Christine Smith is a 33 year old female that presents today with CC “Fever & Flank Pain.” She reports that her pain started out 2 days ago was mild and increased to an 8 out of 10 today, constant
with no relief. She reports fever as high as 101F that is helped some with Acetaminophen, with chills and the onset of nausea with vomiting 3-4 times past two days with decreased appetite. She
reports that eating or drinking causes worsening of nausea. She reports history of frequent bladder infections, the last being 2 months ago. She reports Orthotri Cyclen 28 (oral contraceptive) as
her only medication at present. She denies any history of STDs, PID, or multiple sexual partners.

PROBLEM STATEMENT
Christine Smith is a 33-year-old-female that presents with fever (101F), chills, flank pain, nausea and vomiting by 2 days. Exam reveals tachycardia (112) and positive right CVA (costovertebral
angle) tenderness. Genitourinary exam is negative for vaginal discharge, cervical friability, cervical motion tenderness, and adnexal tenderness or enlargement. History of frequent cystitis.

TEST RESULTS
Abnormal comprehensive metabolic panel- CO2 32

White blood cells (WBCs) 13500

Platelets (thrombocytes) 500

Urine culture Positive for greater than 100,000 gram-negative rods
PLAN OF CARE FOR PYLONENEPHRITIS