Pelvic Discomfort in an Elderly Female Patient


Chief Complaint

“I feel weak, and a pressure in my pelvis.”


The case of a 72-year-old female with a past medical history of osteoporosis, osteoarthritis comes to visit for pelvic discomfort and weakness starting one week ago.

She was feeling well and active, but this time she just does not feel well. She had mild bilateral knee pain due to arthrosis for years, controlled with Acetaminophen when needed. She denies fever, burning urination, lower back pain, leg pains, constipation, diarrhea, or vaginal discharge.


Acetaminophen 500 mg PRN.

Alendronate 70 mg PO weekly Calcium and Vitamin D 1200 and 5000 U.


Allergies: The patient does not suffer from any environmental, food, or drugs allergies

Medication Intolerances: KDA

Chronic Illnesses/ Major trauma

Osteoporosis two years ago on Alendronate 70 mg PO weekly Calcium and Vitamin D 1200 and 5000 U

Osteoarthritis on Acetaminophen 500 mg

LMP three weeks ago 42 years ago G3 P3. The patient denies having major traumas.


MAMMOGRAM 2016 Bi Rads 2

PAP SMEAR 2014 Normal

Family History

Father died in an accident at 51. Negative for hypertension, cancer, heart disease, diabetes, tuberculosis, and other medical illnesses.

Mother died in a car accident at 46 Negative for diabetes, cancer, hypertension, heart disease, tuberculosis, other medical illnesses.

Social History

The patient is socially active and retired. She spends her daytime attending meetings, conferences and visiting underserved areas for social help with her husband. She never used tobacco or drugs. She drinks one glass of wine a day or two glasses a week. She is sexually active.



The patient is feeling abnormally with poor energy without strength. She denies weight loss/gain, fever, and night sweats.


No rash, lesions, bruising, bleeding, senile spots over arms and legs.


She uses glasses to improve her vision. The patient denies blurring, visual changes.


The patient had no ear pain, ringing in the ears, etc. There are no reports of ear traumas or hearing loss.


The patient does not have a sore throat or any oral cavity complaints.


The patient denies feeling lumps, bumps, or changes.


She denies having a blood transfusion, extreme sweating, changes in her appetite, lumps, bleeding, or equimosis.


She denies chest pain, edema, orthopnea, palpitations.


The patient denies shortness of breath, cough, congestion, wheezing, hemoptysis, and dyspnea.


Abdominal bloating when eating fatty food or too much. No abdominal pain, diarrhea reflux.

Genitourinary / Gynecological

The patient feels mild discomfort in her pelvic area. She found this one week ago a mild pressure above the pubis.

No history of STDs or vaginal infections.


Bilateral knee pain when walking more than 30 minutes or climbing stairs. She takes Acetaminophen when needed.


She does not experience spontaneous episodes of weakness, memory loss.


Denies depression, sleeping disorder, or suicidal attempts.


Weight: 176lbs.

BMI: 29.3

Temp: 98.2 F tympanic

BP:130/86 right arm, sitting

Height: 5’5”

Pulse: 68 x min

Resp: 14 x min. Oxy Sat 98%

General Appearance

Female. Not in distress cooperative, answers questions willingly and appropriately.


The patient’s skin is warm, clean, with age spots in the arms and legs area. No petechiae ecchymosis or moles were found.


The patient’s head is norm-cephalic, is symmetric, no lesions found. Her hair is distributed in accordance with her sex and age. No tenderness.

The patient’s eyes demonstrate no abnormal signs. Pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. The sclera is clear.

Ears: Symmetric, normal hearing tympanic positive light reflex.

Nose: No visible septum deviation, fine and pink mucosa, no polyps.

Neck: Symmetric, no nodes, no thyromegaly. No gingival edema.


No extra sounds are discovered during the patient’s investigation. The rate and rhythm are regular. Capillary refill – 1.6 seconds. There is no edema.


The patient’s chest wall is symmetric expansion. She demonstrates regular respirations. There are no problems with breathing.


The patient’s abdomen is obese. Soft bowel sound present. No epigastric tenderness to deep palpation No masses. Active in all quadrants.


Symmetric breast no masses no edema or erythema.


External exam: Vulva inspection with no edema, pubic hair scarce, atrophic changes found. Urethral edema and erythema. Speculum found vaginal walls thin and dry, os closed, no masses, no discharge, mild cystocele, and rectocele. Suprapubic tenderness when performing bimanual palpation. A rectal exam demonstrates the absence of pain, masses, or signs of trauma. No bleeding signs were found. The urine sample was taken for an site exam.


Bilateral knee pain to palpation, full range of motion, locomotor apparatus is fine. Muscular strength 5/5 four limbs.


The patient’s speech is clear. She responds to all answers appropriately. Demonstrates an appropriate level of cognitive activity. DTR patellar reflexes are intact 2/2 patellar. Balance is stable.


The patient maintains eye contact. Speech is clear. Understands all questions. No visible signs of mental disorders. The family history also does not contain any records of this sort.

Lab Tests

Dipstick UA: Bacteria ++ Blood ++ WBC ++ Nitrites+ Glucose Neg, Protein +

Urinalysis diagnoses urinal tract infections by looking for evidence of infection. Some of the indicators of infection include the presence of bacteria or white blood cells in urine. Dipstick urinalysis is a simple, fast, and convenient test that can be performed in an office setting in cases of suspected urinary tract infection (UTI) (Simati, Kriegsman, & Safranek, 2013). Dipstick urinalysis is reported to have a sensitivity of between 80% and 90%, as well as a specificity of 50% (Mambatta, Jayalakshmi Jayarajan, Harini, S., Menon, & Kuppusamy, 2015). Components such as nitrates, the enzyme leukocyte esterase, protein, and blood are valuable in diagnosing UTIs. Certain infectious pathogens can reduce dietary nitrates found in urine to nitrite, which is an indication of bacteriuria. However, this test can also be used to narrow down to specific groups of infecting bacteria. Gram-negative bacteria such as Escherichia coli, Proteus spp., and Klebsiella pneumonia are capable of this reaction in addition to the leukocyte esterase reaction (Mambatta et al., 2015). UTI cases are also characterized by small quantities of protein and red blood cells. The presence of proteins is attributed to protein-containing substances, for example, leukocytes, bacteria, and mucus. The patient’s urinalysis results indicate the presence of bacteria and white blood cells, which point towards infection in the urinary tract.

Special Tests

Calcium test: The purpose of this test is to quantify the concentrations of calcium in the blood. Consequently, this test is useful in screening patients for kidney disease. Normal blood calcium concentrations should range from 8.5 to 10.2 mg/dL. Any values that fall below the normal range are indications of kidney failure (Bodro et al., 2015). The patient has a history of osteoporosis, which is associated with low calcium levels. Therefore, a calcium test is necessary to rule out the possibility of kidney failure.

Assessment Findings and Plan

Differential Diagnoses


UTI is an infection of the urinary tract caused by the entry of bacteria into this area. The signs of UTIs include lower abdominal pain, burning sensation when passing urine, and an increased frequency of urination. The patient does not complain of frequent urination, itching, and discomfort when urinating. However, she explains that she experiences an uncomfortable feeling and pressure on her lower abdomen. Additionally, the dipstick urinalysis findings show white blood cells, nitrates, blood, and proteins, which indicate the likelihood of UTI (Strasinger & Di Lorenzo, 2014).

Vulvovaginal Candidiasis

Candidiasis is a fungal ailment brought about by excessive growth of Candida species, particularly Candida albicans, which is a normal flora of the vagina. Excessive growth is often caused by hormonal alterations, ailments such as diabetes and HIV, practices such as douching and taking prescriptions of broad-spectrum antibiotics that can promote the propagation of Candida species (Gandhi, Patel, & Jain, 2015). The common symptoms of Candidiasis include a burning sensation, itching as well as the secretion of a profuse, white curd-like vaginal discharge (Clancy & Ngunyen, 2013). The vaginal area may also have a reddish rash. The patient does not exhibit these symptoms, which rules out the possibility of this diagnosis.

Kidney Infection

Kidney infections may manifest with symptoms of UTIs such as inflammation of the urethra, itching, and lower abdominal pain. However, additional symptoms include fever (with body temperatures higher than 37.7◦C), pain in the flank, queasiness, and vomiting (Kauffman, 2014). The patient reports the symptoms of UTIs but does not complain of any nausea, vomiting, or flank pain, which eliminates the possibility of this diagnosis.


The patient should receive oral sulfamethoxazole-trimethoprim 800 mg-160 mg every 12 hours for 10 to 14 days (Al-Badr & Al-Shaikh, 2013). Ibuprofen 400 mg every 8 hours should be administered to manage the abdominal discomfort.


Follow-up testing may not be necessary if the symptoms resolve the following treatment. However, if symptoms persist, the patient may be asked to provide urine samples for urine culture and sensitivity testing. The purpose of these tests is to identify the causative organism for specific antimicrobial therapy.


The patient was informed that her symptoms should resolve at least 24 hours following the commencement of treatment. She was advised to return to the clinic if her symptoms persisted for more than two or three days afterward. Additional advice included practicing post-coital voiding of the bladder because she admitted to being sexually active. She was encouraged to clean the genital areas before and after intercourse and wipe from front to back to prevent the introduction of bacteria such as E. coli from the perigenital area to the urethra (Al-Badr & Al-Shaikh, 2013). She was asked to stay away from tight undergarments and avoid potential allergens from bubble baths, vaginal creams, deodorant sprays, soaps, and lotions. She was advised to take plenty of fluids and pass urine more often to assist in flushing bacteria from the bladder. Keeping urine for protracted periods facilitates the multiplication of bacteria within the urinary tract, which may lead to cystitis. The patient was asked to avoid vaginal douching because it may inflame the vagina and urethra and promote the entry and establishment of pathogenic bacteria within the urinary tract.


Al-Badr, A., & Al-Shaikh, G. (2013). Recurrent urinary tract infections management in women: A review. Sultan Qaboos University Medical Journal, 13(3), 359-367.

Bodro, M., Sanclemente, G., Lipperheide, I., Allali, M., Marco, F., Bosch, J.,… Moreno, A. (2015). Impact of antibiotic resistance on the development of recurrent and relapsing symptomatic urinary tract infection in kidney recipients. American Journal of Transplantation, 15(4), 1021-1027.

Clancy, C. J. & Ngunyen, M. H. (2013). Finding the “missing 50%” of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clinical Infectious Disease, 56(9), 1284-1292. doi: 10.1093/cid/cit006

Gandhi, T. N., Patel, M. G., & Jain, M. R. (2015). Prospective study of vaginal discharge and prevalence of vulvovaginal candidiasis in a tertiary care hospital. International Journal of Current Research and Review, 7(1), 34-38.

Kauffman, C. A. (2014). Diagnosis and management of fungal urinary tract infection. Infectious Disease Clinics, 28(1), 61-74.

Mambatta, A. K., Jayalakshmi Jayarajan, V. L. R., Harini, S., Menon, S., & Kuppusamy, J. (2015). Reliability of dipstick assay in predicting urinary tract infection. Journal of Family Medicine and Primary Care, 4(2), 265-268.

Simati, B., Kriegsman, W., & Safranek, S. (2013). American Family Physician, 87(10): online. Web.

Strasinger, S. K., & Di Lorenzo, M. S. (2014). Urinalysis and body fluids. Philadelphia, PA: F. A. Davis.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with Online Academic Experts
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
See why 20k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
It was gotten well after time I needed to make needed additions, but it is something that did help me. I could not get the concept of ho to start such a project but now reading this, I was over thinking the project it seems.
Customer 452801, July 19th, 2021
Emergency Management
Overall, I think it's a great service. I have yet to submit the assignment, so I don't know what kind of grade I'll get. But customer service was excellent. Reviews were made and the assignment proofed for satisfaction.
Customer 453015, December 15th, 2021
Paper much better compared to the one prior revision request. References need to be no more than the past 5 years.
Customer 452547, July 20th, 2021
Don't really see any of sources I provided, but elsewise its great, thank you!
Customer 452697, May 8th, 2021
English 101
great summery in terms of the time given. it lacks a bit of clarity but otherwise perfect.
Customer 452747, June 9th, 2021
Criminal Justice
This has been the greatest help while I am recovering from an illness. Thank your team so much.
Customer 452671, May 2nd, 2021
Human Resources Management (HRM)
Always great! My son has been in critical health these last few semesters. Many times I have thought he wasn't going to make it and thought about quitting or postponing school until he was healthier but it always happens to be in the middle of the semester. This service has been a lifesaver for my mindset in helping keep my grades up and keep my son alive at the same time. I don't know if I could have made it through this period without it.
Customer 453077, June 6th, 2022
Human Resources Management (HRM)
On time and as always a great service! This semester has been very time consuming a tough for my family so this service has not only been a life saver but helped me keep up my grades! If you are in a time crunch or need help, don't hesitate! They are worth it!
Customer 453077, April 4th, 2022
Looks great and appreciate the help.
Customer 452675, April 26th, 2021
Social Work and Human Services
Although it took 2 revisions I am satisfied but I did receive it late because of that.
Customer 452603, March 25th, 2021
Thank you so much for your help! :)
Customer 453167, May 11th, 2022
Thank youuuu
Customer 452729, May 30th, 2021
Customer reviews in total
Current satisfaction rate
3 pages
Average paper length
Customers referred by a friend
15% OFF your first order
Use a coupon FIRST15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat
Live ChatWhatsApp