NR 603 Week 6 Collaboration Cafe_Clinical Education Associates CEA Pre-Diagnostic Case Study Part 1

Medications: OTC Multivitamins Immunizations: Up to date Allergies: none History of Present Illness (HPI): KH, a 22-year-old female, presents to the clinic with chief complaint of frequent urination and suprapubic discomfort for the past 4 days. She denies fever, discharge, back/flank pain, chills, and foul urine odor. She reports redness and vagina itching. She has no major medical history. She denies trying any OTC treatments. KH is single and reports being sexually active with two partners within the past 3 weeks. Both parents are alive and healthy with no medical history, and her only sibling is a 6-year-old sister who is healthy. She drinks alcohol occasionally and denies recreational drug use. She works out regularly and sweats a lot due to running. She doesn’t take any prescription drugs and denies smoking. She is up to date on her immunizations. Analysis of Risk Factors and Demographics: KH’s age and reproductive status put her at risk for common urinary and gynecological conditions. • Female- the has the highest incidence during reproductive age • Multiple sex partners- can increase the risk of infection by introducing new bacteria into the urinary tract • Poor Hygiene- not washing the genital area thoroughly can cause bacteria to enter the urinary tract. Differential Diagnoses: 1. UTI Pathophysiology- According to the evidence-based article by Bono & Leslie (2025), an uncomplicated UTI is a bacterial infection that usually only involves the bladder and is caused by enteric coliform organisms that inhabit the periurethral vaginal introitus (Bono & Leslie, 2025). These organisms invade the bladder mucosal wall causing an inflammatory reaction known as cystitis. Symptoms of cystitis include dysuria (painful urination), urinary frequency, hesitancy, urgency, suprapubic pain or discomfort, bladder spasms, and hematuria. Symptoms usually don’t include fever, chills, nausea, vomiting, or back/flank pain. Rationale- KH reports symptoms of frequent urination, dysuria, and suprapubic discomfort. She denies fevers, chills, foul odor, back/flank pain, and discharge. 2. Gonorrhea Pathophysiology- Infection begins with the adhesion of gonococci to epithelial cells and is followed by a local cellular invasion (Springer & Salen, 2023). Gonorrhea is the Urinary Tract Infection- Symptoms of cystitis include dysuria (painful urination), urinary frequency, hesitancy, urgency, suprapubic pain or discomfort, bladder spasms, and hematuria. Gonorrhea- Symptoms include dysuria, vaginal discharge, and pelvic pain. Vaginal Candidiasis- Symptoms include copious thick discharge, vaginal irritation, excoriation, dysuria, itching, burning, and swelling. Diagnostic Testing: Urinary Tract Infection- Urinalysis and urine culture are the primary tests used to diagnose UTI. Gonorrhea- Nucleic Acid Amplification Test (NAAT) is the primary test used to diagnose gonorrhea. Vaginal Candidiasis- Whiff test, wet mount, or pH testing is used to diagnose yeast infection. National Guidelines: Urinary Tract Infection- Based on the guidelines, diagnosis can be confirmed with urinalysis and urine cultures. Treatment consists of oral nitrofurantoin 100mg twice a day for 5 days for uncomplicated UTIs (Lawati, et al., 2024). Gonorrhea-NAAT diagnostic test is recommended for diagnosing, and treatment consists of a single dose of ceftriaxone 500mg Intramuscular injection (CDC, 2021). Vaginal Candidiasis- Whiff test, wet mount, or