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do you have an outline yet?
here's what i think is essential in each sectoin
last menstrual cycle
associated symptoms, dysuria, fever? flank pain? nausea or vomiting?
abdominal pain? vaginal bleeding or discharge?
vital signs, note any abnormal
blood in urine?
general appearance (well appearing?
flank pain with palpation?
urinalysis or dipstick
send urine for culture
if young and healthy would only get pregnancy test
if febrile or with flank or back pain might also get CBC though these are rarely helpful
if only urine infection and not pregnant and no flank pain then dx is UTI or Cystitis if blood
treatment would be with cipro or septra
follow up if worse
could also give pyridium as a urinary tract anesthetic (this is part of plan)
if flank pain consider dx of pyelonephritis and levaquin might be beter choice
if simple utie, fluids and meds and home, follow up if worse, fever, back pain, vomiting
please let me know if you have questions about my answer.
if pyelo, levaquin, nausea medicine like phenergan, tyelenol, fluids, home and recheck next day
How soon would you have pt follow up if prescribed septra?
if for simple urinary tract infection and the patient improves and feels well there is no in person follow up needed though a phone call in a day or two would be nice.
if for kidney infection (pyelonephritis), septra is not the right drug, levaquin would be better, and follow up next day. often pyelonephritis patients are admitted to the hospital so this would be a good idea to follow up next day.
One last question. how much fluid would be recommended for intake?
good question. a simple way to recommend proper hydration is to tell the patient to drink enough water to make their urine a light yellow color. caffeinated drinks will make hydration harder as they cause diuresis, so water is best for hydration.