Case Study UTI using Barrows and Pickell model of problem solving cited by Crumbie.

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy.

Mr. Sánchez diagnostic is Nephrolithiasis which is another name for kidney stones also called renal calculi. Renal calculi are like little pieces of stones almost the size of the grain of sand that stuck in the ureters that formed in the kidneys. During urination, the patient will experience severe pain from passing out stones through the ureter. Kidney stones occur from a buildup of certain substances as well as minerals found in the urine such as calcium phosphate and uric acid. According to Livestrong, calcium phosphate known as hydroxyapatite is the primary mineral your body uses to build and strengthen bones and teeth. According to Wikipedia, uric acid is a product of the metabolic breakdown of purine nucleotides, and it is a normal component of urine. When the blood is concentrated in a high level of uric acid this can lead to gout that associated with other medical complications such as diabetes and the development of ammonium acid urate calculi. These minerals along with other substances travel through the bloodstream forming solid masses called stones.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

2. What additional questions should you ask regarding this patient’s chief reason for seeking care?

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

“Oh, this is awful,” Jenny muttered to herself. She was sitting on the toilet with a pair of very wet panties and slacks around her ankles. Jenny never knew when it would hit―this need to urinate quickly. She would find herself running to the bathroom like a woman possessed and then usually not making it in time. “It also seems like I’m peeing all the time,” she said. “This is getting old really fast,” she thought, as she continued trying to squeeze the urine out of her panties using quantities of toilet paper.

* Refer to primary care doctor to address ongoing pain in stomach client reported it uncontrolled for several month with over the counter medications and to rule out any other medical problems or symptoms.

D/A: Maurice Brown had one appointment this week. On 12/14, he was seen by Doctor Nat Ramani of the GI Associates of Delaware. According to Doctor’s note, consumer tolerated procedure well. He did not have fever, rash, or chills post procedure, but still complains of having periumbilical abdominal pain frequently for 2-3months. He describe pain as sharp in nature, rates it 7 out of 10, wakes him up from sleep at night, no exacerbating factors, radiates to both sides of his abdomen, alleviating on passing gas and having a BM. On 12/14, 12/17, Mr. Brown went for his dialysis. On 12/17, he went twice, in the morning at 10:00 a.m. and in the afternoon at 4p.m. when this writer his Case Manager asked him how his treatment was going? He said ‘’fine,

normal flow of urine out of both kidneys from a blockage caused by kidney stones, a tumor,

The pathology is graded from 1 to 5 with increasing degree of severity. Grade 1 describes a reflux that is limited to the non-dilated ureter. In grade 2, the urine refluxes into the renal pelvis and the calyces, without causing any dilation. In grade 3 the ureter and renal pelvis are moderately dilated and/or tortuous, but no or minimal blunting of the fornices should be observed. The dilation and tortuosity of the ureter and renal pelvis becomes more severe in grade 4, while the sharp angles of the fornices are obliterated but papillary impressions are preserved. Grade 5 describes severely dilated and tortuous ureter, pelvis and calyces; loss of papillary impressions is observed in most calyces. The radiologic features of the grades are illustrated in figure