| Course | NUR-7072 Adult Primary Care Part II |
|---|---|
| Module | Module 6 |
| Paper type | Case paper: genitourinary care |
| Length | About 1,023 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7072 Module 6
Burning and Frequency, No Discharge: Diagnosing and Treating Cystitis From the History
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7072: Adult Primary Care Part II
Mentor Name
Month Day, Year
Burning and Frequency, No Discharge: Diagnosing and Treating Cystitis From the History
The Patient
Sarah Kim, an invented 29-year-old graphic designer, has had burning with urination, frequency and urgency for two days, with mild suprapubic discomfort. Fever, chills, flank pain, nausea and vomiting are all absent, as are vaginal discharge and itching. Her period ended two weeks ago; a urine pregnancy test came back negative. She has one male partner and uses oral contraception. She had one similar infection three years ago. She has no diabetes, kidney disease or recent antibiotic use. Her temperature was 98.6 F, and she had mild suprapubic tenderness without costovertebral angle tenderness.
How Much the History Tells Us
Bent et al. (2002) reviewed studies of how well symptoms and signs predict urinary tract infection in women. Among those reporting any urinary symptom, the chance of a urinary tract infection was roughly one in two. Dysuria, frequency, hematuria and back pain each raised the probability, while vaginal discharge or irritation lowered it. When dysuria and frequency occurred together, with no vaginal discharge or irritation, the probability of infection rose above 90 percent, high enough that the authors suggested treatment without further testing in many cases. Dipstick results added information when symptoms were less typical but could not rule out infection when the history was strongly suggestive.
Excluding Complicated Infection
Uncomplicated cystitis is defined by the absence of factors that change management: pregnancy, fever or flank pain suggesting pyelonephritis, structural or functional urinary abnormalities, immune suppression, recent instrumentation or male sex. Ms. Kim has none. Because sexually transmitted infections can cause similar symptoms, I asked about new partners and discharge; with neither present, testing for chlamydia and gonorrhea was offered but not considered urgent. A urine dipstick showed leukocyte esterase and nitrites, consistent with infection. A culture is not needed for a typical first or occasional episode but would be sent if symptoms persist or recur.
First-Line Treatment
Gupta et al. (2011), on behalf of an American and a European infectious diseases society, recommend first-line options chosen to balance effectiveness against collateral damage, the promotion of resistance in the patient's own bacteria. First line is nitrofurantoin monohydrate-macrocrystals, 100 mg taken two times a day over five days. A three-day course of trimethoprim-sulfamethoxazole is suitable when fewer than 20 percent of local strains resist it and the patient has not used it in the past three months. Fosfomycin 3 g as a single dose is an option with somewhat lower effectiveness. Fluoroquinolones are effective but should be reserved for other infections because of resistance and adverse effects, and beta-lactams are generally less effective.
Evidence From a Head-to-Head Trial
Huttner et al. (2018) randomly assigned 513 women with uncomplicated lower urinary tract infection to five days of nitrofurantoin or a single dose of fosfomycin. At 28 days after therapy, clinical resolution occurred in 70 percent of women given nitrofurantoin and 58 percent of those given fosfomycin, and microbiologic resolution in 74 and 63 percent. Adverse events were few and mild in both groups. The trial supports nitrofurantoin as the preferred first choice when a single-dose regimen is not essential.
| Source | Key point | Application to Ms. Kim |
|---|---|---|
| Bent et al. (2002) | Dysuria and frequency without discharge make infection over 90 percent likely | Diagnosis from history and dipstick |
| Gupta et al. (2011) | Nitrofurantoin for five days is first line; reserve fluoroquinolones | Nitrofurantoin chosen |
| Huttner et al. (2018) | Nitrofurantoin cured more women than single-dose fosfomycin | Five days preferred over one dose |
Plan
She was given nitrofurantoin monohydrate-macrocrystals, one 100 mg capsule every 12 hours across five days. I explained that the "strong" antibiotic she had heard about, a fluoroquinolone, is kept for infections that need it, given risks such as tendon injury and the resistance overuse breeds. Phenazopyridine for one or two days was offered for burning, after explaining that it colors urine a bright orange. Her local antibiogram showed trimethoprim-sulfamethoxazole resistance above 20 percent, another reason to prefer nitrofurantoin.
Return Precautions
She was told to return or call if she develops fever, chills, flank pain, nausea or vomiting, which could mean the infection has reached the kidneys, or if she is not better two to three days into treatment, in which case a culture will be sent and treatment adjusted.
When a Culture Helps
A urine culture is not needed for a typical first episode in a healthy, nonpregnant woman, but it is the right step when symptoms persist after treatment, recur within a month, suggest pyelonephritis or occur in pregnancy. Culture results then guide a change in antibiotic.
Bacteria Without Symptoms
Bacteria found in the urine of a woman with no symptoms usually should not be treated, except in pregnancy or before certain urologic procedures. Treating them adds side effects and resistance without benefit, a point worth remembering when a routine urinalysis returns positive.
Sexual Health
Because chlamydia and gonorrhea can cause painful urination, especially with a new partner, a brief sexual history belongs in every urinary visit. Ms. Kim has had one partner for two years and no discharge, so testing was offered as routine screening for her age rather than as part of this diagnosis, and she accepted.
Prevention and Recurrence
Recurrent infection is usually defined as two episodes in six months or three in a year. With one infection in three years, she does not meet that definition. We discussed staying well hydrated, which has trial support for reducing recurrences in women who drink little fluid. If infections become frequent, options include postcoital or continuous prophylaxis and further evaluation.
Limits
Many studies in Bent and colleagues' review were older and conducted in settings with different patient populations. Resistance patterns vary by region and change over time. The patient is invented.
Conclusion
Bent and colleagues showed that dysuria and frequency without vaginal symptoms make infection highly likely, Gupta and colleagues placed nitrofurantoin first among treatments that limit resistance and Huttner and colleagues showed that five days of nitrofurantoin cured more women than a single dose of fosfomycin. A history-based diagnosis, exclusion of complicating features, nitrofurantoin and clear return precautions give Ms. Kim effective treatment while protecting the antibiotics others will need.
References
Bent, S., Nallamothu, B. K., Simel, D. L., Fihn, S. D., & Saint, S. (2002). Does this woman have an acute uncomplicated urinary tract infection? JAMA, 287(20), 2701-2710. https://doi.org/10.1001/jama.287.20.2701
Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Moran, G. J., Nicolle, L. E., Raz, R., Schaeffer, A. J., & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103-e120. https://doi.org/10.1093/cid/ciq257
Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., Kosiek, K., Martinez de Tejada, B., Roux, X., Shiber, S., Theuretzbacher, U., von Dach, E., Yahav, D., Leibovici, L., Godycki-Cwirko, M., Mouton, J. W., & Harbarth, S. (2018). Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: A randomized clinical trial. JAMA, 319(17), 1781-1789. https://doi.org/10.1001/jama.2018.3627
What the NUR 7072 Module 6 instructions ask for
Genitourinary care is one of the systems TESU's catalog description of NUR-7072 includes, and because enrolled students alone see the syllabus, this sixth paper is modeled as a urinary tract infection case. Present a woman with urinary symptoms, explain how the history alone changes the probability of infection and document the features that rule out complicated infection, pyelonephritis, pregnancy and sexually transmitted infection. Decide whether a culture is needed, choose a first-line antibiotic using guideline and trial evidence, consider local resistance and explain what was not prescribed and why. Give return precautions and address recurrence. Some sections ask for a male urinary or prostate case instead. Ask whether your local antibiogram should be cited.
How the NUR 7072 Module 6 example is put together
Sarah Kim, an invented 29-year-old graphic designer, has two days of burning urination and frequency without vaginal symptoms and asks for a culture and "the strong antibiotic." Bent and colleagues' review shows her history makes infection more than 90 percent likely, and complicating features, pregnancy and sexually transmitted infection are addressed. The review, the IDSA guideline and the nitrofurantoin trial are linked in a table. Five days of nitrofurantoin are chosen over a fluoroquinolone and single-dose fosfomycin. Return precautions, prevention and recurrence definitions, limits and a conclusion follow. Sections on when a culture helps and why bacteria without symptoms are left untreated come before prevention. A short section on sexual health explains why screening was offered.
Reading the NUR 7072 Module 6 grading rubric
Urinary tract infection papers earn credit when the diagnosis uses the predictive value of specific symptoms and when complicating features, pregnancy, pyelonephritis and sexually transmitted infection are explicitly considered. Readers look for a first-line antibiotic with correct dose and duration, local resistance taken into account and a clear explanation of why fluoroquinolones are reserved. Knowing when a culture is and is not needed shows efficient practice. Return precautions for kidney infection and an accurate definition of recurrent infection show safe, complete management that also protects antibiotics for future patients. Knowing when not to treat bacteriuria without symptoms shows sound stewardship. Offering routine screening for sexually transmitted infection shows attention to the whole patient.
NUR 7072 Module 6 help: mistakes that cost marks
Urinary tract infection papers often order cultures and fluoroquinolones by habit. Use the history to estimate how likely infection is, rule out complicating features and decide whether a culture adds anything. Choose a first-line drug with the right dose and duration, check local resistance and explain what you did not prescribe. Give clear return precautions for fever and flank pain and define recurrence accurately. Email the prompt plus the patient's story and receive a free first draft to revise. Note when a urine culture would change the plan. Include a brief sexual history and say whether screening for sexually transmitted infection was offered.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7072 Module 6 questions, answered
Where can I find a free NUR 7072 Module 6 sample paper?
The uncomplicated cystitis case paper, from history-based diagnosis to nitrofurantoin, is published here.
How accurate is the history for diagnosing UTI in women?
According to Bent and colleagues, burning plus frequency, without discharge, makes infection more than 90 percent likely.
What is first-line treatment for uncomplicated cystitis?
The IDSA guideline lists nitrofurantoin for five days first, with trimethoprim-sulfamethoxazole where resistance is low and single-dose fosfomycin as options.
Is nitrofurantoin better than fosfomycin?
Yes; in Huttner and colleagues' trial, more women were cured with the five-day course than with one fosfomycin dose.
Why avoid fluoroquinolones for simple cystitis?
Because of resistance and harms such as tendon rupture, they are kept for infections that truly need them.