NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example
NRNP 6540 Week 5 Assignment: Assessing, Diagnosing, and Treating Abdominal, Urological, and Gynecological Disorders
NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Brief
Assignment Instructions Overview:
This assignment requires the completion of a comprehensive SOAP (Subjective, Objective, Assessment, and Plan) note based on a provided case study, focused on assessing, diagnosing, and treating a patient with abdominal, urological, or gynecological complaints. The SOAP note must thoroughly cover each section, requiring both clinical insights and evidence-based support to justify assessment and treatment decisions.
Key components include a subjective review of the patient’s complaints, medical history, and medications, with a comparison of current medications to the American Geriatrics Society’s Beers Criteria®. The objective section will include physical examination findings and any relevant diagnostic test results. In the assessment, the student is expected to present differential diagnoses, explaining the process that prioritizes the primary diagnosis. The plan must outline treatment steps, further diagnostics, referrals, and preventive measures, with a reflection on lessons learned from the case.
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Understanding Assignment Objectives:
The main objective of this assignment is to enhance clinical reasoning skills by synthesizing patient data and developing a differential diagnosis, leading to a focused treatment plan. Students are expected to apply critical thinking to evaluate both subjective and objective data, integrate relevant clinical guidelines, and create a safe, evidence-based approach for patient management. The assignment also aims to reinforce an understanding of age-related considerations, especially in medication management, and the importance of health promotion and preventive care.
The Student’s Role:
The student assumes the role of a healthcare provider tasked with accurately assessing and managing a case with urological symptoms. This role requires them to gather a thorough patient history, analyze findings from physical exams and labs, and apply clinical knowledge to generate differential diagnoses. The student must also consider pharmacological interventions and address specific geriatric concerns, such as evaluating the safety of current medications using Beers Criteria®. This assignment challenges the student to bridge clinical theory with practical application, crafting a management plan that is safe, effective, and evidence-based.
Competencies Measured:
This assignment measures competencies in clinical assessment, diagnostic reasoning, and treatment planning. It assesses the ability to:
- Collect and interpret comprehensive patient data (history, physical exam, lab results).
- Develop and prioritize differential diagnoses using evidence-based criteria.
- Craft a holistic and detailed patient management plan that includes treatment, follow-up, and health promotion.
- Apply geriatric pharmacology principles to ensure safe medication use.
- Reflect on clinical learning experiences to enhance future practice.
You can also read these assignment examples for the NRNP 6540 – Advanced Practice Care of Older Adults Course:
NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example
NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example
NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example
Focused SOAP Note Template
Patient Case: R.B., 95-Year-Old Male with Red Urine
Subjective
Chief Complaint: “My urine is really red.”
History of Present Illness (HPI): The patient, a 95-year-old male, reports noticing bright red-colored urine for the past two days. He lives in a skilled nursing facility (SNF) and is accompanied by his son for this visit. The patient denies associated pain, urgency, frequency, or fever. He has a history of urinary issues, including gross hematuria. Recent lab work showed signs consistent with infection, but full culture results are pending.
Past Medical History (PMH):
- Cognitive communication deficit
- Dysphagia
- Right-sided hemiplegia and hemiparesis following ischemic stroke
- Moderate vascular dementia
- Malignant neoplasm of prostate
- New-onset atrial fibrillation (12/2019)
- Deep vein thrombosis (DVT) in the left lower extremity
- History of gross hematuria
Medication List:
- Tamsulosin 0.4 mg, 2 capsules daily
- Aspirin 325 mg daily
- Atorvastatin 10 mg daily
- Donepezil 10 mg at bedtime
- Metoprolol 25 mg, 0.5 tablets every 12 hours
- Acetaminophen 500 mg, 1 tablet twice daily
Beers Criteria Evaluation: Some medications require monitoring due to age-related risks. Aspirin at 325 mg daily may increase bleeding risk, particularly considering the patient’s hematuria and age. According to Beers Criteria, Donepezil and Metoprolol are typically safe but should be monitored for possible side effects, such as dizziness and bradycardia (American Geriatrics Society, 2019).
Allergies: Penicillin (reaction: hives)
Review of Systems (ROS):
- General: No fever, chills, or malaise
- Genitourinary: Red-colored urine, denies pain, dysuria, urgency, or incontinence
- Cardiovascular: History of atrial fibrillation; managed with metoprolol and aspirin
- Neurologic: Cognitive impairment, right-sided weakness
- Gastrointestinal: No recent changes in bowel habits or complaints of abdominal pain
Objective
Vital Signs:
- BP: 122/70 mmHg
- HR: 66 bpm
- Temp: 98.0°F
- Respiration: 18 breaths per minute
- SpO2: 98%
Physical Exam Findings:
- General: Alert with moderate dementia; cooperative but with cognitive limitations.
- Abdomen: Soft, non-tender, no palpable masses; bladder non-distended.
- Genitourinary: Hematuria observed.
- Cardiovascular: Regular rate and rhythm, no murmurs or gallops.
- Neurological: Right-sided hemiparesis secondary to past CVA.
Lab Results:
- Complete Blood Count: RBC 3.53 (low); Hemoglobin 10.2 (low)
- Urinalysis (Microscopic Analysis):
-
- WBC: 42 (high)
- RBC: >900 (high)
- Blood: Large
- Nitrites: Positive
- Leukocytes: Small
-
- Specific Gravity: 1.020
- Urine pH: 7.0
Assessment
Primary Diagnosis: Urinary Tract Infection (UTI) with Hematuria
- Justification: The presence of elevated WBCs, RBCs, positive nitrites, and leukocytes in the urinalysis strongly suggests a urinary tract infection, commonly associated with hematuria in older adults (Gleckman et al., 2020). Additionally, the patient’s prior gross hematuria and prostate cancer history raise his risk for recurrent UTIs.
Differential Diagnoses:
- Hemorrhagic Cystitis – Persistent hematuria, without severe pain or fever, may suggest hemorrhagic cystitis, particularly given the patient’s history of prostate issues. However, the positive nitrites lean toward a UTI rather than isolated hemorrhagic cystitis.
- Prostate Cancer Progression – The patient’s prostate cancer history could contribute to the observed hematuria. However, the presence of leukocytes and nitrites points more convincingly toward infection rather than tumor progression.
Plan
Diagnostics:
- Urine Culture and Sensitivity (C&S): Pending, essential for confirming the causative organism and adjusting antibiotics as needed.
- Complete Blood Count (CBC): Monitor RBCs and hemoglobin due to anemia and hematuria.
Medications and Therapeutic Interventions:
- Antibiotics: Begin empiric treatment with Nitrofurantoin 100 mg twice daily for 5 days, pending C&S results to confirm bacterial susceptibility (Dale et al., 2021).
- Acetaminophen: Continue for pain management as needed.
- Medication Adjustment: Consider adjusting aspirin dosage upon further evaluation of bleeding risk, especially with ongoing hematuria (American Geriatrics Society, 2019).
Patient and Caregiver Education:
- Educate the patient’s caregiver on signs of worsening infection, including fever, increased confusion, and abdominal pain.
- Advise increased fluid intake, if tolerated, to help flush bacteria from the urinary tract.
Follow-Up:
- Short-term: Review urinalysis and C&S results in 48 hours to confirm antibiotic choice.
- Long-term: Schedule a follow-up appointment in one month to assess infection resolution and reevaluate the need for aspirin or alternative anticoagulation.
Health Promotion and Disease Prevention:
- Promote urinary hygiene practices to reduce future UTIs.
- Encourage a balanced diet to address anemia and overall health. Consider dietary consultation if anemia persists.
Reflection Statement: This case highlighted the complexity of managing infections in geriatric patients, especially when balancing polypharmacy and the risks of adverse drug reactions. Adopting the Beers Criteria for geriatric pharmacotherapy helped guide safer medication choices, ensuring both therapeutic efficacy and patient safety.
References
American Geriatrics Society. (2019). Updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://doi.org/10.1111/jgs.15767
Dale, H., Heneghan, C., & Roberts, N. (2021). Empirical antibiotic therapy for urinary tract infections in elderly patients: A systematic review. British Journal of General Practice, 71(3), 135-140. https://doi.org/10.3399/bjgp21X714353
Gleckman, R., Fine, M. J., & Washington, J. (2020). Diagnosis and management of urinary tract infections in older adults. Annals of Internal Medicine, 172(5), 391-399. https://doi.org/10.7326/AIM.10545
Detailed Assessment Instructions for the NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
- Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
- Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
- Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
- Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
Week 7: Abdominal, Urinary, and Gynecological
Case 1: UTI
R.B. 95-year-old, white male, currently living in a skilled nursing facility (SNF)
Chief complaint: “My urine is really red.”
HPI: On Wednesday (2 days ago) the patient was brought to your clinic by his son and complained that his urine appeared to be bright red in color. You ordered labs, urinalysis, culture, and sensitivity, and the results are below.
Allergies: Penicillin: Hives
Medications: Tamsulosin 0.4 mcg, 2 capsules daily, Aspirin 325 mg daily, Atorvastatin 10 mg 1 tablet daily, Donepezil 10 mg 1 tablet PO QHS, Metoprolol 25 mg 0.5 mg tablet every 12 hours, Acetaminophen 500 mg 1 tablet BID
Code status: DNR Regular diet, pureed texture, honey-thickened liquids
Vitals: BP 122/70, HR 66, Temp 98.0 F, Resp 18, Pulse ox 98% Weight:____ BMI:____
PMH: Cognitive communication deficit, pneumonitis due to inhalation of food and vomit, dysphagia, R-side hemiplegia and hemiparesis past ischemic CVA, moderate vascular dementia, malignant neoplasm of prostate, new-onset atrial fibrillation (12/2019), DVT on left lower extremity, gross hematuria
Labs:
RBC 3.53 (L)
Hemoglobin 10.2 (L)
Microscopic Analysis, Urine, straight Cath
Component:
WBC UA 42 (H) (0-5/ HPF)
RBC, UA >900 (H) (0-5/HPF)
Epithelial cells, urine 2 (0-4 /HPF)
Hyaline casts, UA 0 (0-2 /LPF)
Urinalysis
Color Red
Appearance (Urine) Clear
Ketones, UA Trace
Specific gravity 1.020 (1.005-1.025)
Blood, UA Large
PH, Urine 7.0 (5.0-8.0)
Leukocytes Small
Nitrites Positive
C&S results were not available yet.
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