Dysuria: 

- Onset of symptoms this morning with complaint of pain with urination

- Used the restroom during the night which is atypical
- Had episode of enuresis today which is atypical
- Endorses suprapubic abdominal pain
- Denies fever, hematuria
- Denies history of urinary tract infection
- Denies history of urine tract abnormalities in self or family
- Reports adequate fluid intake
- Otherwise healthy
- Denies concerns for constipation, last bowel movement yesterday, denies pain or straining
with bowel movements 

Dysuria, pelvic pain: 

- Onset of symptoms 8 days ago; diagnosed with UTI at Nora Urgent Care; prescribed
Macrobid, completed as prescribed yesterday
- Slight relief of symptoms with initiation of antibiotic but then returned
- Endorses urinary urgency and frequency
- Endorses feeling of heaviness in pelvis
- Holding urine often at work due to busy schedule
- Attempting cranberry juice without symptomatic relief
- Denies fever, abdominal pain
- Denies hematuria
- Denies new vaginal discharge
- LMP 9/24; no new sexual partner, denies history of STI
- Normal food and fluid intake, healthy clean diet, drinking over 1 gallon of water daily 
 
 
Urinary tract infection in pediatric patient
- GU exam unremarkable
- Recent CT scan results reviewed
- UA unremarkable for acute infection; urine culture ordered due to persistent symptoms
- UPT negative 
- SURESWAB, VAGINOSIS/VAGINITIS PLUS collected
- Dietary modification education materials for relief of interstitial cystitis provided
- Recommend adequate fluid hydration, trial OTC Azo (discussed appropriate administration
and precautions)
- Recommend avoid constipation
- Return precautions discussed

- Symptoms and UA consistent with acute infection; afebrile, no CVA tenderness, no history of
prior infection, otherwise healthy  
- Start Keflex 500mg BID x7 days
- Urine culture ordered, await results
- No indication for imaging at this time but may consider if recurrent infections
- Encourage fluid intake, over the counter medication as needed for symptomatic relief
- Education provided regarding hygiene measures
- Recommend monitoring bowel movements to ensure no constipation, consider Miralax as
needed
- Signs and symptoms warranting immediate evaluation by physician reviewed; parent
understands and is agreeable to plan of care