Case Study Module 6 Chief Complaint – “Painful urination.” History… Case Study Module 6Chief Complaint – “Painful urination.”History of Present IllnessA 32-year-old single man presents to his PCP with complaints of dysuria for the past week. He reports 8/10 burning with a painfully heavy sensation in his bladder and rectum, and he is unable to void except small amounts with great frequency throughout the day. He also complains of nocturia, which he denies ever occurred before. He reports a fever of 100.7°F (38.2°C) with chills that started yesterday. He admits to discomfort with bowel movements and is trying hard not to strain as the pain intensifies. He discloses having multiple female sexual partners and seldom uses condoms but relies on his partners to provide birth control. He was last sexually active 4 to 5 days ago, engaging in unprotected anal intercourse. He denies ever having STIs, blood in his urine, ejaculate or stool, penile discharge or pain, abdominal pain, and scrotal or testicular pain. He has not tried any over-the-counter medications to relieve his pain or fever.Review of SystemsThe patient’s ROS is positive for increased frequency of urination with burning pain/pressure, nocturia, urgency, reduced caliber of stream, and hesitancy. He admits to fever, chills, malaise, and insomnia. His ROS is negative for nausea, vomiting, abdominal pain, change or frequency in bowel habits, rectal bleeding, hemorrhoids, constipation, diarrhea, or hepatitis. He denies kidney stones, hernias, penile discharge, lesions, testicular pain, masses, STIs, and exposure to HIV.Relevant HistoryThe patient has a history of hypercholesterolemia. He has smoked a pack of cigarettes a day for 10 years. He consumes 3 to 4 alcoholic drinks on the weekends. He denies any recreational or illicit drug use. AllergiesNo known drug allergies; no known food allergies.MedicationsAtorvastatin 20 mg PO QD.Physical ExaminationVitals: T 38.4°C (101.2°F), P 104, R 14, BP 148/92, HT 188 cm (74 in.), WT 100.2 kg (221 lbs), BMI 28.4.General: Well-developed, well-nourished male appearing of stated age laying in obvious discomfort on the examination table. He is alert and oriented, makes good eye contact and answers all questions appropriately.Skin, Hair, and Nails: Consistently warm throughout, diaphoretic, without rashes, lesions, or masses.ENT/Mouth: Good repair of teeth and gums, no bleeding. Dry mucosa without lesions or masses, patent oropharynx, uvula midline.Neck: FROM, supple, anterior cervical and tonsillar adenopathy bilaterally.Lungs: Clear to auscultation bilaterally, without wheezes.Heart: +S1/S2, RRR, without murmurs, rubs, or gallops.Abdomen: Protuberant, soft, BS ×4, tender at suprapubic aspect. Negative CVA tenderness.Genital/Rectal: Circumcised male without urethral discharge, no scrotal masses, lesions or varicosities. (++) perineal pain, prostate firm, unable to determine the size (performed gently), hot to the touch, no masses, guaiac (-). Musculoskeletal: FROM throughout without pain.Neurologic: Cranial nerves II to XII grossly intact.Clinical Discussion Questions1. What are your differential diagnosis? Explain how each fit this pt presentation. (5)2. What is the most likely diagnosis? Why? (2pts)3. Demonstrate your understanding about the pathophysiology in regard to the most likely diagnosis. (3pts)4. Should tests/imaging studies be ordered? Which ones? Why? Think about tests/imaging beyond the primary care setting as well. (5pts)5. What are the next appropriate steps in management? (2pts)6. What are the prevalence, risk factors, typical presentation, and complications of this diagnosis? Provide references for your response. (5pts)7. What is the appropriate patient education for this case? (5pts)8. If not managed appropriately, what is/are the medical/legal concern(s) that may Health Science Science NursingNURSE 4010
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