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1.Describe urinary tract infection, causes, symptoms and treatment

• A urinary tract infection encompasses multiple causes of urethral, bladder, or kidney inflammation. This inflammation is typically caused by yeast, bacteria, or chemical irritants.
• Women are 30x as likely as men to have a urinary tract infection. Women’s urethras are shorter than men’s, meaning there is less distance for bacteria to travel and the woman’s urethra is much closer to the anus than that of men, posing the risk of cross-contamination when wiping or during sexual intercourse. In men, the most common causes of urinary tract infections include having anal sex, the partner inserting their penis into another’s anus, and having an uncircumcised penis, as it traps bacteria.
• The most common symptoms associated with a urinary tract infection include urinary frequency, urinary urgency, and difficult or painful urination. Patients may also experience back or suprapubic pain. In patients with kidney infections, they may also experience flank pain, fever, nausea, and vomiting.
• Although around a quarter of uncomplicated urinary tract infections can resolve on their own, antibiotics are the treatment of choice. Antibiotics used to treat urinary tract infections include Bactrim, Trimpex, Macrobid, Cipro, Floxin, Levaquin, Noroxin, and Suprax. Urinary analgesics may also be prescribed to reduce pain, frequency, and urgency. These include Urised, Pyridium, and Urispas (Arcangelo, et al., 2017, pp. 1503-1522).
• Discuss treatment for benign prostatic hyperplasia
  • There are three main drug classes used to treat benign prostatic hyperplasia: A-Adrenergic antagonists, 5-A-reductase inhibitors, and PDE type 5 inhibitors.
  • A-adrenergic antagonists relax the prostate and bladder’s smooth muscle fibers. These drugs include tamsulosin, doxazosin, terazosin, alfuzosin and silodosin.
  • 5-A-reductase inhibitors, like finasteride and dutasteride, reduce the size of the prostate by up to 20-30% by decreasing intracellular DHT, which is the hormone that promotes prostate cell growth.
  • PDE5 inhibitors (tadalafil) is used when A-adrenergic antagonist use is unsuccessful or in men who also have erectile dysfunction. This drug regulates the prostate’s smooth muscle tone.
  • Alternative therapies can also be considered for benign prostatic hyperplasia even though there is no scientific proof to back them. Some men are choosing to take saw palmetto, Pygeum, and zinc to treat their BPH (Virginia Poole Arcangelo, Et Al., 2017, pp. 1543-1563)
• Describe overactive bladder, causes, symptoms and treatment 
  • Overactive bladder is a broad term, it encompasses urinary urgency, nocturia, frequency, and possibly incontinence, not caused by a UTI (Scarneciu et al., 2021).
  • Pinpointing the cause of overactive bladder is not always possible. Many physiologic, anatomic, and comorbidity-related factors can contribute to the development of overactive bladder. In most cases, the cause is idiopathic, while other causes are typically neurogenic or myogenic related.
  • Symptoms typically include urinary frequency, urinary urgency, nocturia, and incontinence. Patients may experience some or all of these symptoms.
• Treatment includes non-pharmacological and pharmacological interventions. Pelvic floor muscle exercises, bladder training, and weight loss are important treatments to aid in the reduction of symptoms. Medications used to treat overactive bladder include anticholinergics/antimuscarinics like oxybutynin or trospium, beta-3-adrenoreceptor agonists like Myrbetriq, OnabotulinumtoxinA better known as botox, serotonin norepinephrine reuptake inhibitors like duloxetine, alpha-adrenergic antagonists like tamsulosin or doxazosin, estradiol vaginal suppositories, estrogen ring, or desmopressin oral or intranasal spray (Virginia Poole Arcangelo, Et Al., 2017, pp. 1587-1626)
• Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea and Syphilis)
  • For chlamydia, the treatment of choice is a one-time 1g dose of PO azithromycin or a 7-day 100mg BID regiment of doxycycline. If the patient is pregnant, they should not be prescribed doxycycline.
  • For gonorrhea, the treatment of choice is a one-time 250mg IM injection of ceftriaxone and either a one-time 1g PO dose of azithromycin or a 7-day 100mg BID regiment of doxycycline.
  • For genital herpes, the initial outbreak should be treated with acyclovir 400mg PO TID, acyclovir 200mg PO 5x daily, or valacyclovir 1g PO BID for 7-10 days. Recurrent treatments should be treated with acyclovir 400mg PO TID for 5 days, acyclovir 800mg BID for 5 days, acyclovir 800mg TID for 2 days, famciclovir 125mg PO BID for 5 days, famciclovir 100mg BID for 1 day, valacyclovir 500mg PO BID for 3 days or Valacyclovir 1g QD for 5 days. Suppressive treatment is also an option with acyclovir 400mg BID, famciclovir 250mg BID, Valacyclovir 500mg QD, or valacyclovir 1g QD.
• For Syphilis, treatment depends on when it is caught. If caught within the first year, regardless of it being primary, secondary, or latent syphilis, the adult dose is a one-time benzathine penicillin G 2.4 million U IM injection, child doses are weight based. For latent disease > one year, the same medication is given to adults, but instead of a one-time dose, they receive three doses one week apart. For children, the dose is weight based, but also done in 3 doses one week apart. If a patient is allergic to penicillin and not pregnant, they can be prescribed 14 days of 100mg PO doxycycline BID or tetracycline 500mg PO BID (Virginia Poole Arcangelo, Et Al., 2017, pp. 1630-1631).

References:

Virginia Poole Arcangelo, & Al, E. (2017). Pharmacotherapeutics for advanced practice : a practical approach (4th ed., pp. 1503-1522). Wolters Kluwer Health, Cop

Scarneciu, I., Lupu, S., Bratu, O., Teodorescu, A., Maxim, L., Brinza, A., Laculiceanu, A., Rotaru, R., Lupu, A.-M., & Scarneciu, C. (2021). Overactive bladder: A review and update. Experimental and Therapeutic Medicine, 22(6). https://doi.org/10.3892/etm.2021.10879

2.Describe urinary tract infection, causes, symptoms, and treatment

Urinary tract infection is a broad term encompassing a range of infectious syndromes, affecting areas from the urethra to the kidneys (Al Lawati et al., 2024). The infection occurs when bacteria colonize the urethra or periurethral space, migrate into the bladder, and trigger an inflammatory response (Al Lawati et al., 2024). The primary causative agents include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. The classic symptoms are dysuria, urinary frequency, urinary urgency, or suprapubic pain without systemic illness such as fever, rigors, or vomiting. It is confirmed with two main laboratory tests, a urinalysis and urine cultures, which show the presence of white blood cells in the urine.

Treatment includes proper hygiene, adequate hydration, and antibiotics. The first-line agent commonly used is nitrofurantoin 100 mg twice daily for five days. If the first-line agents are contraindicated, amoxicillin-clavulanic acid can also be used.

1. Discuss treatment for benign prostatic hyperplasia

Benign prostatic hyperplasia is a diagnosis that refers to the growth of glandular epithelial tissue and smooth muscle in the transitional zone of the prostate (Eitftu et al., 2024). The exact mechanism of BPH remains unclear; age-related changes leading to metabolic disturbances, hormonal changes, and chronic inflammation may play a role.

Some patients may choose conservative treatment methods, such as lifestyle modifications like losing weight, reducing evening fluid intake, and limiting overall fluid intake or the number of substances that irritate the bladder or have diuretic effects, including carbonated beverages like coffee, tea, and cola. Additionally, bladder management techniques should be considered, which include timed voiding every 2-3 hours and performing pelvic floor stretches or relaxation exercises. Pharmacotherapy includes alpha-blockers that relax the smooth muscles in the bladder neck and prostate, reduce constriction of the urinary channel, and lower resistance to urinary flow (Eitftu et al., 2024). These include second-generation terazosin and doxazosin and third-generation tamsulosin, alfuzosin, and silodosin.

1. Describe overactive bladder, causes, symptoms, and treatment 

Overactive bladder is a chronic condition that affects both men and women. It is characterized by a sudden, involuntary contraction of the bladder muscle, leading to an urgent need to urinate, frequent urination, and urge incontinence (Scarneciu et al., 2021). Common causes include neurological disorders, bladder abnormalities, and BPH.

The first line of treatment includes bladder training, which involves urinating at regular intervals, as well as control techniques, like pelvic floor muscle training, which can also be positive. Pharmacologic interventions include antimuscarinic drugs and beta-3 adrenergic agonists, which help relax the bladder muscle.

1. Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea, and Syphilis)

Chlamydia infections can spontaneously clear. However, people with positive test results should always be treated. The treatment for non-pregnant people is doxycycline, 100 mg, twice a day for seven days. Patients can also be treated with a single 1-g dose of azithromycin or an alternative amoxicillin, 500 mg orally three times per day for seven days. Treatment for Gonococcal Infection includes higher doses of ceftriaxone, as azithromycin is no longer a recommended therapy for nonpregnant individuals (Yonke et al., 2022). Syphilis is primarily treated with penicillin G administered intramuscularly. The dosage and duration are based on the stage of the disease.

References

Al Lawati, H., Blair, B. M., & Larnard, J. (2024). Urinary tract infections: Core curriculum 2024. American Journal of Kidney Diseases, 83(1), 90–100. https://doi.org/10.1053/j.ajkd.2023.08.009Links to an external site.

Eiftu S. Haile, MD, Ayodeji E. Sotimehin, MD and Bradley C. Gill, MD, MS

Cleveland Clinic Journal of Medicine March 2024, 91 (3) 163-170; DOI: https://doi.org/10.3949/ccjm.91a.23027

Scarneciu, I., Lupu, S., Bratu, O. G., Teodorescu, A., Maxim, L. S., Brinza, A., Laculiceanu, A. G., Rotaru, R. M., Lupu, A. M., & Scarneciu, C. C. (2021). Overactive bladder: A review and update. Experimental and therapeutic medicine, 22(6), 1444. https://doi.org/10.3892/etm.2021.10879Links to an external site.

Yonke, N., Aragón, M., & Phillips, J. K. (2022). Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment. American family physician, 105(4), 388–396.

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Discuss the process you prefer to use when looking up codes from the imaging section of the ICD-10-PCS book. Do you find coding from the section easier than some of the previous sec

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• Review practice agreements in your state. FLORIDA
• Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
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 Hello, everybody. I am Katte Gabriela Peña Morales. I am the ARMP today for Mr. Aragon, and the condition that he has is my guardian infraction. Okay, I’m going to start the PowerPoint. Let’s see. Okay, so we have Mr. Alexander Aragon. He’s 58 years old, has a diagnosis of MI. social background will be participating in family dinners he often need fast food because he doesn’t have time he’s very close to his family but very limited socialization outside the family because he’s always busy working he smoked for 25 years and has been a non-smoker for the last five years we find him alert and oriented times four he does have fatigue dizziness and some sweating he’s hyper He has chest pain for the last three days. Also has pain in the jaw, radiation to the left arm. The EKG shows an ST elevation. He also complains about nausea. He has not vomit. He has no diarrhea. His lungs are clear. But in the heart auscultation assessment, he had A .R.S.4 atrial gallop. medical, past medical history will be hyperlipidemia, hypertension, obesity, and diabetes type 2. We can see his laps for Mr. Aragon and the education that I am preparing for him. I will tell him, Mr. Aragon, the most important, one of the most important symptoms here is your laps. You have something called torporins are elevated. His TKMB is elevated as well. He has inflammation process going on with his CRP elevated as well. He has risk of having kidney damage because creatine is also elevated with 1.3. He has elevated WBCs and has a great hemoglobin. Has good platelets as well. I will tell him that the way that we diagnose my cardiac infection is when we do the EKG, if there’s an ST elevation, and if the cardiac enzymes, the troponins, a EKMB, are elevated in trends up in the next two hours, he will have to go quickly to the cardiac ad suite. He has a surgical, his cerepandectomy by laterally replacement, and his vital signs are as follows. This is 160 over 95, hypertensive. His heart rate is 102. His respiratory is 24, a little bit altered. His BMI is elevated. He is obese. And his oxygen saturation is 95 arumina. I will explain to Mr. Aragon that how this happened. How do you get a heart attack myocardia infection all of the sudden? So an arteloscleric plaque rupture or trombose forms, and this one will block one of the cardiac arteries. Let me see, you create a block clot and will partially or completely will occlude the blood flow to the heart. A sudden blockage of coronary blood flow leads to ischemia and subsequent necrosis of the myocardia tissue. That’s very painful. That’s why you’re having that chest pain. Mycardia ischemia can happen if we wait too long and he doesn’t get any treatment. We can also tell him that the lack of oxygen may disrupt the ATP production, leading to anaerobic metabolism, lactic acid buildup, and loss of normal electrolyte imbalance. So not only his heart can get damage, also other parts of his body. We also explain, we’ll explain him. If blood flow is not restored quickly, myocardias, cells undergo irreversible necrosis, leading to impair contractility, arrhythmias, heart failure, or cardiogenic shock. It’s very important that we get treatment quickly for this type of patients. The clinical manifestations of this condition is that Aragon is already presenting it. He’s presenting with chest pain that radiates to the arm, the jaw. He didn’t complain of back pain or showness of breath. He did complain of not. He did complain of Nausea. Autonomic nervous system symptoms, patients might experience are faredic, nausea, vomiting, dizziness, and anxiety due to the body’s stress response. Mr. Ragon is already experiencing nausea. Some patients can have hypotension. In this case, my patient is having hypertension. It could be due to the anxiety or just the process that he’s going through with the blockage of his artery. A complication of an MI can be very severe and includes heart failure, aridemia, cardiac shock. It’s very important that his history of diabetes smoking in obesity and his sedentary lifestyle is also a bad factor for having a myocardia infection. All these things get together and that’s how it blows up. Okay. how we diagnose the conditions with an EKG with some blood work he does has a ST elevation EKG when we did it he has elevated troponins elevated cardiac enzymes imaging studies we didn’t do in this case but we can do a CTA to see how bad is the plague is but that calls him score in his body. He’s already presenting with symptoms, so we will go straight to the AKG and labs to see if he qualifies to go to the cardiac heat really quick to prevent any more damage to his heart. Okay, these are my references. I hope everybody enjoy. Bye-bye. 

 Good evening, everyone. My name is Candace Coonrad, and I’m here to present my pathophysiology adventure. My diagnosis was congestive heart failure, and my patient’s name was Mr. Thomas Brown. Good afternoon, Mr. Brown. I wanted to review your recent diagnosis today and answer any questions you may have. You have recently been diagnosed with congestive heart failure. It says here that you’re a retired engineer living at home with your wife. I’m very pleased to see that you have quit smoking and that you and your wife usually enjoy a nice social life. You guys have no drug use and no recent travel. And I see you like to golf, but it doesn’t look like you’ve been doing much golfing lately. You are looking pale, and your vital signs tell me you’ve been struggling lately. I hope that with this diagnosis of interventions, we can get you back on track and able to start enjoying the things that you love to do again. Your lab results, such as your EKG, echo -cardiogram, and B&P reflect your diagnosis. and I also want to stress the importance of taking your cholesterol medication. The good news is that your ejection fraction can improve with treatment and some lifestyle changes. It will be essential to monitor your vital science and blood sugar due to your health history so that it doesn’t exacerbate or worsen your new diagnosis of CHF. Your activity and tolerance and frequent nighttime urination are also linked to your diagnosis of congestive heart failure. I expect these symptoms to improve by improving your baseline condition. How much they improve depends on your compliance with the treatment plan that you and your cardiologist will develop. As you can see, by stopping your cholesterol medication without discussing it with your care providers, your cholesterol is now dangerously high. I don’t want something similar to happen with your CHF condition. And as you can see here, I’ve got your lab results listed for you. We’ll go over those more in detail in just a few minutes. Next, I’d like to discuss the pathophysiology of your condition that led to your congestive heart failure. It occurs differently in patients depending on their medical history. Your previous MI or heart attack, along with your chronic comorbidity such as hypertension, type 2 diabetes, and obesity led to the chronic inflammation that reduced your cardiac output. The decreased cardiac output, or as your heart is pumping blood throughout your body, impaired the ability of your heart to pump this blood, which reduced your ejection fraction. The reduced ability to pump blood can cause structural abnormalities and remodeling or changing of your heart, such as an enlarged atrium, as we saw on your echocardiogram, and inadequate tissue profusion, which is when your body does not have the appropriate amount of blood, pumping to deliver the oxygen to your tissues. And you can experience side effects such as fatigue and shortness of breath like you’ve been complaining about. And here I’ve listed some basic ways that congestive heart failure causes all the symptoms that you’re having. Next, let’s talk about clinical manifestations of the condition of congestive heart failure. These should look familiar to you because you’ve been complaining about several of the symptoms. Left-sided heart failure causes a patient to become short of breath and causes an increase in the rate of breathing due to increased pressure and possible fluid in the lungs. Right-sided heart failure can affect the kidneys, causing the body to retain water and causing swelling in the lower extremities, which we call edema, like you have now. Eventually, patients can experience weight loss and muscle wasting as the disease progresses. In chronic congestive heart failure, a patient can expect the liver and abdomen to become swollen due to fluid backing up in the larger veins. This also causes edema, like we discussed, and an increased heart rate because your body is working harder than usual to perform its basic tasks. Heart failure can impact all of your organ systems. This is why you must take care to monitor your body closely. Finally, I’d like to discuss how we diagnosed your condition. We looked at several factors to diagnose you with heart failure, including your lab results, medical history, and imaging tests. Your blood test showed a higher than normal ENP level, which was 350, which suggests heart stress. Your EKG showed sinus tachycardia and left ventricular hypertrophy, indicating that your heart is working harder than normal. The echocardiogram that we did showed that your heart’s pumping ability or ejection fraction that we discussed earlier is reduced to 32% along with mild to moderate diastolic dysfunction and mitrovalfalph problems. Your medical history of high blood pressure, diabetes, coronary artery disease, and past heart attack put stress on your heart. These findings, along with your symptoms of tiredness, difficulty doing everyday activities like golfing, helped confirm the diagnosis of congestive heart failure. I’m going to refer to a cardiologist for any further testing they feel you might need, such as a cardiac catheterization and a stress test, which we have not done yet. But still, with the above test results, I can state confidently that your diagnosis is correct. But you and your cardiologist will work together and formulate a treatment plan to hopefully mitigate the symptoms of your disease and hopefully prevent it from worsening and get you back living the life that I know you love to live. Thank you. 

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