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YArlie

Shelly, a 4-year-old child mentioned in this case study is primarily been diagnosed with Urinary Tract Infection (UTI). Apart from fever and other visible signs such as frequent and painful urination, the other assessment data that are required for the diagnosis of UTI is the positive urinalysis, and the urine culture tests. Urinalysis is performed to identify the presence of blood cells, bacterial cells or pus cells in the urine whereas the urine culture tests are performed in order to identify the presence of the causative organism of UTI in the urine sample (Patel, Soni, Bhagyalaxmi, & Patel, 2019).

The most predominant causative organism responsible for the cause of UTI is the Gram-negative anaerobic Escherichia coli. The other bacterial organisms causing UTI are Klebsiella, Enterobacter, Proteus, and Staphylococcus species. Apart from these bacterial species, certain fungal organisms are also responsible for the cause of UTI (Patel et al., 2019). Considering the safety concerns to avoid adverse drug conditions when prescribing for children, the pharmacological treatment recommended for Shelly is the oral intake of trimethoprim-sulfamethoxazole (Bactrim, Septra). The recommended dose for Shelly is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days (Lashkar & Nahata, 2018). This initial antimicrobial drug is considered to be safe and effective for young children as a long-term prophylactic drug therapy against the UTI (Lashkar & Nahata, 2018).

Prior to discharge from the clinic, Shelly and her mother were educated with prescribed medications, its importance in treating the infection and its consequence on discontinuing the course. They were also advised in completing the full course of the medication even if the symptoms were found to be reduced after the oral intake of the drug for few days. They were informed on the importance of hygiene, proper toilet training, and maintaining cleanliness after each bowel movement in order to prevent the germs from entering into the urethra from the anal region. Shelly was also recommended to empty her bladder whenever she urges to urinate as holding the urine for a long time creates more bacterial infection in the urinary bladder (Shaikh & Hoberman, 2019).

PEER 2 Nathalia

1. The nurse needs to familiarize with the history of symptoms exhibited by Shelly. For instance, the nurse needs information on the young girl’s urine color. Urine concentration and description of cloudiness are equally relevant assessment factors because she already knows there is increased volume and urgency (Masika & Armstrong, 2017). Hourly visits to the bathroom are a critical indicator that there could be a urinary tract infection (UTI) but additional assessment details such as odor would provide further information to help assess gravity, diagnosis and subsequent care and treatment.

2. Escherichia coli is a typical causative microorganism that is responsible for the urinary tract infection (UTI). Klebsiella is equally culpable for UTI as well as Proteus spp, although they mostly suggest the presence of stone disease (Taylor & Moore, 2018). The increased levels of gram-positive bacteria also show that enterococcus and staphylococcus are microorganisms related to UTI.

3. The four-year-old Shelly needs antibiotics to address her situation. Some of the ideal medications include trimethoprim or sulfamethoxazole, which exist as Bactrim or Septra. The alternative pharmacological treatment is amoxicillin or clavulanate, alternatively known as Augmentin (Taylor & Moore, 2018). Cephalosporins such as Suprax, cefprozil, and Keflex are equally effective medication to treat the UTI infection.

4. Shelly and her parents require patient education to minimize exposure to the causative microorganisms. For instance, the Shelly needs information such as wiping strategy after urination or bowel movement. As a child, she might not be acquainted with the recommended front to back technique. The frequent urination on an hourly basis means Shelly needs an equally habitual intake of fluids such as cranberry juice (Masika & Armstrong, 2017). The teaching priorities should focus on behavioral changes for Shelly in the daycare. Minimizing exposure and high levels of sanitation at the facility will reduce or eliminate the recurrence of UTI.

Above are the original questions if you need them;

Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages.

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1. What other assessment data would be helpful for the nurse practitioner to have?

2. What are the organisms most likely to cause an UTI?

3. What is the pharmacological treatment for Shelly? 

4. What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?