Sonya, a 45year old female, is being admitted to your ward from the emergency department during your afternoon shift for observations, treatment and further investigations of her urinary and renal symptoms. Sonya was referred to the local hospital by her GP after returning 5 days ago from her honeymoon overseas with a urinary tract infection (UTI).
Her primary concern was dysuria and frequent scant urination. Sonya was prescribed an oral antibiotic for 5 days and rest. On assessment Sonya stated 3-4 days of fevers with rigors, lower back and flank pain which is not responding to regular paracetamol, nausea with intermittent vomiting and lethargy. She has been unable to tolerate oral intake for over 24 hours and her urine remains dark and offensive. In the emergency department the preliminary diagnosis of pyelonephritis was made by the medical team but confirmation is pending pathology results and renal ultrasound. Sonya has a past medical history of hypertension, hyperlipidaemia and renal calculi but has been unable to tolerate her regular medications. She has a documented allergy to penicillin. Prior to transfer her observations have been charted and remain stable:
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