Question

Ashley James, age 52, developed acute flank pain that came and went in waves. It became so intense that she was pacing the floor and moaning. Her husband drove her to the emergency department, where her laboratory tests showed a small amount of hematuria and a slight increase in WBC in her blood. Her pain rating was a 9 on a scale from 1 to 10 (with 10 being the highest). Ms. James was given intravenous morphine and passed several small stones in her urine during the next few hours.

a. What caused the pain that sent Mrs. James to the emergency department?

b. What adverse effects could arise if a renal calculus completely blocks a ureter? Why?

c. Why is it important for Mrs. James to learn to increase her fluid intake to 8–10 glasses of fluid per day?

Jessica Peyton, age 4, began wetting her bed again after being dry at night for the past 3 months. She cried when she urinated and was crabby and lethargic. Jessica’s mother had seen these signs before, and recognized them as manifestations of yet another urinary tract infection. She took Jessica to a pediatric nurse practitioner who had just opened an office nearby. After taking a thorough health history, the nurse practitioner obtained a urine sample, diagnosed cystitis, and prescribed an antibiotic. She also referred Jessica to a urologist, who discovered that Jessica has vesicoureteral reflux.

d. What findings in the urine sample would be characteristic of cystitis?

e. Why would a urinary tract infection cause Jessica to develop nocturnal enuresis?

f. Explain what vesicoureteral reflux is.

Answer 1

Case scenario :Ashley James,age 52

a) Renal calculus which developed may be large to pass easily through the ureter .This causes ureter stretching and ureter lining irritation causing pain .

b) If a renal calculus blocks the ureter the kidney still produces urine and causes causes hydroureter and hydronephrosis.Because of this urine accmulates and resuts in dilation of ureter and renal pelvis.

c) Drinking 8-10 glasses of fluid per day keeps urine diluted and thus formation of renal calculi is prevented.

Case scenario :Jessica Peyton age 4

d) Cystitis is inflammation of the urinary bladder caused by bladder infection.The urinary characteristics in cystitis are:

• presence of bacteria
• presence of pus
• presnce of nitrate,WBC

e) Jessica who is 4 years doesn't have complete bladder control which is only attained by 5 to 6 years.Urinary tract infection can cause irritation in the bladder function Cystitis causes ininhibited  contraction of detrusor muscle in the bladder and results in frequent day and  nocturnal enuresis.

f)Vesicoureteral reflux (VUR)is the flow of urine in the wrong way ie backflow of urine .Normally urine flows from kidney to ureter and stored in the bladder. In VUR ,urine flows from bladder to ureter then kidneys.This occurs when the valve between ureter and bladder is not properly working as a result of congenital defect or urinary tract infection.VUS can cause infection and if not treated results in renal damage.