Episodic Visit: Genitourinary Condition Focused Note.

Focused Notes are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Focused Notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.Episodic Visit: Genitourinary Condition Focused Note.

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                For this Assignment, you will work with an adolescent patient and complete a Focused Note Template (see attached template) in which you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, past medical history (PMH), socio-economic status, cultural background, etc.Episodic Visit: Genitourinary Condition Focused Note.

Assignment

Select an adolescent patient. With this patient in mind, address the following in a Focused Note.

1. Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent as well as possible reasons for these discrepancies.
2. Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
3. Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 code for the diagnosis. What was your primary diagnosis and why?
4. Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
5. Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?Episodic Visit: Genitourinary Condition Focused Note.

Subjective Data

Personal Particulars

Initials: B.W

Age: 14 years

Gender: male

Race: African American

Chief Complaint

Flank pain and lower limb swelling for one week

History Of The Presenting Complaint

The patient was brought in by his father who reports flank pain bilaterally that was of gradual onset. The pain is dull in nature and has been increasing every day since its first onset. The pain is not radiating. It increases during voiding and on exertion. It is relieved by taking analgesics or resting. It is associated with generalized body weakness, mild headache, and fever. Episodic Visit: Genitourinary Condition Focused Note.The patient complains of bilateral lower limb swelling that has been of gradual onset from the ankle joint had has now progressed to the mid-thigh. The father reports that the child wakes up with facial puffiness in the morning which disappears in the course of the day. B.W reports that his urine color has changed to dark brown and reduced urine output. However the patient denies urine incontinence, dribbling, poor urine stream, and hesitancy

Episodic Visit: Genitourinary Condition Focused Note.

Past Medical And Surgical History

The patient reports no previous history of admission, blood transfusion, and surgical procedure. However, his father reports that during his childhood he had had frequent infections of tonsillitis and sinusitis. There is no history of chronic illnesses and no known history of food and drug allergy.Episodic Visit: Genitourinary Condition Focused Note.

Personal Social-Economic And Family History

The patient is a high school student who stays with his parents and other two siblings. He is the firstborn in his family. His performance in school is brilliant both academically and in extra-curricular activities. He relates well with other students, teachers, siblings, and his parents. He is from a well-up family. His father is hypertensive and his mother has connective tissue disorder. He denies drinking alcohol and indulging in drugs and substances.Episodic Visit: Genitourinary Condition Focused Note.

Review Of Systems

The affected system is the genital urinary system where the patient presents with flank pain, hematuria, oliguria, lower limb edema, and morning facial puffiness. The cardiovascular system is not affected, however, the patient presents with lower limb edema and generalized body malaise. There is no history of palpitation, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and syncope. Respiratory, gastrointestinal, and musculoskeletal systems have no presenting symptoms.Episodic Visit: Genitourinary Condition Focused Note.

Objective Data

General Examination

The patient looks sickly, oriented to time, place, and person. He has generalized pitting edema from the ankle joint to the sacral region and periorbital edema. The edema is pitting and non-tender. The patient has no pallor, lymphadenopathy, dehydration, and cyanosis. His vitals are blood pressure slightly at 141/91mmHg, the pulse rate at 78beats per minute, the temperature at 37.8 degrees Celcius, and oxygen circulation at 99% room air.Episodic Visit: Genitourinary Condition Focused Note.

Systemic Examination

Systemic examination was done when the patient is lying in the supine position. Upon inspection, the abdomen is distended with flank fullness, moving with respiration, there is no mass, and the skin color is normal. Upon palpation, there is flank tenderness bilaterally. The kidneys are not palpable. There is shifting dullness and fluid thrill on percussion.

Diagnostic Investigation

Laboratory workups help in making an accurate diagnosis. For this patient, urinalysis, complete blood count, renal function test, serum electrolytes, c-reactive proteins, antistreptolysin O Titre (ASOT), autoantibodies(ANA, ANCA, anti-ds-DNA), and blood cultures (Tavares, et al, 2020). Urinalysis results show proteinuria and the presence of red blood cells. Complete blood count shows elevated white blood cells and lymphocytes. Hemoglobin levels are reduced (microcytic and hypochromic). The renal function test shows elevated creatinine levels and the glomerular filtration rate is reduced. Antistreptolysin O titer is positive.Episodic Visit: Genitourinary Condition Focused Note.

Assessment

Differential Diagnosis

Differential diagnoses are acute glomerulonephritis, acute kidney injury, and nephrotic syndrome. ICD10 for the respective diseases are; acute glomerulonephritis-N00.7, acute kidney injury-N17.9, and nephrotic syndrome-N04.9 (Asinobi, et al, 2020). Acute glomerulonephritis presents with oliguria, morning facial puffiness, lower limb swelling, and hematuria. Acute kidney injury presents with elevated blood pressure and reduced urine output. The nephrotic syndrome presents with massive proteinuria, periorbital edema, and microscopic hematuria. The primary diagnosis is acute glomerulonephritis.Episodic Visit: Genitourinary Condition Focused Note.

Plan

Pharmacologic Treatment

Furosemide 80mg I.V BD increases fluid output hence reducing the edema (anasarca, periorbital, and lower limb edema). Hydralazine 25mg P.O OD is a vasodilator antihypertensive drug that will help in lowering blood pressure. Erythromycin 500mg P.O QID is an antibiotic that will treat the bacterial infection that could have precipitated AGN. Dexamethasone 8mg P.O BD is a high dose corticosteroid used in the management of acute glomerulonephritis (Araki, et al, 2020). Acetaminophen 1g TDS is an analgesic that treats both pain and fever.Episodic Visit: Genitourinary Condition Focused Note.

Non-Pharmacological

The patient is advised to have restricted dietary sodium, proteins, and fluid intake. This will prevent the worsening of edema and proteinuria. The patient is advised to elevate lower limbs to allow a venous return. A follow-up clinic is necessary every month to monitor the renal function test, electrolytes, blood pressure, and urinalysis.

Reflective Notes

Acute glomerulonephritis is a renal disease that affects the glomerular layer. It can manifest as a primary illness or a secondary illness. Most forms of glomerulonephritis are characterized by progressive glomerular necrosis which causes a reduced urine output and glomerular filtration rate. AGN is more common in young boys, especially after post-streptococcal skin or throat infection.Episodic Visit: Genitourinary Condition Focused Note.