NR 507
Week 4 – Part 1 & 2
Case Study Discussions and Quiz
, NR 507 Week 4 Discussion Part One
Mrs. Orndorf is a 28-year-old woman married for 3 years who has just returned from an
outdoor camping trip with her husb&, with symptoms of dysuria with a burning sensation,
urgency to urinate, & frequent urination. She said, “I have had similar symptoms three
times over the last 2 years. Pubic & low back discomfort awoke me two nights ago & that
is why I am here.” On physical examination, her temperature was 98.6° F, blood pressure
was 114/64 mm Hg, pulse was 68 beats per minute, & the respiratory rate was 12 breaths
per minute. Other than a tender abdominal pelvic area, the examination was
unremarkable.
•What is your list of differential diagnoses in this case & explain how each of these fits with
the case patient as described above. Be sure to list at least four (4) pertinent differential
diagnoses. Indicate which of these you would select as the most likely diagnosis & explain
why.
Acute Cystitis secondary to Urinary Tract Infection (UTI)
Cystitis is the inflammation of the bladder & is usually caused by urinary tract infections.
Cystitis is caused by the invasion of the bladder mucosal by enteric coliform bacteria
(Escherichia coli) that ascends into the bladder via the urethra (Brusch, 2016). Cystitis causes
urgent & frequent urination that can be associated with a stinging & burning pain as seen in Mrs.
Orndorf. Other symptoms include blood in the urine (hematuria), cloudy or strong-smelling
urine, pelvic discomfort, a feeling of pressure in the lower abdomen, & low-grade fever (Brusch,
2016). The pain can radiate from the abdomen & to the back which is also another symptom Mrs.
Orndorf reports to experience. Women with cystitis feel generally unwell & groggy. They may
also have difficulties sleeping, & feel tired, irritable & unable to concentrate.
Pyelonephritis
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, Acute pyelonephritis is a potentially organ- &/or life-threatening infection that often leads to
renal scarring (Fulop, 2016). Acute pyelonephritis results from bacterial invasion of the kidneys
from the lower urinary tract or bloodstream. Timely diagnosis & management of acute
pyelonephritis has a significant impact on patient outcomes. The classic presentations of acute
pyelonephritis are back or flank pain, fever, feeling sick (malaise), nausea &/or vomiting, painful
urination (dysuria), & increased urination frequency (Fulop, 2016). This disorder could also
explain Mrs. Orndorf’s symptoms of dysuria with a burning sensation, her frequent urination, &
back pain.
Vaginitis
Vaginitis is due to an imbalance of healthy bacteria in the vagina which leads to inflammation.
Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of
pathogens (Gor, 2015). The overgrowth of normally present bacteria, infecting bacteria, or
viruses can cause symptoms such as dyspareunia, dryness, vaginal itching or irritation, painful
urination, & abnormal bleeding (Gor, 2015). Factors that alter the vaginal environment include
feminine hygiene products, contraceptives, vaginal medications, antibiotics, sexually transmitted
diseases, sexual intercourse, & stress. This could possibly explain Mrs. Orndorf’s complaint of
dysuria with a burning sensation, however, it leaves to question her back pain & abdominal
pelvic pain.
Sexually Transmitted Infection (STI)
Sexually transmitted infections (STIs) such as chlamydia, genital herpes, & gonorrhea can cause
dysuria & frequent urination similar to that of which Mrs. Orndorf has reported to experience.
Some of these infections can also cause pain in the abdomen & back. Tenderness in the
abdominal pelvic area upon examination can also be a sign & symptom of a STI (American
University, 2016). Although Mrs. Orndorf is married, the possibility of sexually transmitted
infections should still be considered & testing should be done.
•According to the first item in your differential, what are the risk factors for this disorder?
Acute cystitis is more common in women due to the female anatomy; women have a shorter
urethra which means a shorter distance for bacteria to travel to the bladder & cause infection.
Sexual intercourse & the use of birth control such as spermicides & contraceptive diaphragms
can also cause cystitis as it increases the risk for bacteria entering the urethra & traveling to the
bladder (Brusch, 2016). Other risk factors for cystitis include pregnancy, poor hygiene, bladder
catheter placement or anatomical changes in their urinary tract, as well as people who have
diabetes, multiple sclerosis or a urological disease (National Center for Biotechnology
Information, 2013).
•What are some treatments for this disorder?
This study source was downloaded by 100000902171055 from CourseHero.com on 11-27-2025 22:09:06 GMT -06:00
https://www.coursehero.com/file/52790181/NR-507-Week-4-Case-Study-Discussions-Parts-1docx/
Week 4 – Part 1 & 2
Case Study Discussions and Quiz
, NR 507 Week 4 Discussion Part One
Mrs. Orndorf is a 28-year-old woman married for 3 years who has just returned from an
outdoor camping trip with her husb&, with symptoms of dysuria with a burning sensation,
urgency to urinate, & frequent urination. She said, “I have had similar symptoms three
times over the last 2 years. Pubic & low back discomfort awoke me two nights ago & that
is why I am here.” On physical examination, her temperature was 98.6° F, blood pressure
was 114/64 mm Hg, pulse was 68 beats per minute, & the respiratory rate was 12 breaths
per minute. Other than a tender abdominal pelvic area, the examination was
unremarkable.
•What is your list of differential diagnoses in this case & explain how each of these fits with
the case patient as described above. Be sure to list at least four (4) pertinent differential
diagnoses. Indicate which of these you would select as the most likely diagnosis & explain
why.
Acute Cystitis secondary to Urinary Tract Infection (UTI)
Cystitis is the inflammation of the bladder & is usually caused by urinary tract infections.
Cystitis is caused by the invasion of the bladder mucosal by enteric coliform bacteria
(Escherichia coli) that ascends into the bladder via the urethra (Brusch, 2016). Cystitis causes
urgent & frequent urination that can be associated with a stinging & burning pain as seen in Mrs.
Orndorf. Other symptoms include blood in the urine (hematuria), cloudy or strong-smelling
urine, pelvic discomfort, a feeling of pressure in the lower abdomen, & low-grade fever (Brusch,
2016). The pain can radiate from the abdomen & to the back which is also another symptom Mrs.
Orndorf reports to experience. Women with cystitis feel generally unwell & groggy. They may
also have difficulties sleeping, & feel tired, irritable & unable to concentrate.
Pyelonephritis
This study source was downloaded by 100000902171055 from CourseHero.com on 11-27-2025 22:09:06 GMT -06:00
https://www.coursehero.com/file/52790181/NR-507-Week-4-Case-Study-Discussions-Parts-1docx/
, Acute pyelonephritis is a potentially organ- &/or life-threatening infection that often leads to
renal scarring (Fulop, 2016). Acute pyelonephritis results from bacterial invasion of the kidneys
from the lower urinary tract or bloodstream. Timely diagnosis & management of acute
pyelonephritis has a significant impact on patient outcomes. The classic presentations of acute
pyelonephritis are back or flank pain, fever, feeling sick (malaise), nausea &/or vomiting, painful
urination (dysuria), & increased urination frequency (Fulop, 2016). This disorder could also
explain Mrs. Orndorf’s symptoms of dysuria with a burning sensation, her frequent urination, &
back pain.
Vaginitis
Vaginitis is due to an imbalance of healthy bacteria in the vagina which leads to inflammation.
Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of
pathogens (Gor, 2015). The overgrowth of normally present bacteria, infecting bacteria, or
viruses can cause symptoms such as dyspareunia, dryness, vaginal itching or irritation, painful
urination, & abnormal bleeding (Gor, 2015). Factors that alter the vaginal environment include
feminine hygiene products, contraceptives, vaginal medications, antibiotics, sexually transmitted
diseases, sexual intercourse, & stress. This could possibly explain Mrs. Orndorf’s complaint of
dysuria with a burning sensation, however, it leaves to question her back pain & abdominal
pelvic pain.
Sexually Transmitted Infection (STI)
Sexually transmitted infections (STIs) such as chlamydia, genital herpes, & gonorrhea can cause
dysuria & frequent urination similar to that of which Mrs. Orndorf has reported to experience.
Some of these infections can also cause pain in the abdomen & back. Tenderness in the
abdominal pelvic area upon examination can also be a sign & symptom of a STI (American
University, 2016). Although Mrs. Orndorf is married, the possibility of sexually transmitted
infections should still be considered & testing should be done.
•According to the first item in your differential, what are the risk factors for this disorder?
Acute cystitis is more common in women due to the female anatomy; women have a shorter
urethra which means a shorter distance for bacteria to travel to the bladder & cause infection.
Sexual intercourse & the use of birth control such as spermicides & contraceptive diaphragms
can also cause cystitis as it increases the risk for bacteria entering the urethra & traveling to the
bladder (Brusch, 2016). Other risk factors for cystitis include pregnancy, poor hygiene, bladder
catheter placement or anatomical changes in their urinary tract, as well as people who have
diabetes, multiple sclerosis or a urological disease (National Center for Biotechnology
Information, 2013).
•What are some treatments for this disorder?
This study source was downloaded by 100000902171055 from CourseHero.com on 11-27-2025 22:09:06 GMT -06:00
https://www.coursehero.com/file/52790181/NR-507-Week-4-Case-Study-Discussions-Parts-1docx/
