Suri Rose (aged 29) presented to her GP 5 days ago, with genito-urinary symptoms (burning & frequency with voiding, offensive PV discharge, & profuse pelvic pruritis, which she wondered aloud was “probably crabs”). She is a sex worker in a legal brothel in an adjoining suburb. Her GP completed several investigations (Urine M&C, Pap smear, PV swab for M&C, and a pubic skin scraping) before prescribing oral antibiotics for the suspected UTI / STIs, as well as a topical cream to treat the probable pubic lice (scabies).
At 0200 yesterday Suri awoke with severe R flank pain, nausea & vomiting, which became worse during the day. When she arrived at the EMD at 1700 she was flushed, febrile, experiencing rigours, and with pain in flank rated as “…8/10”. She said her last drink was at least 24 hours earlier. Admission data included:-
Vital Signs: T 39.9°C, HR 112/minute, BP 105/65, RR 26/minute, O2 saturation 97% RA
FBE: Hb: 130 g/dl (N=130-180g/dl)
WCC: 30x109/L (N= 4 -11 x 109/L)
U&E: 3.0mmol/l (N = 3.5 - 4.5mmol/L)
FWTU: showed large blood, large leukocytes, PH 6.0, SG 1.030, trace protein, large ketones.
(a) IV fluids @ 8/24 rate:
Flask 1. 1L x N/Saline, with 2G K+Cl- additive Flask 2. 1L N/saline 0.9%
Flask 3. 1L Normal Saline 0.9% Flask 4. 1L N/saline 0.9%
(b) medications: Paracetamol 1 G 6/24hrly. Pethidine 75mg IM 3-4/24, Metaclopramide 10mg IM 6/24,Augmentin Duo Forte 875/125mg BD , Doxycycline 100mg PO BD, Benzemul lotion 25% to affected area initial treatment and then follow up with subsequent treatment to affected areas 7 days later.
(c) food & fluids as tolerated
Suri was transferred to your floor at 2100 hours, with admission medical diagnoses of R pyelonephritis, and STI (Chlamydia & public lice). You are caring for her on this morning’s shift. Your 0800 assessment VS for Suri provide these data: T 38.5°C, HR 100 /minute, BP 120/85, RR 26/minute, O2 saturation 98% RA. Aside from being still slightly nauseated, she is still experiencing severe pain (rated at “6-7/10”) and burning on micturition.
Complete your Case Study Summary Sheet, by briefly explaining the
- Medical diagnosis & Pathophysiology of pylonephritis, Chlamydia and pubic lice.
- Medical investigations
In more detail, complete the Nursing Assessments & Care Plan:-
- Nursing assessments ïƒ 2 (actual) Nursing diagnoses, 1 (potential) Nursing diagnosis
- Nursing care plan
- Client education: what specific education are you going to give regarding her medications, current illness, and her occupational health situation?
In ~500 words & on a separate page, discuss:
- Possible explanation as to why Suri-Rose developed pyelonephritis
- Possible explanation as to why Suri-Rose’s K+ is 3 mmol/L
- How can you demonstrate your advocacy skills in caring for Suri-Rose
- Are STIs notifiable diseases?
- Will Suri-Rose’s illness impact on her occupation? Give a rationale for your responses