Urinary Tract Infection in infant

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍urinary symptomsfever

Symptoms include:

‍fever, up to ‍°, over ‍ ‍hoursdays

‍irritability

‍foul-smelling urine

‍hematuria

‍cloudy urine

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍flank pain

‍urinary frequency

‍urinary urgency

‍dysuria

‍enuresis

‍poor feeding

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍nausea

‍lethargy

‍decreased activity

‍decreased fluid intake

‍decreased urine output



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



recent sexual activity

poor hygiene

use of spermicides or unlubricated condoms

use of scented soaps or bubble baths

urinary retention

urinary catheterization

urinary tract abnormalities

No history of: ‍UTI, ‍urinary tract abnormalities, ‍neurogenic bladder, ‍constipation, ‍kidney stones, ‍immunodeficiency

No use of: ‍antibiotics





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genitourinary: external genitalia ‍normal, testes ‍descended, penis ‍normal, Tanner stage ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍





PLAN:

Investigations:

- Urinalysis

- Urine culture

- Blood work: ‍CBC, ‍CRP

- Renal ultrasound

- Voiding cystourethrogram

- DMSA scan

Treatments:

- ‍Antibiotics

- ‍Acetaminophen

- ‍Ibuprofen

- Encourage fluids

- Avoid constipation

- Avoid bubble baths

- Avoid scented soaps

- Avoid holding urine

Further care:

- Referral to pediatrician

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop