Case
Stacey, a 32-year-old G1P1 new mom, is self-referred for management of urinary incontinence which started 3 months ago following a vaginal birth, with prolonged second stage and forceps. Stacey reports “painful urination and a burning sensation when she urinates” for the past 4 days. Her HPI is also significant for polydipsia and polyuria. Stacey is breastfeeding and says she drinks “a lot” of water during the day. This morning she feels nauseous and thought she might have had a fever last night but convinced herself that it was a “let-down” (of breastmilk). She also feels some back pain but thought it was from carrying Mia all the time.
Stacey has resumed intercourse on a few occasions, the last time being about 5 days ago and reports it “doesn’t feel like it used to.” Stacey has minimal support. Her daughter Mia is a ‘terrible sleeper’ and Stacey is feeling very overwhelmed about being a new parent. She is also distressed about incontinence and having to use the bathroom frequently while out and is avoiding Mother’s group and socializing consequently.
Being so busy with Mia, her diet consists of ‘mainly toast’ with minimal fruit and vegetable intake.
Questions
Advanced Pharmacology
What if Stacy had taken OTC Phenazopyridine (aka Azo)?
What medication would you prescribe today and why?
What in her history should guide your prescribing today?
Advanced Pathophysiology
What diagnostic tests might be ordered to differentiate what is going on with Stacey? Discuss the significance of a urine dipstick and urinalysis
What would you expect to find on the physical exam and how would you document it?
Describe the course of disease (signs, symptoms, physical exam, lab and diagnostic studies) that you expect if she remains untreated?
The bolded descriptions are significant for what and what do they mean?
