History and Physical
A medical history should focus on the location of symptoms, onset, characteristics of symptoms, associated symptoms, timing of symptoms, aggravating or alleviating factors, and treatment of recent and past UTIs. If available, previous urine tests and cultures can help guide therapy.
A pharmacist’s physical exam should consist of vitals and an abdominal exam; if concurrent vaginal symptoms are present, the patient may need a vaginal exam and be referred to a provider.4 To check for CVA tenderness, apply gentle pressure in the costovertebral angle area (imagine an angle formed by the 12th rib and the vertebral spine) on both sides. If this does not elicit pain, then tap with a closed fist once in each area. A positive response is pain elicited by either maneuver. An abdominal exam is done by inspecting the abdomen with the patient lying on a table. Pay close attention to the abdomen’s appearance; is it distended, flat, are there distinct bumps or protrusions. Divide the abdomen into four quadrants based upon the navel. There is the right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant. The examiner should then listen to all four abdomen quadrants, noting the pattern and frequency of bowel sounds. Ask the patient where their pain is and take note not to start percussion or palpation in that area. Next, percuss in all four quadrants by tapping your middle finger of one hand with the other hand’s index finger. Tympanic (drum-like) sounds are produced over air-filled structures, while dull sounds can indicate a solid organ or fluid. Finally, perform light palpation in all four quadrants followed by deeper palpation. This is done by placing one hand on top of the other and having the hand on top apply pressure, and the hand on the bottom feel the abdominal structures. Patients presenting with an uncomplicated UTI may have suprapubic pain upon palpation over the bladder.