Differential Diagnosis for NURS 6512 LAB ASSIGNMENT: ASSESSING THE GENITALIA AND RECTUM Case
Based on the provided information, I would accept the current UTI diagnosis, which is supported by symptoms such as increased urine frequency, dysuria, and urgency for two days. Physical examination findings such as mild tenderness in the suprapubic region also confirm the presence of an infection. However, I would order urinalysis and urine culture to identify the actual causative microorganisms and confirm the primary diagnosis ad rule out the differential diagnosis (Johnson & Russo, 2018). Some of the differential diagnoses for the NURS 6512 LAB ASSIGNMENT: ASSESSING THE GENITALIA AND RECTUM case include vaginitis, pyelonephritis, and pelvic inflammatory disease (PID).
Vaginitis is an inflammatory condition of the vagina characterized by pain, itchiness, and discharge. It is usually caused by an infection or change in the balance of the vaginal normal flora. The patient is positive for pain during urination (Paladine & Desai, 2018). However, according to the Amsel criteria, the diagnosis of vaginitis requires the presence of clue cells on microscopy of vaginal fluid, vaginal pH higher than 4.5, milky discharge, and a positive whiff test.
Pyelonephritis or kidney infection is a type of UTI which normally starts in the patient’s bladder or urethra and travels to both or one of the patient’s kidneys (Johnson & Russo, 2018). Patients with this disease normally present with frequent urination, and pain during urination, just like the patient in the provided case study in addition to other symptoms such as fever, fatigue and nausea, and vomiting. Urinalysis or culture is required to confirm this diagnosis, in addition to the patient presenting symptoms as demonstrated above.
Finally, PID is an infection that normally affects the female reproductive organs. It usually occurs when sexually transmitted bacteria travel from the patient’s vagina to the uterus, fallopian tube, or even ovaries (Charvériat & Fritel, 2019). The patient in the provided case study is sexually active and recently changes a sex partner which puts her at risk of this infection. Patients diagnosed with this disease normally present with symptoms such as painful urination, pain during sex, nausea, vomiting, fever, chills, irregular menstrual periods, and abnormal vaginal discharge. To confirm the diagnosis of PID, an endometrial biopsy with histopathologic evidence suggesting endometritis is required. Transvaginal sonography and magnetic resonance imaging of the patient’s pelvic area may also be required to confirm this diagnosis.
Conclusion
The female patient in the provided case study presents to the clinic complaining of increased frequency, pain with urination, and urgency. Associated symptoms include lack of appetite, flank pain, and pelvic discomfort. These symptoms suggest a UTI diagnosis, however, additional subjective and objective information is required to confirm this diagnosis. Several diagnostic tests also needed to be ordered to rule out the differentials and come up with the primary diagnosis. Such tests include cystoscopy tests, urine tests, and urine culture. The possible differential diagnosis includes vaginitis, Pyelonephritis, and PID.
References
Charvériat, A., & Fritel, X. (2019). Diagnosis of pelvic inflammatory disease: clinical, paraclinical, imaging, and laparoscopy criteria. CNGOF and SPILF pelvic inflammatory diseases guidelines. Gynecologie, Obstetrique, Fertilite & Senologie, 47(5), 404-408. DOI: 10.1016/j.gofs.2019.03.010
