question archive History of Present Illness  A 32-year-old female presents to his PCP with reports of dysuria for the past week

History of Present Illness  A 32-year-old female presents to his PCP with reports of dysuria for the past week

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History of Present Illness 

A 32-year-old female presents to his PCP with reports of dysuria for the past week. He reports 8/10 burning with a painfully heavy sensation in his bladder, and she is unable to void except small amounts with great frequency throughout the day. She reports a fever of 100.7°F (38.2°C) with chills that started yesterday. She has not tried any over-the-counter medications to relieve his pain or fever. 

Review of Systems 

The patient's ROS is positive for increased frequency of urination with burning pain/pressure. She admits to fever, chills, malaise, and insomnia. ROS is negative for nausea, vomiting, abdominal pain, change or frequency in bowel habits, rectal bleeding, hemorrhoids, constipation, diarrhea, or hepatitis. She denies kidney stones, hernias, lesions, masses, STIs, and exposure to HIV. 

Relevant History 

The client has a history of hypercholesterolemia. She has smoked a pack of cigarettes a day for 10 years. She consumes 3 to 4 alcoholic drinks on the weekends. She denies any recreational or illicit drug use. 

Allergies 

No known drug allergies; no known food allergies. 

 

1. Select the relevant cues from the case study. 

2. Analyze or interpret the cues from #1. 

3. List the interventions for the cues.

4.What assessment techniques should utilized for this client's chief complaint?

5.What additional questions may be required for this assessment?

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