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Patient is a 67 years old female with complaints of frequent urination and…
Patient is a 67 years old female with complaints of frequent urination and constipation
Admitting Dx: UTI w/out hematuria
Acute cystitis
retrograde movement of gram-negative bacilli into the urethra to bladder
E.coli, bacteria found in the GI tract
type-1 fimbriae binds to receptors on uroepithelium
resist flushing during normal micturition
P fimbriae binds to uroepithelial P-blood group antigen
cefTRIXone 100 mg in 0.9% NaCL q24 hrs
Risk factors: female and type 2 diabetes
s/sx presented with frequent urination
impaired urinary elimination
Constipation
normal transit (functional)
normal rate of stool passage but difficult to evacuate
risk factors: dehydration
hyponatremia; Na+: 138
No BM in the last 10 days
hyperactive BM sounds, tiny hard brown stool
risk of constipaton
CT abd pelvis w/ contrast: large volume of impacted stool in rectum
polyethylene glycol packet 17 g PO daily
suppositories, enemas, and digital removal ordered
prune juice 3x
bottle of citrate of magnesia
Postrenal kidney injury
obstruction
increase intraluminal pressure upstream
gradual decrease in GFR
neurogenic bladder
cause: fecal impaction
volume is large, pressure is low, and contractions are absent
result from peripheral nerve damage
s/sx: overflow incontinence
impaired urinary elimination
CT scan: severe dilation of bladder and hydronephrosis
urinary bladder distended at 15 cm
Rule out CT scan w/o contrast: no acute bleed, mass effect or loss of grey-white differentiation
mild hydronephrosis
enlargement of renal pelvis and calyces
doxazoin 1 mg PO daily
Medical hx
bipolar 1 disorder
lamoTRIgine 100 mg Tab PO daily
Hep B from transmission in childhood
hypertension
increases with age
insulin resistance decreases endothelial release of nitric oxide and vasodilators and affects renal funtion
losartan 100 mg tab
type 2 DM
insulin resistance to glucose
losartan 100 mg tab
enoxaparin 30 mg Inj subcu q 24hrs
Social/Family/Psyc Hx
Chinese, speaks Cantonese only
daughter contribution to illness, but unlikely to care for patient
psychosis in elderly with behavioral disturbances