Nursing

Instructions
In at least 375 words, or 1.5 double-spaced pages, prepare a case report that addresses the following:

Based on the case study provided, respond to the following questions:
Identify and differentiate the symptoms from the signs in this patient.
Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?
What results do you expect to find in the tests ordered?
What are some future complications the patient is at risk of developing?
Do the urinary incontinence and the cystocele have any relationship with dystocic deliveries? Why or why not?
Is cystocele a cause of urinary tract infections? Explain your position.
What could be the cause of the whitish and cottage cheese-like vaginal discharge the patient had in her last pregnancy? Is that common? Why or why not?
What is the prognosis of Mrs. Meriwether’s cystocele? Can you mention other causes of urinary obstructions?
According to the history, our patient was very concerned about having a tumor. What are some tumors of the female reproductive system that we should rule out in this case?
Mrs. Meriwether had two episodes of renal colic produced by a renal lithiasis. Describe this diagnosis and the prognosis. Is this condition related to a chronic kidney disease? Why or why not?

Personal Information
Name: Mrs. Maggie Meriwether

Age: 56 years old

Gender: Female

Description
Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele.

Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake.

On physical examination we found:

Remarkable Signs on Physical Exam by Systems

Urinary system: Leakage of urine through the urethra during Valsalva maneuver
Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing
Lab Tests

Complete blood count (CBC)
Urinalysis
Pelvic ultrasound
Cystourethrogram

ANSWER

Nursing Case Report

Differentiation of symptoms from the signs in the patient

A differentiation of signs and symptoms, in this case, relies on the patient’s assessment and of the physician. Symptoms are manifestations of disease apparent to the patient, while signs are conditions perceived by the physician. The patient evidenced signs such as urine leakage and a soft mass protruding through the vagina. The physician can highlight key signs that support an appropriate diagnosis and treatment through a physical examination process. The symptoms experienced by the patient include vomiting and diarrhea, which led to dehydration and acid-base imbalances. Also, the patient has experienced a whitish and cottage cheese-like vaginal discharge during her last pregnancy. These are potential symptoms perceived by the patient and might be useful for her diagnosis.

Existence of any remarkable details in the patient’s personal and social history useful in making a suitable diagnosis

The patient has encountered various health-related issues that might help in the current diagnosis. One of her past incidents is renal colic development, which might increase the urge for urination and frequent leakages. Renal colic is evidenced by diuresis, which accelerates pressure within the kidney (Macneil & Bariol, 2011). Her past exposure to renal colic might fuel the emergence of the current condition. Notably, the patient has previously suffered from dystocia during childbirth. These two historical occurrences might be useful in making a suitable diagnosis.

Test Results Outcomes

The test results will portray a urinary tract infection. The increased urge to urinate is a clear indication of a possible urinary tract infection. Past exposure to renal colic and her vaginal status after delivery have a closer link with urinary tract infection. The infection causes the muscles and nerves to develop lower resistance where they allow urine to pass. When the urine leaks, a sudden pressure forms on the bladder and urethra, leading to the sphincter muscles’ opening. Consequently, it leads to a protruding in the vagina due to the opening of the muscles.

Possible Future Complications

The patient is at risk of developing kidney failure and relying on a catheter to pass urine for the rest of her life. Renal impairment is one of the possible outcomes associated with recurrent urinary tract infections (Ahmed et al., 2018). In such cases, patients experience increased admissions for worsening kidney function. They rely on catheters to pass urine for the rest of their lives. Thus, kidney failure exists as one of the common long-term outcomes associated with urinary tract infections.

Relationship between urinary inconsistence, cystocele, and dystotic deliveries

Urinary inconsistence and cystocele have a close relationship with dystocic deliveries. During birth, muscles surrounding the vagina might experience prolapse, making it hard to resist increased pressure. The muscles weaken due to increased stress. As Zargham et al. (2013) reveal, pelvic organ prolapse has a close relationship with urinary inconsistence regardless of intensity. While giving birth, muscles weaken, making it hard for women to control the urge to urinate and avoid leakage.

Cystocele as a cause of urinary tract infections

Cystocele is a condition where a woman’s bladder protrudes into the vagina. It is a condition likely to emerge due to recurrent urinary tract infections. Increased exposure to heaviness, pain in the pelvic area, and urine fullness might weaken the vagina muscles because of advanced pressure. For example, a feeling of fullness and heaviness tends to create an opening to allow the passage of large volumes of urine. This leads to the formation of a gap in the vagina where tissues protrude, leading to urinating difficulties.

Whitish and cottage cheese-like vaginal discharge

During pregnancy, it is normal for most women to develop yeast infections. However, in the patient’s case, a white and cottage-like discharge indicates an infection that calls for professional care services. The patient has had a history of renal colic, which might lead to an infection recurrence during the pregnancy. Her past exposure to infections might fuel such conditions during the pregnancy leading to the presence of a whitish and cottage-like discharge.

Prognosis

Mrs. Meriwether’s cystocele prognosis relates to past exposure to infections and her age. She had had instances where she developed challenges with her urinary tract leading to infections. For example, she previously suffered from renal colic and dystocia during childbirth. Also, at her age, she is prone to infections due to reduced estrogen production. She has already clicked the menopause age, which positions her at a disadvantage because this condition increases as people age. Aging weakens the muscles and other supportive body tissues.

Unlikely tumors in this case

The patient is concerned about a possible tumor. One of the tumors that are ruled out is carcinoma since it affects women aged above 60 years. The patient is only 56 years of age and does not qualify for an assessment of carcinoma cancer. Other irrelevant tumors, in this case, include endometrial cancer and uterine sarcomas. She does not engage in inappropriate behaviors such as smoking, which might expose her to endometrial cancer. Also, she has no previous record of radiation and obesity, which could expose her to uterine sarcomas.

Diagnosis and prognosis in past episodes of renal colic

The patient has previously suffered from renal colic produced by renal lithiasis. The presence of kidney stones in the body system generates abdominal complications due to the ureter’s obstruction. The pressure generated on the urinary tract causes the patient to experience increased urination and inability to control the urge. These are potential conditions that expose an individual to a possible urinary tract infection.

References

Ahmed, H., Farewell, D., Francis, N. A., Paranjothy, S., & Butler, C. C. (2018). Risk of adverse outcomes following urinary tract infection in older people with renal impairment: Retrospective cohort study using linked health record data. PLoS medicine, 15(9), e1002652. DOI: 10.1371/journal.pmed.1002652

Macneil, F., & Bariol, S. (2011). Urinary Stone Disease: Assessment and management. Australian family physician, 40(10), 772.

Zargham, M., Alizadeh, F., Moayednia, A., Haghdani, S., & Nouri-Mahdavi, K. (2013). The role of pelvic organ prolapse in the etiology of urinary incontinence in women. Advanced biomedical research, 2. DOI: 10.4103/2277-9175.108010