Case Study UTI using Barrows and Pickell model of problem solving cited by Crumbie.
2791 WordsApr 24, 200712 Pages
INTRODUCTIONThis is a case study concerning a patient presenting with low abdominal pain, frequent micturation and dysuria. I will discuss the consultation and show how I used the problem solving consultation style detailed by Alison Crumbie. This involves listening to the patients' initial complaint and developing hypothetical diagnosis. Focused questioning and clinical examination and investigations will then be used to eliminate some of the initial hypotheses. The patients' perspective of their problem will be addressed and the synthesis of gathered information will enable the practitioner to arrive at a differential diagnosis and to agree on a treatment plan with the patient so that they can manage their problem.
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On later reflection I realized I could have though about interstitial cystitis, appendicitis and renal calculi. My multiple hypotheses for this patient are presented in Table 1.
Formulating an Inquiry StrategySue had told me that she had pain on passing urine and as I focused my questioning she told me her urine appeared darker in colour than normal and smelled different than usual. She described the pain as stinging and said that it was provoked by micturating and relieved a minute or so after she stopped urinating. I asked her to point to where the pain was in her abdomen and she indicated the suprapubic region. She gauged the pain to be level 6 on a pain scale of 0-10 without analgesia but did say it was relieved by analgesia and resolved to a feeling of pressure rather than pain at that time.
Back/loin pain, nausea, vomiting, fever and frank haematuria are all more common with pylonephritis. Sue denied any of these symptoms which made it less likely as a diagnosis ultimately.
On enquiry Sue told me that she used Depo- Provera injections for contraception and dysmenorrhoea and consequently did not menstruate. She also denied any spotting of blood. Her last injection was given in practice 40 days previously and by reviewing her notes I could see her history showed timely attendance