Brianna Gill NR 602 iHuman Case Study Answer Key | Adult
Female Presenting with Painful Urination, Comprehensive
History, Physical Exam, Diagnostics & Treatment Plan
,
,
, 1. PATIENT BIODATA & REASON FOR ENCOUNTER
Field Value
Patient Name Brianna Gill
Age 28 years
Sex Female
Ethnicity Caucasian
Height 5'2" (157 cm)
Weight 132 lb (60 kg)
BMI 24.1 (Normal range)
Setting Outpatient primary care clinic
Source of Information Patient (reliable historian)
Reason for Encounter Chief complaint of dysuria with associated urinary frequency and suprapubic
pain
2. CASE INTRODUCTION
Brianna Gill is a 28-year-old female presenting to an outpatient primary care clinic with a 2-3 day history
of painful urination, urinary frequency, and suprapubic discomfort. She reports the pain as burning and
sharp, "like glass," occurring with urination and lingering for approximately 5-10 minutes after voiding.
She has no significant past medical history and is not currently taking any prescription medications aside
from oral contraceptives. She is sexually active with a new partner and has a history of one prior UTI
approximately two years ago. The patient is afebrile and denies systemic symptoms, vaginal discharge,
or flank pain .
3. CHIEF COMPLAINT (CC)
"It really hurts when I pee and I feel like I have to go every five minutes."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
Presenting Symptom Analysis
Question Patient Response
How can I help you today? "I've been having a lot of pain when I pee for the last two days."
When did your symptoms start? About 2-3 days ago
Did the symptoms begin suddenly or gradually? Started suddenly, gradually getting worse since then
Female Presenting with Painful Urination, Comprehensive
History, Physical Exam, Diagnostics & Treatment Plan
,
,
, 1. PATIENT BIODATA & REASON FOR ENCOUNTER
Field Value
Patient Name Brianna Gill
Age 28 years
Sex Female
Ethnicity Caucasian
Height 5'2" (157 cm)
Weight 132 lb (60 kg)
BMI 24.1 (Normal range)
Setting Outpatient primary care clinic
Source of Information Patient (reliable historian)
Reason for Encounter Chief complaint of dysuria with associated urinary frequency and suprapubic
pain
2. CASE INTRODUCTION
Brianna Gill is a 28-year-old female presenting to an outpatient primary care clinic with a 2-3 day history
of painful urination, urinary frequency, and suprapubic discomfort. She reports the pain as burning and
sharp, "like glass," occurring with urination and lingering for approximately 5-10 minutes after voiding.
She has no significant past medical history and is not currently taking any prescription medications aside
from oral contraceptives. She is sexually active with a new partner and has a history of one prior UTI
approximately two years ago. The patient is afebrile and denies systemic symptoms, vaginal discharge,
or flank pain .
3. CHIEF COMPLAINT (CC)
"It really hurts when I pee and I feel like I have to go every five minutes."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
Presenting Symptom Analysis
Question Patient Response
How can I help you today? "I've been having a lot of pain when I pee for the last two days."
When did your symptoms start? About 2-3 days ago
Did the symptoms begin suddenly or gradually? Started suddenly, gradually getting worse since then
