Author Question: A pregnant patient at 24 weeks' gestation complains of fever, chills, flank pain, frequency, ... (Read 115 times)

torybrooks · **on:** Jun 25, 2018

A pregnant patient at 24 weeks' gestation complains of fever, chills, flank pain, frequency, dysuria, and abdominal pain. A urinalysis demonstrates 100,000 proteus bacteria per mL. The clinician should recognize these findings as:

A. Glomerulonephritis
B. Cystitis
C. Pyelonephritis
D. Nephrolithiasis

Question 2

A pregnant patient at 5 weeks' gestation reports slight amount of vaginal bleeding. The clinician should recognize that the following laboratory test should be done:

A. Serial HCG levels over the next several days
B. Measurement of estrogen levels
C. Cervical mucus analysis
D. Pap smear for sexually transmitted infection

rosiehomeworddo · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: C
UTIs consist of either cystitis, an infection in the bladder, or pyelonephritis, an infection in the kidneys. Cystitis occurs in about 1 to 2 of the pregnant population, and cultures usually grow out a single pathogen, typically Escherichia coli or a species from the genera Staphylococcus, Proteus, Klebsiella, or Pseudomonas (Moran, 2004). Untreated UTIs and pyelonephritis may result in preterm labor and delivery, maternal sepsis, or even septic shock and death.
Asymptomatic bacteriuria may be present in 2 to 10 of pregnancies and is diagnosed by the growth of 100,000 colonies per milliliter of a single pathogen that is cultured from a clean-voided urinary specimen (Cohen, 2008). This may be indicative of an underlying disorder, such as an anatomic urinary tract abnormality or chronic pyelonephritis. Asymptomatic bacteriuria may lead to pyelonephritis and is associated with an increased risk of preterm labor and low-birth-weight babies.
Subjective
Inquiries should be made about the presence of risk factors (frequent/recurrent UTIs, diabetes, urinary tract abnormalities, STDs). Inquire also about any urgency, frequency, dysuria, suprapubic pain, abnormal urinary flow pattern, discolored or malodorous urine, fever, chills, flank pain, or GI complaints.
Objective
Evaluation includes documented fever, clean catch urine, pelvic examination/wet mount (for vaginal infections), costovertebral angle or suprapubic tenderness, urine culture, CBC, and signs of shock (tachycardia, hypotension, and pallor).

Answer to Question 2

ANS: A
Approximately 20 of early pregnancies are complicated by vaginal bleeding, and about half of these will end in spontaneous abortion (Deutchman, 2008). Single or serial qualitative hCG levels can be helpful in evaluating vaginal bleeding during early pregnancy because the levels should double every 2 to 3 days during the fourth to eighth weeks of gestation.
Assessment questions should be directed toward any precipitating factors of bleeding (e.g., after sexual intercourse), the amount of vaginal bleeding (saturation of sanitary napkins and frequency with which the napkins must be changed), the quality of the vaginal bleeding (clotted versus flowing), and whether the bleeding is actually coming from the vagina or from the urethral or rectal area.
The vital signs should be normal for gestational age. Physical examination should concentrate on uterine size, FHTs, a pelvic examination with cervix visualization, and a digital rectal examination. Other tests that may be useful include a transvaginal ultrasound, hCG level measurement, progesterone level, wet mount, urinalysis, and stool for occult blood. A CBC and coagulation studies should be considered.