Program: Midwifery

PBL case Name: Urinary tract infection (UTI)

Module: Foundation of midwifery II

Week: 6

Authors: Midwifery department Members

Author Name Profession Institution

Mengistu Welday (PhD) Public Health Mekelle University
Desalegn Tarekegn midwifery Dilla Univrsity
Ambaye minayehu midwifery Assosa university
Addisu Yeshambel Midwifery Wolayita Sodo university

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 Tutor Guide:

Case: UTI

PBL Objective

 Discuss the anatomy and physiology of genitourinary system(GUS)

 Explain the pathophysiology of UTI
 Discus the techniques of history taking and physical examination of Genitourinary
disorder
 Explain diagnostic mechanisms of UTI
 Discus the pharmacology(PD &PK) of drugs used to treat UTI
 Address confidentiality and concern of the client with UTI problems and pregnancy

Discussion Points

 See the case

Educational Activities

 Group discussion
 Role play
 Clinical simulation
 Video show
 Demonstration (at Clinical skills lab and Basic Sciences lab)

Predication of Students to list the problem, hypothesis and learning issues

Problems

Lower abdominal pain, burning sensation during urination, frequency of urination

Hypothesis

STI, PID, UTI, appendicitis, pregnancy, abortion

Learning Issues

 To be identified after each discussion

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Assessment

Criteria:

Active Participation and communication skill, Comprehension and reasoning skill, cooperation
and team building skill, information gathering skill

Key Readings

 Sue C. DeLaune, Patricia K. Ladner fundamentals of nursing standards & practices 2nd
ed.
 Bate’s guide to physical examination and history taking, 8th edition
 General pathology for Health Sciences: JU, UoG, HU and DU, 2004. Lecture notes
 Medical Parasitology for Medical laboratory technology students, upgraded lecture note
series (Adem M and Chenecke W, 2006).
 Goodman and Gilman’s Manual of pharmacology ad therapeutics 8th edition New York,
MC Graw Hill medical, 2007.
 Williams Obstetrics, 22nd ed, MacGraw Hill
 Danforth’s Obstetrics and Gynecology, 9th ed, Lippincott Williams & Wilkins
 Myles Textbook for Midwives 16th ed, Mosby

Suggestions for tutoring the case

 Try to guide the student’s discussion on history taking, P/E and diagnostic criteria’s of
genitourinary disorders especially UTI and how to maintain client privacy and
confidentiality.

Tutor Support material

1. Bate’s guide to physical examination and history taking, 8th edition
2. Physical diagnosis. Lecture notes for Health Science Students: Gashaw M, etal UoG, 2005
3. Robbin: Basic pathology, 7th edition,
4. General pathology for Health Sciences: JU, UoG, HU and DU, 2004. Lecture notes
5. Medical Parasitology for Medical laboratory technology students, upgraded lecture note series
(Adem M and Chenecke W, 2006).
6. Medical microbiology (Brooks GF, Butel JS, Morse S.A. Jawetz: 21st edition)
7. Monica Cheesbrough, Medical Laboratory Manual for tropical countries Volume I
8. Lippincot: Modern Phrmacology with clinical applications, 4th Edit
9. Bertram G. Katzung, Susan B. Masters, Anthony J. Trevor. Basic and clinical pharmacology
13th edition, New York, MC Graw Hill medical, 2015..

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Case summery

This is a 21 years old woman came at ANC clinic, Bishoftu Hospital with complaints of
lower abdominal pain and burning sensation during urination. She is unmarried and living
with her family and claims to be amenorrhic for the last 3 months. She has been sexually
active and she didn’t use any type of contraceptives. On P/E slightly elevated body
temperature, breast areola was seen, and on speculum examination cervical cyanosis and
Chadwick’s sign were seen. She was emotionally disturbed. On diagnostic investigations
( WBC- 15×103/mm3, Urine analysis: (many WBC, Scanty RBC , many bacteria, HCG
+ve), Imaging studies-(10 weeks of gestation by U/S) ).

Based on the above findings, she has UTI and normal pregnancy

Interventions:

 She was treated with amoxicillin capsule 500mg po TID for 10days
 She was counseled on treatment follow-up and pregnancy

For mini case:

Refer for better management and counseling

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PBL Case

Module name: Foundation of midwifery II(week 6)

Module Code: MidwM-2061

Module ECTS: 20 ECTS

Patient and visit information

Patient Name: Mrs Demekech

Sex: - F

Age: - 21

Site of visit: - ANC clinic at Bishoftu Hospital

Nature of problem: Acute

Presenting problem

Mrs Demekech, Appearied at ANC clinic, said “I am having lower abdominal pain and burning
sensation on urination’’.

Discussion Question # 1

List Demekech’s presenting problems

List your hypothesis and link the presenting problems of the client with your hypothesis? Which
systems might be involved? How?

What aspects of history would you want to obtain that help you test your hypothesis?

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Patient history

A. HPI
This is a 21 years old woman came at ANC clinic, Bishoftu Hospital with complaints of
lower abdominal pain and burring sensation during urination for 1 weeks duration. She is
unmarried and claims to be amenorrhic for the last 3 months. She has been sexually
active and she didn’t use any type of contraceptives.

Past medical history

She has no history of acute/chronic illness of HTN, DM, CHF, renal disease…etc

Past obstetrical gynecological History

 She has no history of abortion, still birth, neonatal loss….

 She saw her 1st menses at the age of 13 yrs. and the cycle is regular and stays for 4-5
days.
B. Social history
 Unmarried and college student
 She is living with her family.
 She is sociable and has friends.

Behavioral history

 No history of smoking
 No history of alcohol use
 History of unprotected sexual Intercourse

Family history

 No history of HTN, DM, etc….

Review of system

HEENT: NAD

LGS: No cervical or axillary lymph node swelling

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Chest: Darkening of the nipple, breast enlargement

GIT: Nausea and vomiting

GUS: Frequency and urgency in urination

MSS: NAD

Discussion Question #2

Summarize the new information you obtained. How does this new information help you to
suggest new hypothesis or re-rank your hypothesis?

What additional information do you want? How does this additional information help you to
refine your hypothesis?

How would you explain to Demekech that you are going to perform investigations that help you
deduct your hypothesis?

Physical examination (P/E)

General appearance: Emotionally disturbed

Vital signs- Temperature 380C, pulse 78bpm, RR-20bpm, B/P-110/70mmHg

HEENT- NAD

Breast: Areola in nipple

Lungs, CVS, Chest- NAD

Abdomen: No previous surgical scar, abdomen moves with respiration

GUS:- No cervical motion tenderness and also no adnexal mass

-On speculum examination revealed that, cervical cyanosis and Chadwick’s sign.

Rectal, extremity and neurological- NAD

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Mental status- She is conscious, oriented to TPP, but she has disturbed emotion.

Ancillary investigations and results

Laboratory test: Hg- 10g/dl, WBC- 15×103/mm3, blood group O+ve

Urine analysis: Many WBC, Scanty RBC , many bacteria, HCG +ve

Imaging studies-10 weeks of gestation by U/S

Other- HIV test- non reactive, Hepatitis-non reactive

Discussion Question #3

Interpret P/E and lab investigations?

Do you want to change the ranking of your hypothesis based on the P/E and lab
investigation? Which findings make you re-rank your hypothesis? And how?

How do you notify the findings to Mrs Demekech? What are the main concerns to you, as a
care provider, while notifying the findings to the client? And how this should be conducted?

How could you treat her pharmaco- therapeutically? And if you used, discuss the PD and PK
of the drug/s?

Follow up

Appointed to follow her ANC, check up

Mini case

What if her pregnancy is unwanted /unplanned?

What if she wants to commit self-suicide?