Ms. F, 48 years old, has been admitted to the hospital with severe abdominal pain. Earlier that
day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of
her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly
improved and the pain seemed to subside somewhat. Later that night, severe, steady abdominal
pain developed, with vomiting. A friend took her to the hospital, where examination
demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and
leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was
indicated, with immediate surgery.
Discussion Questions
1. Why is the sequence of pain (location and type of pain) significant in the diagnosis of
acute appendicitis? Describe the rational for each type of pain. Does this sequence
confirm the diagnosis?
A generalized abdominal pain is the principle presenting complaint in acute appendicitis.
It initiates in the mid-abdominal region and migrates to the lower right quadrant of the
abdomen after several hours.
2. Using the pathophysiology, describe the reason for:
a. the pain subsiding and then recurring.
The pain starts at the mid-abdominal region and after few hours migrates to the lower
right quadrant of the abdomen.
b. leukocytosis and fever.
When infection is present, there is an increase in white blood cells and fever occurs to
assist in actively fighting off the pathogen.
c. abdominal rigidity.
Abdominal rigidity could indicate the onset of peritonitis – “an inflammation of the
peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports
most of your abdominal organs” (Ansorge, 2019).
Ms. T, age 28 years, has noticed urgency, frequency, and dysuria recently, as well as an unusual
odor to the urine. Urinalysis indicated a heavy concentration of Escherichia coli in the urine,
some pus, and WBCs. Ms. T was prescribed antibiotics, which she took for the first few days.
This seemed to give her relief, but she then stopped taking the medication. Within a few days, the
symptoms returned, but she decided to “just live with it.”
Discussion Questions
1. Explain why women are predisposed to cystitis.
Women are predisposed to cystitis because the female urethra is shorter and lies closer
to the anal and vaginal openings. This position increases the risk of bacterial
contamination of the lower urinary tract.
2. What preventive measures are important in reducing recurrence?
Preventative measures that are important in reducing the recurrence of cystitis include:
“Maintaining personal hygiene and keeping the genital area clear, increasing fluid intake
to increase the frequency of urination and flushing out bacteria from the bladder, [not]
refraining from urinating despite the urge to do so [as to not] ... allow bacteria time to
multiply, [not] exposing the genital area to chemicals such as those present in soap,
bubble bath, and talcum powder, emptying the bladder after sexual intercourse [to] flush
out the bacteria, [wearing] underwear [that is] loose and made of cotton, [avoiding]
some foods such as coffee and spicy foods, and drinking cranberry juice” (Mandal,
2019).
This study source was downloaded by 100000847795904 from CourseHero.com on 06-21-2022 10:50:26 GMT -05:00
https://www.coursehero.com/file/122515978/Week-5-Discussion-Mrs-Fdocx/
day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of
her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly
improved and the pain seemed to subside somewhat. Later that night, severe, steady abdominal
pain developed, with vomiting. A friend took her to the hospital, where examination
demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and
leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was
indicated, with immediate surgery.
Discussion Questions
1. Why is the sequence of pain (location and type of pain) significant in the diagnosis of
acute appendicitis? Describe the rational for each type of pain. Does this sequence
confirm the diagnosis?
A generalized abdominal pain is the principle presenting complaint in acute appendicitis.
It initiates in the mid-abdominal region and migrates to the lower right quadrant of the
abdomen after several hours.
2. Using the pathophysiology, describe the reason for:
a. the pain subsiding and then recurring.
The pain starts at the mid-abdominal region and after few hours migrates to the lower
right quadrant of the abdomen.
b. leukocytosis and fever.
When infection is present, there is an increase in white blood cells and fever occurs to
assist in actively fighting off the pathogen.
c. abdominal rigidity.
Abdominal rigidity could indicate the onset of peritonitis – “an inflammation of the
peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports
most of your abdominal organs” (Ansorge, 2019).
Ms. T, age 28 years, has noticed urgency, frequency, and dysuria recently, as well as an unusual
odor to the urine. Urinalysis indicated a heavy concentration of Escherichia coli in the urine,
some pus, and WBCs. Ms. T was prescribed antibiotics, which she took for the first few days.
This seemed to give her relief, but she then stopped taking the medication. Within a few days, the
symptoms returned, but she decided to “just live with it.”
Discussion Questions
1. Explain why women are predisposed to cystitis.
Women are predisposed to cystitis because the female urethra is shorter and lies closer
to the anal and vaginal openings. This position increases the risk of bacterial
contamination of the lower urinary tract.
2. What preventive measures are important in reducing recurrence?
Preventative measures that are important in reducing the recurrence of cystitis include:
“Maintaining personal hygiene and keeping the genital area clear, increasing fluid intake
to increase the frequency of urination and flushing out bacteria from the bladder, [not]
refraining from urinating despite the urge to do so [as to not] ... allow bacteria time to
multiply, [not] exposing the genital area to chemicals such as those present in soap,
bubble bath, and talcum powder, emptying the bladder after sexual intercourse [to] flush
out the bacteria, [wearing] underwear [that is] loose and made of cotton, [avoiding]
some foods such as coffee and spicy foods, and drinking cranberry juice” (Mandal,
2019).
This study source was downloaded by 100000847795904 from CourseHero.com on 06-21-2022 10:50:26 GMT -05:00
https://www.coursehero.com/file/122515978/Week-5-Discussion-Mrs-Fdocx/
