A 20-year-old male presents with hematuria and has a history of ulcerative colitis
Assignment Details: In our case study, a 20-year-old male presents with hematuria and has a history of ulcerative colitis. Dunphy et al. (2023) mentioned that hematuria is defined as blood in urine which could be visible (gross) or occult (microscopic). Many diseases or disorders can cause hematuria; thus, there could be many differential diagnoses for our patient with hematuria and ulcerative colitis. Dunphy et al. (2023) mentioned the causes of hematuria as infection, calculus, trauma, benign prostate hypertrophy (BPH), renal cell carcinoma, tumor, intense exercise, certain medications, some foods, and coagulopathies. The following are differential diagnoses for the patient in our case study:
Urinary tract infection (UTI) – UTIs can cause hematuria. A point-of-care dipstick can be performed to check for urine infection. The treatment for UTIs usually involves antibiotics.
Kidney stones – these are crystalline mineral deposits that form in the kidney (DynaMed, n.d.). Kidney stones can result in hematuria, diagnosis can be confirmed with advanced imaging such as CT scan. Treatment for kidney stones is based on the location of the stone, size, and severity of symptoms. Hydration and non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain control, surgical removal or destruction of stones may be indicated in some cases (DynaMed, n.d.). Patient education about dietary changes is important to prevent the recurrence of kidney stones. A urology referral may be needed.
Hemorrhagic cystitis – in our case study patient may be using some medications that can cause hematuria, or ulcerative colitis can be a reason for the hematuria. Treatment would be to stop the use of the medications and treat underlying conditions. Referral to a urologist will be made by the APRN.
Malignancy or tumor – tumors in the bladder or ureters can cause hematuria. Treatment for these tumors would be based on the type and severity of the tumor. Chemotherapy, radiation, or surgery may be required to treat tumors. APRN would be referring the patient to oncology.
Health promotion – hydration should be emphasized for this patient to prevent UTIs and kidney stones in the future. The patient will be encouraged to quit smoking (if he is a smoker) or to never start smoking refraining. If the patient is found to have kidney stones, dietary changes will be discussed with him to prevent recurrent stone formation. Regular follow-up with his primary physician and gastroenterologist to monitor and control ulcerative colitis will be encouraged. Colorectal cancer screening will be discussed with the patient due to his higher risk. Olen et al. (2020) discussed that ulcerative colitis is a risk factor for colorectal cancer. The patient will be educated about routine immunizations and will be encouraged to get the vaccines for preventable diseases.
Ulcerative colitis is a chronic inflammatory bowel disease that involves the mucosa of the rectum and can extend up to the colon and cecum (DynaMed, n.d.). In our case study, the patient has a history of ulcerative colitis. Evaluation of his treatment requires a thorough history and the symptoms he is currently experiencing, whether he has abdominal pain, diarrhea, or rectal bleeding. Is he on any medications, and if he is, does he take the medications as prescribed? Feuerstein et al. (2014) mentioned that the goals of care for the treatment of ulcerative colitis are to induce and maintain remission, reduce the risk of complications, and improve quality of life.
References:
Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2022). Primary care: The Art and Science of Advanced Practice Nursing – an Interprofessional Approach. F. A. Davis Company.
DynaMed. (n.d.). https://www.dynamed.com/condition/nephrolithiasis-in-adults-24
Feuerstein, J. D., M.D., & Cheifetz, A. S., M.D. (2014). Ulcerative Colitis: Epidemiology, Diagnosis, and Management. Mayo Clinic Proceedings, 89(11), 1553-1563. http://americansentinel.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/ulcerative-colitis-epidemiology-diagnosis/docview/1622368416/se-2
Olén, O., Erichsen, R., Sachs, M. C., Pedersen, L., Halfvarson, J., Askling, J., Ekbom, A., Henrik Toft Sørensen, & Ludvigsson, J. F. (2020). Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. The Lancet, 395(10218), 123-131. https://doi.org/10.1016/S0140-6736(19)32545-0
Paper Format: APA
Answer preview to A 20-year-old male presents with hematuria and has a history of ulcerative colitis
APA
377 words
