Vital Signs: BP 138/88, HR 118, T 38.9C, RR 20, 02sat 98% on RA

Pain assessment: Onest of pain started this mprning; localized as falnk pain with7/10 intensity, pain while voiding, denies headache

Skine assessment: Patient flushed and hot to tuch; no abnormalities or discoloration to skine

Respiratory assessment: tachycardic, S1 S2 sounds present, peripheral pulses equal and 4+

Abdominal assessment: Abdoment soft with slight lower tenderness, no gurding.Noted costoverterbral angle tenderness to mleft flank area. Question nausea or vomiting

Neurovaslscular Assessment: Alert and oriented but feels less energetic and fatigued

Urinary Assessment: Query dysuris, polyuria and other issues with frequency, nocturia or urgency

Reproductive Assessment: Query porential pregnancy

Frequent UTIs strarting at the age of 18

Patient explains that the pain is the worst she has ever experienced

Has been taking Advil every 8 hours; most recent dose taken yesterday

No known druge allergies

Assesses the cells, electrolytes, and chemical constituents (urea and creatinine to mesure kidneyt funcation) that circulate in the blood and identifies the presence osmicroorganisms

Normal CBC finding for females inculde RBCs 4.0 - 5.2 x 10^12/L;

WBCs 4- 10 x 10^9/L;Hgb 123-157g/L;Hct 0.370 - 0.460; plt 130 - 400x100^9/L; and absence of microorganisms

Normal E/U/C finding for females include Na 1356 -, k 3.5-5.0 Ca 2.18-2.58,p 0.8-1.5, Mg 075-0.95; Bun 2.5-8.0 mmol/L; and Creatinine 50-90 mmol/L

Findings commonly associted with a UTL include increased WBCs and persence of E. Coli

Examiniton of the urine for either routine or microsocopic studies to provide baseline information or about possible abnormalities

Includes description of appearance; amell; specific gravity; PH; presence of glucose, nitrates, ketones and protein; examination of urine sediments for red and white blood cells, crystals and casts

Normal findings in a urinalysis include amber yellow, aromatic urine; protein <0.15g/day; absence of glucose, ketones, Bilirubin, and casts; specific gravity of 1.005-1.030; pH 4.6-8.0; RBCs 0-4 and Wbc 0-5 per high-power field.

Findings commonly associted with UtIs include; unpleasant smell, pH>8.0, increased WBCs, presence of casts (moulds of renal tubules and may contain protein, WBCs,RBCs, or bacteria) and a bacteria count>105/mL

Additional evalution in urinalysis that identifies presence of organisms in the bladder; frequently to determine causative organisms in suspected UTIs

Normal finding for this diagnostic tool include the absence of organisms in the urine

Finding commonly associted with UTIs include the presence of E. coil, enterococci, Klebasiella species, Proteus species, and streptococci

Provides visualization of kidneys, bladder and repoductive organs to dect cyst, tumours, masser, abscesses, and/or obstruction

Utilized when obstruction in the urinary system is suspected, hematuria after tretment of urinary tract infection, or unxplainable pelvic or flank pain

Kidney stones (polycrystalline aggregates) causing urinary tract obstruction

S/S:

Reasons to suspect: Actue lower abdominal tenderness. Unilateral sodtavertebral angle tenderness

Reasons to rule out : Skin is hot and flush, no nauses or vomiting

Bascteria infection in any part of the urinary system (kidneys, ureters, bladder and urethra).

S/S: urinary frequency, lower abdominal or back discomfrot, burning or pain on urination (dysuria), cloudy/foul smelling urine. In adults, fever and other signs of infection are absent

Resons to supsect: pain on urination, lower abdominal tenderness, Hx of previous UTIs,3+ Leuks, positive nitrates

Reasons to rule out : Febrile, Tachycardic, Hypertensive, low energy and fatigue, hot and flush skine, left-sided costoverebral angle tenderness

Rotation of ovary at its pedicle, occluding the ovsrisn srtery and/or vein.

S/S: Sudden onset of sharp, unilateral lower abdominal pain. Nasusea and vomiting/S:

Resons to supspect: Lower abdominal pain, Nause and vomiting

Reasons to rulr out: Fever, Dysurea, CVAT

Infection of the kidney parenchymal and renal pelvis

Acute S/S: abrupt onset of shanking, moderate to high fever, consant ache in the loin area of the back, lower urinary tract symptoms (dysuria, urgency, frequency) significant malasis, nausea and vomiting, unilateral costovertebral angletenderness, and pyuria

Chronic S/S: same as acture or may have insidious onset.Often history of recurrent episodes of UTI or actue pyelonephritis. Polyuria and nocturia and mild protrinuria. Hypertension not a symptom but a cause.

Reasons to suspect: febrile, dysuria, malaise, unilateral costovertebral angle tenderness, pyuriaReasons to suspect Chronic: History of several UtIs, Hypertension

Pathophysiology: E. Coli (common pathogen causing UTi) experess febrea projection that help them adhere to surfaces.Thes projections help them adhere and climb the urethra. E.Coli ascend urethra and the bladder. In the bladder, the bacteria colonize and cause infection and cause infectiion. Therefore,Pyelonephritis commonly occure secondry to lower UTI.

Obstructive abnormalities: Anatomic abnormality, Kidney stones, BPH

Vesicoureteral reflux: Ureter enters the bladder at apporoximate right angle, forcing urine back into bladder during micturation. This is a common cause of chornic UTI/pyelonephritis in young patients

Functional abnormalities: neurogenic bladder, detrusor muscle instabillity, sonstipation

High blood pressure

Risk factors present in the patient: potentially refiex (due to chronic UTIs at a young age) and HTN

Trear fever as directed to redyce systemic inflammation

SBBAR communication

Collect urine culture and sensitivity, and urinalysis as this willindicate the bacteria causing the infection

Collsborate with medical team for treatment instructions

Monitor input and output, as this can indicate the concentrationof urine and renal and renal tubular funcation

Ongoing monitoring of VS and neuro status

Provide comfrote and ressurance

Adivse patient she may need to go to hospital, as pyelonephritis mayinvolve multiple pathogens that can be resistant to common antibiotictreatment

Adequate fluid intake

NSAID or antipyretics

Urine analgesics (phenazopyridine [Pyridum])

Follow -up urine culture and imaging studies

Broad spectrum antibiotics (ampicillin orvancomycine combined eith aminoglycosidesuch as tobramycine)

Switch to sewnsitivite guided therapy when C/Sresults are available, for 14-21 days

Trimethoptim-sulphamethoxazole (ex. Septra)

Fluoroquinolones (Ciprofloxacin, norfloxacine)

Swtiching to a non-invasive method ofcontraception

Urinationg after intercourse

Adequate hydration

Wiping front to back

Voiding promptly after feeling the urge

Avoid tight-fitting underwear

Avoid douching

Low-does antibiotic use

Post-coite antibiotic use

Estrogen therspy via cream

Short trem use of methenamine salts

Renal ultrasound

Intravenous pyelography

CT scan

MRI

Cytomography