CASE: Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages. Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.


In this case, Shelly, a 4-year-old preschooler, is experiencing a fever, frequent urination, and pain while urinating. These symptoms have been present for the past two days, with her fever spiking intermittently despite the use of Tylenol. Shelly’s mother has made an appointment with a nurse practitioner to address these concerns. This analysis will explore potential causes for Shelly’s symptoms, considering common illnesses that affect young children. We will also discuss the importance of a thorough assessment and proper diagnosis to ensure appropriate treatment and management.

Potential Causes for Shelly’s Symptoms:

Based on the symptoms described by Shelly’s mother, several potential causes can be considered. One possibility is a urinary tract infection (UTI). UTIs are more common in females and can cause symptoms such as frequent urination and pain while urinating. Young children may also experience associated symptoms like fever and abdominal pain. Another possibility is a viral infection, such as a common cold or flu, which can cause a fever and general malaise. Additionally, GI illnesses such as gastroenteritis or food poisoning could lead to fever, abdominal discomfort, and changes in bowel habits.

A thorough Assessment:

To determine the underlying cause of Shelly’s symptoms, a comprehensive assessment is crucial. The nurse practitioner should begin by gathering a detailed medical history, including any recent illnesses or infections. This information will help establish a timeline of events and identify any potential sources of infection. It is also important to inquire about Shelly’s urinary and bowel habits, including any changes or abnormalities.

During the physical examination, the nurse practitioner should assess vital signs, paying close attention to Shelly’s temperature. These assessments will help monitor the severity of her fever and any changes over time. The nurse practitioner should also perform a focused abdominal examination to check for tenderness or other signs of discomfort. Finally, a thorough genitourinary examination should be conducted to assess for any abnormalities or signs of infection.

Diagnostic Tests:

While a comprehensive assessment can provide valuable information, diagnostic tests may be necessary to confirm or rule out potential causes. In the case of a suspected UTI, a urine analysis and culture should be obtained to identify any bacteria or abnormal findings. Blood tests, such as a complete blood count (CBC), may also be ordered to assess for signs of infection or inflammation.

If a viral infection is suspected, specific tests to identify the specific virus may be available, although these are not always necessary or readily available. Generally, viral infections are diagnosed based on clinical findings and a positive response to treatment measures.

Management and Treatment:

Once a diagnosis has been established, appropriate management and treatment can be initiated. In the case of a UTI, antibiotics are typically prescribed to clear the infection and alleviate symptoms. It is crucial to select an appropriate antibiotic based on the specific type of bacteria causing the infection and any identified sensitivities. Additionally, measures to promote adequate hydration and comfort, such as pain relief medication, may be recommended.

For viral infections, treatment is primarily supportive, focusing on symptom management and allowing the body’s immune system to fight off the infection. Measures such as rest, hydration, and over-the-counter fever reducers can help alleviate symptoms and promote recovery. It is important to monitor for any worsening symptoms or complications and seek further medical attention if needed.


In conclusion, Shelly’s symptoms of fever, frequent urination, and pain while urinating warrant a comprehensive assessment to determine the underlying cause. Potential causes may include a UTI, viral infection, or gastrointestinal illness. Diagnostic tests, such as urine analysis and culture, may be necessary to confirm or rule out specific conditions. Once a diagnosis has been established, appropriate management and treatment can be initiated to alleviate symptoms and promote recovery.