According to Haddock & MacDonald (2013), over half of all women will have at least one urinary tract infection (UTI) in their lifetime, which results in fifteen percent of the prescribed antibiotics in primary care. When assessing a history of presenting illness, appropriate questions will be:
- The OLD CARTS mnemonic –
- the Onset of her symptoms
- the Location of her discomfort and if the pain radiates anywhere,
- the Duration of the symptoms and if the discomfort is constant or intermittent,
- Characteristics or a description of the symptoms,
- what Aggravates the condition,
- what makes the condition feel better, what she has tried for symptom Relief, (Treatment)
- and finally a current pain Scale rating.
- Her past medical history, frequency of UTIs in the past, and ask if there is any chance of her currently being pregnant.
- According to Ferri (2018), three additional differential diagnoses for this patient, not including urinary tract infection, include pyelonephritis, pelvic inflammatory disease, or ovarian pathology.
- Physical exam would include assessment of vital signs, assessing for abdominal or flank tenderness with palpation, and potentially a cervical exam if there were reports of vaginal discharge.
- Diagnostic testing would include a urinalysis with culture and sensitivity.
Evidence-based plan of care:
- Education risk factors associated with urinary tract infections, such as proper hygiene after intercourse and how to have healthy voiding habits (Ferri, 2018).
- Nitrofurantoin (Ferri, 2018). Although this antibiotic is considered the first-line treatment, this antibiotic may not treat all pathogens that cause UTI, so urine culture and sensitivity will be assessed and if need to switch antibiotics, the patient will be notified by the clinic within the next two days (Lingenfelter, Drapkin, Fritz, Youngquist, Madsen, & Fix, 2016).
- Phenazopyridine (Ferri, 2018). Education for this medication should include that urine will have an orange color, and that the patient should not wear contact lenses when taking this medication, as it will dye her contacts orange. Education would also include taking the full course of antibiotics, side effects of antibiotics, the use of back-up contraceptives when on antibiotics, and encouragement to take the antibiotic with yogurt to promote some good bacteria into the gut and GI tract.
- Nonpharmacologic treatments include aggressive hydration (Ferri, 2018).
- Encourage the patient to return to the clinic if symptoms do not improve in the next 5 days, or with any worsening symptoms.
Ferri, F. F. (2018). Ferri’s Clinical Advisor 2018: 5 Books in 1 (Ferri’s Medical Solutions). Philadelphia, PA: Elsevier.
Haddock, G., & MacDonald, A. (2013). Managing simple lower UTI in women under 65. Practice Nursing, 24(6), 283-286.
Lingenfelter, E., Drapkin, Z., Fritz, K., Youngquist, S., Madsen, T., & Fix, M. (2016). ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI. The American Journal of Emergency Medicine, 34(8), 1600-1603.