Download Mia Anderson Situation Mia is a 31-year

Mia Anderson
Situation
Mia is a 31-year-old woman who is 24 weeks pregnant with her 1st baby. Her admission complaints are
flank and suprapubic pain plus dysuria. She states that urgency, nocturia, and frequency are unchanged
“but I go a lot since I became pregnant.” She says, “I usually work the register at the grocery store in the
evenings but I had to call in sick yesterday because I was so tired and nauseated.”
Background
Medical History:
She reports that she has had cystitis a few times in the past but none since she married 1 year ago.
She also reports a having kidney stones twice in the past 7 years. This is her first pregnancy. Remaineder
of medical history is normal.
Social History: Married, lives in student housing on campus. She is attending college for physical therapy
and works part time as a cashier to cover tuition costs. Her husband works as an engineer. They have no
family close by for support but rely on a few close friends.
Assessment
Physical Exam:+
Head: Normacephalic, normal hair distribution, Face: Puffiness around eyes (peri orbital edema) no
conjunctival pallor. EOMs intact PERRLA
Thorax: AP:Transverse 1:2 ration, non labored breathing, lungs clear all fields, HR no murmurs
T, 102 F; P, 114; R, 22; and BP, 130/90.
Abdomen: Gravid uterus, no lesions or scars noted no tenderness to palpation anteriorly,
.+ CVA tenderness right side of flank region posteriorly
UE: ROM + no pain, strength equal, cap refill <3 sec, rings tight, 2+ radial bilaterally
LE: ROM + no pain, strength equal, cap refill <3 sec, ankle edema bilaterally
Diagnostics
Her urine is cloudy, amber, and foul smelling, positive for both leukocyte esterase and nitrate, with white
blood cells and gram-negative bacteria.
CBC: RBC 5.2,Hgb 14 Hct:42% WBC 26,000, neuts 70% bands 10%, lymphs15%, mono 3%, eos 1%,
baso 1%, platelets 300,000
UA: + protein, + nitrates, +leukoesterase, + blood +WBC culture _+ gram – cocci
1. What additional assessment data should you obtain?
a; Subjective?
b.Objective?
2. Highlight all pertinent data that correlates to Mia’s condition on your worksheet.
Which manifestations are specific to cystitis, which are specific to pyelonephritis, and which are
common to both? Make a table comparing these two urinary problems.
Cystitis
Pyelonephritis
3. What risk factors for pyelonephritis are present for this patient? Highlight this on your worksheet.
4. Explain whether this patient’s acute pyelonephritis is an ascending or a descending infection.
5. How do the findings of the physical examination relate as a cause of her acute pyelonephritis?
.
Mia is diagnosed with acute pyelonephritis. Because she is pregnant, she is considered a “complicated”
presentation of pyelonephritis. A urine culture is obtained along with a Gram stain that shows grampositive cocci. The perineal examination indicates that her urethral meatus is located abnormally close to
her vagina. She will undergo cystography after she recovers from her delivery of her child in 6 to 12
months from now. Further testing is deferred because of her pregnancy. Her serum creatinine is normal at
1.0, which indicates adequate renal function, further indicating that additional diagnostic testing can be
deferred.
6. Explain whether this patient’s acute pyelonephritis is an ascending or a descending infection.
7. How do the findings of the physical examination relate as a cause of acute pyelonephritis?
Recommendation:
Mia’s admission orders include: She has no known drug allergies;
a. Lactated Ringers 1000mL every 12 hours
b. Ceftriaxone 2g IVPB daily
c. Acetominophen grX po for c/o mild pain and tem > 100 degree Ft
(What pregnancy category is this?)
d. Regular diet encourage fluids orally
e. BR/BRP
f. Fetal heart rate every 8 hours
g. I/O
1. What pregnancy category is Ceftraxone? Why is this important to know?
2. What is the hourly rate for Mia’s IV? She is on a gravity IV. The drop factor for the tubing is
10gtt/min. Solve for mL/h and gtt/min.(there is no math on the test).
48 hours have passed and Mia’s condition has improved so she is being discharged.
1. What discharge teaching do you feel is important for Mia to have once she is able to go on
outpatient antimicrobial therapy?
2. What could you suggest as measures for this patient to reduce her risk for future episodes of
pyelonephritis and cystitis?
Develop a discharge care plan for MIA.
Instructions for care map:
1. Take report onto worksheet
2. Highlight appropriate information for this diagnosis: discuss this information with your
group.
3. highlight medications to correlate with medical diagnosis
4. Develop the priority diagnosis for this patient and give your rationale.
5. List interventions from highest priority to lowest priority.
6. Must be completed in 45 min.