Pyelonephritis

HISTORY:

‍FeverFlank painDysuria for ‍ ‍hoursdays

‍fever, up to ‍°, over ‍ ‍hoursdays

‍flank pain

‍dysuria

‍frequency

‍urgency

‍hematuria

‍cloudy urine

‍fatigue

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍chills

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Thoracic

Lumbar spine: ‍no tenderness on ‍, range of motion ‍fulllimited



ASSESSMENT:

‍Pyelonephritis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍CRP, ‍blood culture

- Urinalysis

- Urine culture

- Abdominal ultrasound

- CT scan of abdomen

- CT pyeloscan

- ‍Antibiotics

- ‍Analgesics

- Increase fluid intake

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, vomiting, or increased pain

- Go to ER if severe abdominal pain, severe vomiting, or high fever