8: Pyelonephritis

PATIENT PRESENTATION

Chief Complaint

“I have severe back pain and it hurts when I urinate.”

History of Present Illness

KJ is a 58-year-old female who presents to the emergency department (ED) with complaints of fever, chills, dysuria, urgency, and back pain. Upon physical exam CVA tenderness is noted; no other significant physical findings. She has a fever of 101.2°F; however, she is hemodynamically stable in the ED.

Past Medical History

Hypertension × 10 years, congestive heart failure, hyperlipidemia, type 2 diabetes mellitus

Surgical History

None

Social History

Married, lives at home with husband and has 2 adult children who do not live at home

Allergies

Penicillins (reported a rash as a child)

Home Medications

Lisinopril 40 mg PO daily

Carvedilol 6.25 mg PO BID

Furosemide 20 mg PO daily

Atorvastatin 40 mg PO daily

Metformin 500 mg PO BID

Physical Examination

Vital Signs

Temp 101.2°F, P 89, RR 18 breaths per minute, BP 139/73 mm Hg, Ht 5′4″, Wt 78 kg

General

Mild distress, nontoxic appearing

HEENT

Atraumatic, pupils equal round and reactive to light and accommodation, moist mucosa, normal pharynx, normal tonsils and adenoids, normal tongue

Pulmonary

Normal chest wall expansion; no rales, no rhonchi, no wheezing

Cardiovascular

Regular rate and rhythm, no murmurs, no gallops, normal S1 and S2

Abdomen

Soft, non-tender, non-distended, normal bowel sounds in all quadrants, no hepatosplenomegaly

Genitourinary

No incontinence, complains of dysuria

Neurology

No headache, focal numbness or weakness, dizziness, or seizures

Musculoskeletal

CVA tenderness noted, normal ROM in upper and lower extremities, no swelling, no joint erythema; Integumentary: warm, dry, pink, with no rash, purpura, or petechia

Laboratory Findings

QUESTIONS

1....