[email protected]

New Order

Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

Photo Credit: Photographee.eu / Adobe Stock

As you prepare for this i-Human Case Study, reflect on your prior case studies and feedback you have received. Focus on what to strengthen or improve in your examination process and procedures. As you consider possible renal and genitourinary conditions you may address, identify particular issues or patient ages of greatest interest or concern to you. In short, do the most to maximize this experience in any and all ways.

ORDER A PLAGIARISM-FREE PAPER HERE

To prepare: Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

Review this week’s Learning Resources. Consider how to apply knowledge of renal and genitourinary conditions and understanding of socio-cultural family needs to assessing, diagnosing, and treating pediatric patients.
Access i-Human from this week’s Learning Resources and review the i-Human Case Study. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify 3–5 possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with renal and genitourinary conditions and their families Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.

Subjective

Reason for Encounter: testicular pain

HPI (History of Present illness): Calvin Moss is a 13-year-old male who was brought for evaluation of testicular pain by his father, but his father was not present at the time of inquiry. The patient presents with the chief complaint of testicular pain that started a two hours ago while he was playing basketball doing layups. He denies any history of trauma to the genital area and reports that the pain came on suddenly and felt like he had been punched. The pain is worse on the left side and he graded it as a 9/10 on the pain scale. The pain has been getting worse since onset and has no known relieving or aggravating factors. The pain is present at all times even at rest with no variations and does not change with changes in posture. The pain is described as being both on the surface and deep inside the testis. The pain does not radiate to any other site. There is associated groin pain and testicular swelling that started at the same time that the pain in the testis begun. There is associated nausea and one episode of vomiting on the way to the hospital. The patient denies any history of lower abdominal pains, fever, but reports feeling really sick.

Current Medications: none

Allergies: He denies known/unknown food, drug, or environmental allergies

Pertinent PMHx: He states that he had tubes inserted in his ears when he was little but denies any other medical, surgical, or dental conditions. He has no history of recent hospitalizations and has never been hospitalized for similar complaints. He claims that he has been healthy. He states that he started taking flu shots since he started middle school but cannot recall the date of his last physical or immunization. His last well child visit was 3 months ago.

Social Hx: He lives with his parents (father 60 y/o and mother 49 y/o) and sister 10 y/o. He denies consumption of alcohol or any recreational drugs, and sexual debut. He is in school, unknown grade and plays basketball.

Fam Hx: He states that his father has high blood pressure for which he has been taking medication. His mother and sister are said to be healthy. He does not know of any conditions that run in the family and he is unaware of his grandparents’ health Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

ORDER HERE

History questions asked:

  • How can I help you today?
  • Are there any other symptoms we should discuss today?
  • When did the testicular pain start?
  • What were the events surrounding the onset of the testicular pain?
  • What makes your testicular pain better or worse?
  • On a scale of 1-10 how severe is the pain?
  • Does the pain radiate elsewhere? If yes, where?
  • Do you have abdominal pain?
  • Do you have groin pain?
  • Did you have trauma or inure yourself?
  • Are you taking any prescription medications?
  • Do you have any previous medical, surgical, or dental procedures?
  • Are you taking any over-the-counter or herbal medications?
  • Do you have any allergies? Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

Review of Systems

General: Calvin Moss is a 13-year-old male who presented to the hospital in pain, he denies fever, fatigue, difficulty sleeping, unintentional weight loss/gain, or night sweats.

Skin: He denies any problems with an itchy scalp, skin changes, moles, thinning hair, or brittle nails.

HEENT: He denies having intractable headache, blurred vision, and difficulty with night vision, problem hearing, ear pain, sinus problems, chronic sore throats, or difficulty swallowing.

Respiratory: He denies experiencing shortness of breath, wheezing, difficulty breathing, cough, or sputum production.

Cardiovascular/Peripheral Vascular: He denies experiencing chest pains/pressure/discomfort, palpitations, decreased exercise tolerance, or blue/cold fingers and toes.

Gastrointestinal: He complaints of nausea and one episode of vomiting non-blood stained or not containing coffee-ground substances but denies any abdominal pain.

Genitourinary: He complaints of testicular and groin pain on his left side but denies any changes in his micturition habits such as pain, color change, burning, blood, difficulty starting or stopping, dribbling, incontinence, urgency during day or night, or nay changes in frequency.

Musculoskeletal: He denies any muscle pain or cramping, redness, swelling, joint stiffness, joint swelling or redness, back pain, neck or shoulder pain, or hip pain.

Neurological: He denies experiencing, dizziness, weakness, seizures, tremor, tingling, fainting, or loss of consciousness  

Hematological: He denies easy bruising, bleeding gums, nose bleeds, or other sites of increased breathing.

Endocrine: He denies any problem with heat or cold intolerance, increased thirst, increased sweating, frequent urination, or changes in appetite.

Psychiatric: He denies any problems with anxiety, depression, sadness, memory loss, or mood changes Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.

Objective

General: Patient is AOX4

VS: Temp: 36.40C, BP- 120/70 HR-120bpm (radial), RR-18bpm, O2 sat-100% RA, Height-5’5 Weight- 120.0lb, BMI-19.9

General Appearance: Calvin Moss is A and O x4, of good nutritional status, well-groomed, not in respiratory distress.

HEENT: There is no eye lid edema, the conjunctiva is pink, no discharge present. The throat and tongue is of normal color, no swelling, or ulcerations. The oropharynx is pink, tonsils without exudates. No hoarseness.

Skin/Integumentary: He mildly diaphoretic. The skin is warm, there is acne noted on his face and back, and there are no rashes.

Cardiovascular: Apex beat 5th intercostal space mid-clavicular line (MCL). Normal heart sounds.

Respiratory: Chest is clear and normal breath sounds and good air entry.

Abdomen: On inspection, the abdomen is lean, muscular, and non-distended, present bowel sounds on all abdominal quadrants on auscultation, on palpation, the abdomen is soft, non-tender, no organomegally, no abdominal or inguinal mass. Normal note to percussion.

GU/Rectal: Left hemiscrotum is swollen and mildly erythematous. Left testicle appears higher than the right, scrotum is too swollen to determine testicular lie. Left testicle exquisitely tender to touch, no masses appreciated. Absent cremasteric reflex; right is within normal limits. Negative Phren’s sign. Tanner stage 3; circumscised, no penile discharge. No rash or lesions. Rectal area has no fissures, induration, or lesions Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.

Musculoskeletal: There is no edema, clubbing, or cyanosis. There is no tenderness, muscle resistance, rigidity, or deformity on palpation.

Lymphatics: No inguinal lymphadenopathy

Assessment

  • Scrotal ultrasound – Doppler (Schick & Sternard, 2021).
  • Complete blood count (CBC)
  • Urinalysis

Primary Diagnosis and ICD-10 code

    • Testicular Torsion (N44.00): is a true urological or surgical emergency that requires immediate attention. It presents with acute onset testicular pain that is more common among teenagers or adolescents between the ages of 12 to 18 years (Schick & Sternard, 2021). The patient often has a swollen, erythematous, hard, high-riding testis, with absent cremasteric reflex (Schick & Sternard, 2021). The disease requires early identification to prevent testicular amputation (Schick & Sternard, 2021)Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.

Differential Diagnoses

    • Torsion of Appendage testis (N44.03): It refers to the twisting of a vestigial appendage located along the testicle. It is a common cause of acute scrotal pain through of gradual onset sometimes, in pre-pubertal children with peak age of occurrence being 7 to 12 years (Pomajzl & Leslie, 2021). It is often self-limiting and has an unknown cause. However, trauma and pre-pubertal enlargement plays a role (Pomajzl & Leslie, 2021). It has pain localization to the upper pole of the testis or epididymis and has no constitutional symptoms (fever, nausea, or vomiting). The testis is often tender with a palpable mass at the area of maximum tenderness (Pomajzl & Leslie, 2021). It has an intact cremasteric reflex but associated blue dot sign.
    • Epididymitis (N45.9): this is the inflammation of the epididymis often following the inoculation of an infective pathogen, more commonly a bacterium. It is common among males 20 to 39 years (Rupp & Leslie, 2021). It presents with testicular pain that is of insidious onset, swollen, red, and warm testis, especially if the infection spreads to the testis giving epididymo-orchitis (Rupp & Leslie, 2021). This disease often has Phren sign positive as the pain is relieved by raising the testis.
    • Testicular neoplasm (C62.9): It refers to malignancy or cancer development in the testis. It often presents with a mass, pain, and enlargement of the testis. It requires early diagnosis for better prognosis in the patient through early initiation of therapy to avoid adverse sequelae.
    • Acute appendicitis (K35): This one of the many causes of an acute abdomen and is caused by inflammation in the appendix following appendicular obstruction. It often present with RLQ – right lower quadrant pain that tends to migrate from the umbilicus to the right iliac fossa. The patient will have low-grade fever, nausea vomiting, and constipation or diarrhea. There will be McBunny’s point tenderness, Rovsign’s, psoas, and obturator sign positive. Laboratory test will show leukocytosis and elevated markers of inflammation. The appendix will require appendectomy and can be diagnosed using an abdominal ultrasound or CT Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment

Plan

  • Additional laboratory and diagnostic tests:
    • none
  • Consults:
    • Direct surgical or urologist consultation, and pediatrician consult for further evaluation and development of a definitive management (Keays & Rosenberg, 2019).
  • Therapeutic Modalities: Pharmacological And Nonpharmacological Management
    • Analgesic – Morphine sulfate intramuscular 5 mg every four hours.
    • Keep patient nil per oral in preparation for urgent surgery.
    • Keep the patient well hydrate the patient with 1Ltr Lactated Ringers given over two hours.
    • Start immediate prophylactic antibiotic – Ceftriaxone 1g 0.5 to 2 hours before the procedure.
    • Arrange immediate or urgent surgery – detorsion and bilateral orchidopexy (Mukendi, Kruger, & Haffejee, 2020; Keays & Rosenberg, 2019)Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.
  • Social Determinants of Health (SDoH)
    • Evaluate for exposure to secondary smoke.
  • Health Promotion
    • Discuss about  maintaining an up-to-date childhood immunization status  as per the CDC schedule
  • Patient education: Explanations and advice given to patient and family members.
    • Nature of the disease
      • Inform the father that the disease is a surgical emergency and that Calvin would require urgent surgery.
      • Educate on possible complications of surgery such as loss of testis and possible infertility in future.

Post-surgery care

      • Encourage the father to ensure adequate or good or balance nutrition after surgery to promote wound healing.
      • Advice on danger signs such as fever, increasing or worsening pain, or discharge from the incision site.
      • Advice to ensure testicular self-assessment in the child to avoid missed testicular masses that could become neoplastic.
  • Disposition/follow-up instructions:
    • Admit the patient to the surgical ward and ensure prompt surgery is done to help salvage the affected testis (Mukendi, Kruger, & Haffejee, 2020)Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment.
    • Upon discharge, follow up with the patient in four weeks to evaluate for proper wound healing and vitality of the testes.

References

Keays, M., & Rosenberg, H. (2019). Testicular Torsion. CMAJ: Canadian Medical Association Journal, 191(28), E792. https://doi.org/10.1503/cmaj.190158

Pomajzl, A., & Leslie, S. (2021). Appendix Testes Torsion. StatPearls [Internet]. Treasure Island; Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546994/

Rupp, T., & Leslie, S. (2021). Epididymitis. StatPearls [Internet]. Treasure Island; Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430814/

Schick, M., & Sternard, B. (2021). Testicular Torsion. StatPearls [Internet]. Treasure Island; Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448199/

Mukendi, A., Kruger, D., & Haffejee, M. (2020). Characteristics and management of testicular torsion in patients admitted to the urology department at Chris Hani Baragwanath Academic Hospital. African Journal of Urology, 26(34). https://afju.springeropen.com/articles/10.1186/s12301-020-00044-7

Assignment: i-Human Case Study: Evaluation and Management of Renal and Genitourinary Conditions

Photo Credit: Photographee.eu / Adobe Stock
As you prepare for this i-Human Case Study, reflect on your prior case studies and feedback you have received. Focus on what to strengthen or improve in your examination process and procedures. As you consider possible renal and genitourinary conditions you may address, identify particular issues or patient ages of greatest interest or concern to you. In short, do the most to maximize this experience in any and all ways.
To prepare: Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment
• Review this week’s Learning Resources. Consider how to apply knowledge of renal and genitourinary conditions and understanding of socio-cultural family needs to assessing, diagnosing, and treating pediatric patients.

ORDER TODAY

• Access i-Human from this week’s Learning Resources and review the i-Human Case Study. Based on the provided patient information, think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
• Identify 3–5 possible conditions that may be considered in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with renal and genitourinary conditions and their families Case Study Of Evaluation And Management Of Renal And Genitourinary Assignment