ÐÏà¡±á>þÿ =@þÿÿÿ<ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á€ ð¿˜bjbj´V´V .Ö<Ö<˜ÿÿÿÿÿÿ·‚‚ÅÅÅÅÅÿÿÿÿÙÙÙÙíÙy!¬ äääø ú ú ú ú ú ú $%#¢Ç%j!ÅËääËË!ÅÅ Û3!ËšÅ Å ø Ëø VÈ@Œ ÿÿÿÿÃ±ûËÙe" ä I!0y! x1&‡@1&Œ 1&ÅŒ XähLJ–<Òùäää!!Ç@äääy!ËËËËÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ1&äääääääää‚ ‹: Jill Collins jccgcollins@yahoo.com April 14, 2011 WASHBURN UNIVERSITY SCHOOL OF NURSING NU 513 Advanced Pharmacology: Pediatrics On-line Case Study #2 (10 points) Shannon is a 10 year old girl presenting to the clinic with a 7 day history of burning on urination. Yesterday her urine appeared bloody and she told her mother about her symptoms. Her mother states she has never had this problem before and she is concerned that this is her daughter’s first menstrual cycle. Associated signs and symptoms include lower pelvic pain, frequency and urgency. The patient is on valproic acid suspension for juvenile myoclonic epilepsy diagnosed when she was 7 years old. Her dose is 7.5 ml tid (250mg/5ml). Her last blood work for therapeutic level was one month ago and was within normal limits. She has no known allergies to medications. Her physical exam reveals a well developed, well nourished female in Tanner Stage 2. Her physical exam is unremarkable. The patient lives with her nuclear family of mother, father and two twin younger brothers aged 6. 1. List your three differential diagnoses. What is your priority diagnosis? Provide rationale. (3 points) My top 3 differential diagnoses for this patient would be: Urinary tract infection Renal calculi Beginning of menses My priority diagnosis would be a urinary tract infection due to the symptoms she is presenting with. The burning with urination, pelvic pain, frequency and urgency are all classic symptoms of a UTI. Depending on the severity of the infection, blood could also be present in the urine. Renal calculi generally present with more acute onset and intense pain in the flank and lower abdomen. UTIs would be more common at this age than renal calculi and UTIs are more prevalent in females. You would expect the pelvic pain and blood with the beginning of menses but not necessarily the urgency, frequency and dysuria. (Porth & Matfin, 2009) 2. What diagnostics would you order to support your priority diagnosis? Provide rationale. (3 points) The diagnostic studies I would order would be: Urinalysis-to test for bacteria Urine culture and sensitivity-to treat the appropriate organism if the UA indicates an infection Possibly a KUB if the urinalysis came back negative-less radiation than a CT and will still show stones. 3. What pharmacological treatment would you recommend for this patient? (4 points) Pyridium 4mg/kg TID for 2 days Since Ecoli is the most common cause of UTIs in children, I would start her on Ceftin 30 mg/kg/day divided into 2 doses for 10 days. (Ahmed & Swedlund, 1998) References Ahmed, S. M., & Swedlund, S. K. (1998, April 1). Retrieved April 14, 2011, from American Family Physician: http://www.aafp.org/afp/980401ap/ahmed2.html Epocrates under "Ceftin" and "Pyridium" Porth, C., & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States. 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