Dysuria Case Study: Patient Diagnosis, Treatment, and Outcomes

This case study focuses on a 35-year-old male patient presenting with dysuria, characterized by pain and urgency during urination. The assignment details the patient's subjective complaints, objective findings from urinalysis (including positive nitrite results and elevated leukocyte count), assessment of a urinary tract infection (UTI) as the likely cause, and a proposed treatment plan involving further laboratory testing (blood culture, complete blood count) and antibiotic therapy. The study emphasizes the significance of urinalysis in diagnosing dysuria, differentiating between bladder and kidney problems, and guiding treatment decisions. It also discusses the impact of laboratory findings on the treatment plan, and the need for additional tests like GFR and ACR to assess kidney function if necessary. The document references relevant medical literature to support the analysis.

Running head: DYSURIA
Dysuria
Name of the student:
Name of the University:
Author’s note

1DYSURIA
SOAP note for a patient with dysuria
S (Subjective): A 35 year old male patient came to the acute care unit with complains of pain
during urination. The patients reported about urgency to urinate and getting troubled by pain at
the end of urination.
O (Objective): The review of lab test results revealed a positive urine culture evidenced by high
predictive value of nitrite in the urine sample. The PV value was 80% which indicates a highly
positive test. The number of leukocyte was more than the normal range and this also indicated an
abnormal urinalysis test results.
A (Assessment): Based on the review of urinalysis test results, it can be said that the patient is
suffering from urinary tract infection which had led to dysuria. The patient might have immune-
comprised status or functional abnormalities of the urinary tract thus leading to the diagnosis of
dysuria. This type of urinary tract infection occurs because of bladder muscle contraction and
peristalsis thus causing urine to come in contact with inflamed mucosa (Mehta & Reddivari,
2019).
P (Plan): It is planned to conduct additional laboratory testing such as blood culture and
complete blood count test. It is also planned to implement antibiotic therapy. Patient medication
history and local resistance patterns need to be reviewed before selecting the antibiotics (Michels
& Sands, 2015).

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Meaning of the laboratory diagnostics and its effect on the treatment plan
Urinalysis is a common test given to patients with symptom of dysuria. The significance
of this test is that it helped to rule out whether urinary infection is present or not, which is the
common pathological process behind the disease. High value of nitrite in the urine culture is
indicative of positive result. Positive dipstick test for nitrite can indicate that UTI is present in
patient. In contrast, a negative result may help to rule out UTI and do additional test to find the
cause of the disease (Goonewardene, Pietrzak & Albala, 2019). Thus, the urinalysis test can help
to identify whether infection is present or not and rule out the suspected diagnosis of dysuria.
This finding can help to determine whether antibiotic treatment is appropriate for patient or they
need advanced treatment such as surgery.
Decision making for patient
Based on the symptoms observed in patient, there is a possibility that pain in urine may
be due to bladder problem or due to kidney problem. In case of urinalysis test, presence of
protein and blood in the urine may detect kidney problem. Urinalysis also helped to rule out risk
of UTIs. Presence of nitrites in the urine sample is indication of bacterial injection, whereas
presence of protein in the urine is indication of kidney disease. Kidney problem is assessed by
other additional diagnostics tests too. Thus, urinalysis is a useful diagnostic test to determine
whether the patient has kidney problem or bladder problem. However, to further confirm the risk
of kidney problem, conducting glomerular filtration rate (GFR) test and ACR (albumin to
creatinine) will be necessary. GFR gives an estimate of how well kidney is functioning to filter
out waste, whereas ACR gives details about albumin to creatinine ratio (Srinivasulu, Rao &
Kumar, 2018).

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References:
Goonewardene, S. S., Pietrzak, P., & Albala, D. (2019). Diagnostic Pathway for Dysuria.
In Basic Urological Management (pp. 91-91). Springer, Cham.
Mehta, P., & Reddivari, A. K. R. (2019). Dysuria. In StatPearls [Internet]. StatPearls Publishing.
Michels, T. C., & Sands, J. E. (2015). Dysuria: evaluation and differential diagnosis in
adults. American family physician, 92(9), 778-786.
Srinivasulu, K., Rao, K. V. P., & Kumar, K. P. (2018). Urine Analysis as a Screening Tool in
Early Detection of Renal Abnormalities in Asymptomatic School Children. World
Journal of Nephrology and Urology, 7(1), 17-24.