Reasons for this patient?s pain could be recurrent UTIs,ÿkidneyÿstones, pyelonephritis, or cystitis.ÿHer complaint of flank pain can be a sign of kidney stonesÿor other issues with organs in that region. Flank pain with chills, blood noted in urine,ÿfeeling of frequent urination, an urgency to urinate, or fever can be signs of renalÿcomplications.ÿLaboratory workupÿor testsÿfor this patient would be CBC, CMP, H&H,ÿrenal ultrasound, blood cultures, and possibly CT scans and or MRI.ÿFeasibleÿcauses ofÿrecurrent UTIs include reactions to medications, irritating soaps/hygiene products,ÿand frequent sexual intercourse thatÿisÿintroducingÿbacteria.Prerenal acute renal failureÿis due to inadequate renal perfusion. This can be caused by sepsis, diarrheal illness, cardiovascular disease, decompensated liver disease,ÿor inadequate fluid intake.ÿ(Malkina, 2020).Intrarenal acute renalÿfailureÿis due toÿintrinsic kidney disease or damageÿcaused by acute tubular necrosis, acuteÿglomerulonephritis, and nephrotoxins.ÿ(Malkina, 2020).Postrenal acute renal failureÿis due to various types of obstruction in the voiding and collecting parts of the urinary system.ÿ(Malkina, 2020).ÿObstruction ultrafiltrate increases pressure in the urinary space of the glomerulus, reducing GFR. Obstruction affects renal blood flowÿincreasing the flow and pressure in the glomerular capillary by reducing afferent arteriolar resistance.ÿAn exampleÿisÿwhen there is an enlarged prostateÿcausingÿan obstructionÿreducing or eliminating the bladderÿto have anÿoutletÿto release urine. This can be a sudden onset and is common.As noted in announcements thisÿweek’sÿdiscussionÿwill also includeÿPDSA model schemataÿfor case studies. For the PDSA for these cases, I would plan accordingly.Plan: Collect more information like labs, history, physical, studies, and a list of current medications.Do:ÿ Use results to form a diagnosis and form a plan of care and patient education. This includes treatment with medications.Study:ÿÿSee if treatment, plan of care, and education were able to work to treat the patient adequately.Act: If treatment was unsuccessful then reformulateÿwith the second plan of care.ÿ Reevaluate the first diagnosis and other possible new diagnoses. Retreat withÿalternativeÿmedications, plan of care, and patient education. If treatment was successful evaluate treatmentÿpositivesÿwith specificsÿas future resources.

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