Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.
chose from four case studies to identify common health implications for women. You will then explore the chosen case study to determine the diagnosis, diagnostic tests, and treatment options for the patient.
Sample Answer
A concise response requires selecting a case study scenario before proceeding. Since I cannot choose for you, I will select a Case Study (Scenario 1) that covers a common, high-impact women's health issue to demonstrate the required structure and content.
Case Study 1: Diagnosis and Management of Urinary Tract Infection (UTI)
Scenario Summary
A 28-year-old female patient presents to the clinic complaining of dysuria (painful urination), urinary frequency, and a persistent sensation of needing to urinate (urgency). She denies fever, flank pain, or vaginal discharge. Her symptoms began suddenly 24 hours ago. She is otherwise healthy and is sexually active.
1. Diagnosis and Rationale
The likely diagnosis is Uncomplicated Cystitis, which is a common Urinary Tract Infection (UTI) limited to the bladder.
Rationale
Classic Symptoms: The patient exhibits the triad of classic lower UTI symptoms: dysuria, frequency, and urgency.
Absence of Complicating Factors: The lack of fever, chills, or flank/back pain suggests the infection has not ascended to the kidneys (pyelonephritis), making it uncomplicated.
Epidemiology: UTIs are significantly more common in young, sexually active women due to anatomical factors.
Diagnostic Tests
While an uncomplicated UTI can often be treated presumptively based on symptoms, a definitive diagnosis and confirmation of the causative organism requires laboratory testing.
| Test | Purpose | Expected Finding (Positive) |
| Urine Dipstick | A quick, point-of-care screening tool. | Positive for nitrites (suggests E. coli presence) and/or leukocyte esterase (suggests pyuria/white blood cells). |
| Urinalysis (UA) | Microscopic examination to confirm infection. | Presence of ≥105 colony-forming units (CFU)/mL of bacteria, ≥5 white blood cells (WBCs) per high-power field (pyuria), and sometimes red blood cells (RBCs) (hematuria). |
| Urine Culture and Sensitivity (C&S) | Identifies the specific pathogen and determines its susceptibility to various antibiotics. Crucial for guiding treatment if symptoms persist or in complicated cases. | Growth of a single organism, typically Gram-negative bacteria such as Escherichia coli (E. coli) (≈ 75-95% of cases). |
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3. Treatment Options
Treatment for uncomplicated cystitis focuses on short-course oral antibiotics, symptom relief, and patient education.
Pharmacological Treatment (First-line Antibiotics)
The goal is empirical treatment targeting the most common pathogen, E. coli. Treatment duration is typically 3–7 days.
Trimethoprim-Sulfamethoxazole (TMP/SMX) / Bactrim (160mg/800mg twice daily for 3 days).
Nitrofurantoin (Macrobid) (100mg twice daily for 5–7 days). Often preferred due to low resistance rates.
Fosfomycin (3g single dose). Convenient, but less effective than others.
Symptom Relief
Phenazopyridine (Pyridium): An azo dye used to relieve local symptoms of dysuria, frequency, and urgency. It causes bright orange/red urine, and patients must be warned about this side effect.
Increased Fluid Intake: Encourages flushing bacteria from the urinary tract.
Patient Education and Prevention
Hygiene: Wipe front to back.
Voiding Practices: Urinate before and immediately after sexual intercourse.
Fluid Intake: Maintain high fluid intake throughout the day.
Atypical Presentation: Educate the patient to return immediately if symptoms worsen or if they develop signs of an upper UTI (pyelonephritis), such as fever, vomiting, or flank pain.