silliman, C. C., Banerjee, A., & Sauaia, A. (2017). The hypercoagulability paradox of chronic kidney disease: The role of fibrinogen. American Journal of Surgery, 214(6), 1215–1218. https://doi.org/10.1016/j.amjsurg.2017.08.039
Shaikh, H., & Aeddula, N. R. (2022). Anemia of chronic renal disease. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539871/
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
- According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probable diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
From the case study information, the most probable diagnosis for Ms. P.C. is gonorrhea. Gonorrhea is a sexually-transmitted infection (STI) caused by a bacterium called Neisseria gonorrhoeae. This is a gram-negative bacterium usually in the shape of a coffee bean and appears as intracellular diplococcus under microscopic observation (Yeshanew & Geremew, 2018). The bacterium is spread through unprotected sexual contact with an infected partner. Female patients with gonorrhea usually present with a number of symptoms including increased and smelly vaginal discharge which is often greenish-yellow in color. The disease may also cause pain in the lower abdomen, nausea, pain during urination, interrupted monthly periods, and pain during sexual intercourse (Mayo Clinic, 2020). Laboratory examination of vaginal discharge in patients with gonorrhea reveals the presence of gram-negative intracellular diplococci and elevated levels of white blood cells (Yeshanew & Geremew, 2018). Ms. P.C.’s history reveals that she has been sexually active, having engaged in unprotected sex with her partner eight days ago. She might have contracted gonorrhea during this intercourse. Furthermore, her symptoms are positive for gonorrhea including a 2-day history of lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge. Ms. P.C. has an abnormal vaginal discharge which she describes as thick, greenish-yellow in color, and very smelly. Furthermore, a microscopic evaluation of the vaginal discharge has revealed the presence of white blood cells and gram-negative intracellular diplococci. These findings confirm the presence of gonorrhea infection.
- Based on the vaginal discharge described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
Based on the vaginal discharge described in the case study together with the microscopic examination of Ms. P.C.’s vaginal discharge, the microorganism involved in her symptoms is Neisseria gonorrhoeae. This micro-organism causes symptoms that resemble those described by the client especially thick, greenish-yellow, and smelly vaginal discharge. Additionally, it is a gram-negative intracellular diplococcus as confirmed by the microscopic evaluation (Yeshanew & Geremew, 2018). Neisseria gonorrhoeae is transmitted sexually through unsafe sexual behaviors.
- Name the criteria you would use to recommend hospitalization for this patient
Treatment of gonorrhea should be started immediately after the presence of Neisseria gonorrhoeae has been confirmed through diagnostic evaluation. The best treatment for adults with gonorrhea is the use of antibiotics (Mayo Clinic, 2022). According to the Centers for Disease Control and Prevention, healthcare professionals should prescribe antibiotics to an adult patient with gonorrhea. The evidence-based antibiotic medications for use in adult patients with gonorrhea include oral azithromycin taken orally or ceftriaxone antibiotic given as an injection. Ms. P.C.s symptoms do not necessarily require hospitalization but she can be treated effectively as an outpatient. The physician should prescribe 1 gram of azithromycin taken orally as a single dose in combination therapy with 250 mg of ceftriaxone injected intramuscularly. This combination therapy is recommended in order to limit the possibility of antibiotic resistance (Centers for Disease Control and Prevention, 2020). Ms. P.C.’s partner should also get tested and treated before they engage in sexual activity again (Mayo Clinic, 2022). It is important to educate the patient about the possible side effects of these drugs such as nausea which resolve with time. For follow-up care, Ms. P.C. should be advised to visit the clinic after 2 weeks for symptom monitoring and further guidance.
References
Centers for Disease Control and Prevention. (2020). Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
Mayo Clinic. (2022). Gonorrhea. https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774#:~:text=Gonorrhea%20is%20an%20infection%20caused,vaginal%2C%20oral%20or%20anal%20sex.
Yeshanew, A. G., & Geremew, R. A. (2018). Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, North West Ethiopia. Antimicrobial Resistance and Infection Control, 7, 85. https://doi.org/10.1186/s13756-018-0376-3