Assignment task:
Leonorah Jones is 26 years old and presents to the clinic with abdominal pain and urinary symptoms that have worsened over the last couple of days. She is now experiencing nausea and vomiting. On assessment, Leonorah indicates supra-pubic pain and appears to be guarding her abdomen, she states the pain gets worse when she moves. Leonorah tells you she is feeling "sick" and has been vomiting since yesterday and now unable to tolerate any food or fluid. Today she is also feeling a "bit dizzy" when she stands up, has a sharp and almost constant pain in her "stomach" and at night has "shaking episodes like I am cold" despite feeling quite sweaty. She presents looking pale, unwell, and tired as she has been unable to sleep due to pain in her back and also having to get up and go to the toilet. She describes "sharp stinging pain" when she passes urine. Leonorah is teary and anxious - she tells you that yesterday her urine was pink/red but now it is just "smelly"; she provides a fresh urine sample today. She also divulges that she has had urine infections in the past but not like this. Leonorah denies being pregnant and states is sexually active however does not have a regular partner. She tells you that she practices 'safe sex' using a diaphragm most of the time. You do some assessments and document the following : • HR 116 beats per minute • BP 101/71 • SpO2 Sats. 97% RA • RR 24 • Temperature 38.6o C • BGL 5.1mmol/L • Pain 8/10 • Dry mucosa and lips • Supra-pubic tenderness on palpation • Non-distended abdomen, soft with tenderness [guarding] to LUQ and LLQ. • Tenderness at the at the costovertebral angle with notable pain response • Urine - Dark, cloudy, malodorous, pyuria?. • SG 1.030, pH 7, Leucocytes +++, Nitrites +, Glucose -, Protein +, Bilirubin -, Ketones +, Blood + • Oriented to person/place/time. • Subjective: rigors described Medical History : previous UTIs, nil other relevant Current Medications: Nil. Allergies - Nil known. Social Background: Leonorah is a university student studying animal biology and wildlife management. She is single, lives alone in a 2 bedroom unit, works part time at a veterinary clinic. Sexually active, no regular partner. No recent overseas travel
PATHOPHYSIOLOGY
- Identify two (2) signs/symptoms that Leonorah is experiencing that are characteristic of her diagnosed condition. In your explanation, you must relate each sign/symptom you identified, back to the pathophysiological process (i.e. why is she experiencing the sign/ symptom) with evidence to support your reasoning.
- Identify the most common and likely infective pathogen in this case and briefly justify your decision