211382077 final-ap-case-study

A CASE STUDYOF
COLLEGE OF NURSING
PATIENT WITH
ACUTE
PYELONEPHRITIS
Submitted to:
DENNISON JOSE C. PUNSALAN, RN, MN
SUBMITTED BY:
Camba, Ma. Liezel M.
Lumba, Chared Joy D.
Masbang, Maria Elaine D.
Pugeda, Bianca Camille P.
BSN III-3 GROUP 12 SUBGROUP 1

2 | P a g e
Table of Contents
I.INTRODUCTION................................................................................................................................4
A.Current trends about the disease condition...................................................................................6
B.Reason for choosing such case for presentation.............................................................................7
C.Objectives....................................................................................................................................8
II. NURSING PROCESS.........................................................................................................................7
A. Assessment................................................................................................................................7
1. PERSONAL DATA .........................................................................................................................7
a. Demographic data...................................................................................................................7
b. Socio-economic and cultural factors.........................................................................................7
c. Environmental factors..............................................................................................................8
2. PERSONAL HISTORY.....................................................................................................................8
a. Maternal – obstetric record .....................................................................................................8
b. Prenatal history.......................................................................................................................9
Growth and Development ...........................................................................................................9
3. FAMILY HEALTH-ILLNESS HISTORY.............................................................................................. 10
Genogram................................................................................................................................ 11
Explanation of Genogram.......................................................................................................... 12
4. HISTORY OF PAST ILLNESS.......................................................................................................... 12
5. HISTORY OF PRESENT ILLNESS....................................................................................................12
6. PHYSICAL ASSESSMENT ............................................................................................................. 13
Initial Assessment (LIFTED FROMTHE CHART) ............................................................................ 13
First Nurse-Patient Interaction...................................................................................................14
7. DIAGNOSTICAND LABORATORY PROCEDURES............................................................................ 17
III. ANATOMY AND PHYSIOLOGY ......................................................................................................24
SCHEMATIC DIAGRAM(CLIENT-CENTERED) ................................................................................... 30
IV. THE PATIENT’S ILLNESS................................................................................................................ 31
Synthesis of the disease................................................................................................................ 31
1. Definition of the disease........................................................................................................31
2. Predisposing/Precipitating Factors.......................................................................................... 33
3. Signs and Symptoms.............................................................................................................. 34

3 | P a g e
4. Health Promotion and Preventive Aspects of the Disease ........................................................ 35
V. THE PATIENT AND HIS CARE ......................................................................................................... 38
A. MEDICAL MANAGEMENT .......................................................................................................... 39
a. IVFs......................................................................................................................................39
b. Drugs....................................................................................................................................42
c. Diet.......................................................................................................................................48
d. Activity/Exercise.................................................................................................................... 50
B. NURSING MANAGEMENT .......................................................................................................... 51
1. NURSING CARE PLAN................................................................................................................. 51
2. ACTUAL SOAPIEs ....................................................................................................................... 61
VI. CLIENT’S DAILY PRORGESS IN THE HOSPITAL................................................................................ 63
1. Client’s Daily Progress Chart ......................................................................................................63
VII. CONCLUSION AND RECOMMENDATIONS.................................................................................... 68
VIII. LEARNING DERIVED................................................................................................................... 68
IX. BIBLIOGRAPHY............................................................................................................................ 71
Books......................................................................................................................................... 71
Websites....................................................................................................................................71

4 | P a g e
I. INTRODUCTION
“A wise man should consider that health is the greatest of human blessings, and
learn how by his own thought to derive benefit from his illnesses.”
- Hippocrates
The quote stated above implies that man is in control of his health. Health is
indeed one of the greatest blessings that man could ever have. Being healthy is also
reflected in the way how man perceives his illness. It is either seeing the benefit or the
negative out of it. Man is in full control over what he would want to do with his body.
Illness is subjective to man. Therefore, it is up to him whether he would take it as a
challenge to conquer and step up in order to place himself in a better condition or get
conquered by the illness itself.
The urinary tract is the body’s drainage system for removing wastes and extra
water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The
kidneys are two bean-shaped organs, each about the size of a fist. They are located near
the middle of the back, just below the rib cage, one on each side of the spine. Every day,
the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of
urine, composed of wastes and extra water. Children produce less urine than adults. The
amount produced depends on their age. The urine flows from the kidneys to the bladder
through tubes called the ureters. The bladder stores urine until releasing it through
urination. When the bladder empties, urine flows out of the body through a tube called
the urethra at the bottom of the bladder.
Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though
many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is
often the cause. Bacteria and viruses can move to the kidneys from the bladder or can
be carried through the bloodstream from other parts of the body. A UTI in the bladder
that does not move to the kidneys is called cystitis.

5 | P a g e
One of the most common renal diseases, acute pyelonephritis is a sudden
inflammation caused by bacteria. It primarily affects the interstitial area and the renal
pelvis or, less often, the renal tubules.
Chronic pyelonephritis is persistent kidney inflammation that can scar the
kidneys and may lead to chronic renal failure. This disease is most common in patients
who are predisposed to recurrent acute pyelonephritis, such as those with urinary
obstructions or vesicoureteral reflux.
People most at risk for pyelonephritis are those who have a bladder infection
and those with a structural, or anatomic, problem in the urinary tract. Urine normally
flows only in one direction—from the kidneys to the bladder. However, the flow of urine
may be blocked in people with a structural defect of the urinary tract, a kidney stone, or
an enlarged prostate—the walnut-shaped gland in men that surrounds the urethra at
the neck of the bladder and supplies fluid that goes into semen. Urine can also back up,
or reflux, into one or both kidneys. This problem, which is called vesicoureteral reflux
(VUR), happens when the valve mechanism that normally prevents backward flow of
urine is not working properly. VUR is most commonly diagnosed during childhood.
Pregnant women and people with diabetes or a weakened immune system are also at
increased risk of pyelonephritis (National Kidney and Urologic Diseases Information
Clearinghouse-NKUDIC, 2012)
The estimated annual incidence of pyelonephritis was 27.6 cases per 10,000
persons. Only 7% of cases required hospitalization. Escherichia coli caused 85% of cases,
including 6 of 7 cases among inpatients for whom data were available. Of E. coli isolates,
85% were sensitive to trimethoprim-sulfamethoxazole, while 99% were susceptible to
ciprofloxacin.

6 | P a g e
A. Current trends about the disease condition
Our local trend is a health program/service made by the Department of Health
which is about “Renal Disease Control Program (REDCOP)”
The REDCOP consists of the following components: RDR (Renal Disease Registry);
Study on GN and Kidney Stones; Follow-up of PNP cases; and Organ Donation.
This is a relatively new program with the objective of reducing the mortality and
morbidity rates caused by renal diseases. (http://www.doh.gov.ph/CHD-12-
new/degenerative.htm)
We have researched a foreign trend about “Kidney-damaging Protein Offers Clue
to New Treatment to Kidney Diseases”.
Scientists led by a University of Cincinnati (UC) kidney expert have found that a naturally
occurring protein that normally fights cancer cells can also cause severe kidney failure
when normal blood flow is disrupted. This finding, seen in mice in which the gene
controlling the protein is actually expressed or "turned on," could provide a target for
drugs that will reduce the risk of kidney damage in humans, the researchers believe.
Acute kidney failure is a life-threatening illness caused by sudden, severe loss of blood
flow to the kidneys (ischemia). Despite advances in supportive care, such as dialysis,
severe kidney injury is a major cause of death.
The scientists, headed by Manoocher Soleimani, MD, director of nephrology and
hypertension at UC and the Cincinnati Veterans Affairs Medical Center, report their
findings, the issue of the Journal of Clinical Investigation.
The protein, thrombospondin (TSP-1), is known for its role in fighting cancer. It does this
by killing off cancer cells and preventing the tumor from building a greater blood supply.
Although TSP-1 causes irreversible, severe kidney damage when blood flow to mouse
kidneys is disrupted, the researchers say, this only occurs in animals whose TSP-1 gene is
turned on.

7 | P a g e
The study showed that the protein damages kidney cells when blood flow is reduced for
30 minutes or more. When blood flow is restored to the kidneys, if TSP-1 protein is
present, normal kidney function doesn't return.
"This raises the important possibility that TSP-1 may serve as a target in preventing or
successfully treating acute kidney failure," said Dr. Soleimani. "Understanding the
mechanisms of kidney cell injury moves us that much closer to preventing this life-
altering damage from happening.
"If we can develop a drug that will inhibit or turn off the TSP-1 gene function, then
severe kidney damage could be prevented--even during a 30-minute disruption in blood
flow," he said.
"Since the incidence of death remains high in patients with damaged kidneys,
prevention or early treatment of acute kidney failure will increase survival."
The study showed that the damaging protein is released rapidly, in response to
diminished blood flow, in mice that have the active TSP-1 gene. TSP-1 also killed kidney
cells when exposed to them in a Petri dish.
"Most importantly," Dr. Soleimani said, "we found that genetically engineered mice,
which lack TSP-1 protein, were significantly protected from kidney damage. Mice
without TSP-1 preserved their kidney function relatively well, even after being subjected
to a 30-minute disruption of blood flow to the kidneys.
"Consequently, this study raises an important possibility that TSP-1 may serve as a
target for preventing or successfully treating acute kidney failure," Dr. Soleimani said.
(Source: http//:www.sciencedaily.com)
B. Reasons for choosing such case for presentation
This study was a part of the partial requirement in NCM 103 (R.L.E.) of
the Third year college students of the Angeles University Foundation. The group
decided to take up Acute Pyelonephritis as a subject in their case study in order for
them to learn further regarding this disease that affects the kidneys, since kidneys

8 | P a g e
play a vital function in the over-all health of a person. This condition is usually
encountered in the medical field. In this case, it will be helpful not only for the
student nurses, but as well as for every medical professional to gain broader
knowledge and updates in the said condition.
C. Objectives
Nurse – Centered Objectives
After the completion of the study, the student nurse – researcher will be able to:
• Establish a therapeutic relationship with the patient and the significant others
• Gather the personal information of the client, from his / her past medical history
and from the family’s health history
• Perform a complete physical assessment (cephalocaudal) of the client
• Make a comprehensive understanding and analysis regarding the laboratory and
diagnostic findings, as a part of the nursing responsibilities of every nurse
• Identify the predisposing and precipitating factors of the client’s condition
• Determine the dependent and independent function as a nurse in rendering
health care services.
Patient – Centered Objectives
Upon completion of the study, the patient will be able to:
• Acquire and enhance knowledge about the disease, the factors that contribute
to the development of the client’s condition
• Build trust and gain respect among the nurses and able to deepen information
about his / her condition
• Meet the needs of the client in the best way possible, either physically, mentally,
socially, spiritually and emotionally
• Develop independence in performing self – care before the discharge of the
client

9 | P a g e
II. NURSING PROCESS
A. Assessment
1. PERSONAL HISTORY
a. Demographic data
“Kitkat” is a 22 years old female, affiliated in the Roman Catholic Church
(but a former Baptist) and a Filipino citizen. She was born on January 5, 1991 in
Mexico, Pampanga. She is an independent daughter and has her own family
already, living separately from her parents. Her family is currently residing at D-
10 B-92 L-22 Pandacaqui Resettlement, Mexico, Pampanga. She was admitted
last August 14, 2013 at 8:13pm with an acute pyelonephritis.
b. Socio-economic and cultural factors
The family falls under the nuclear type. Her own family with his husband
is composed of three members namely: Kitkat herself, husband Ferrero, and
their daughter Kisses, which is the first and only child. On the other hand,
Kitkat’s parents namely daddy Toblerone and mommy Cadbury lives separately.
Their family has a good relationship with each other. She is already independent
from her parents. She hasn’t finished fourth year in high school, but studied a
vocational course in electric (eg. Fixing cellphones, etc.)
Husband Ferrero works in a furniture shop and earns 10,000php a month.
While Kitkat is a plain housewife. Their family is categorized as not poor, and
according to Kitkat, the family’s income is enough to support and suffice the
needs of the family.
The patient came originally from Pampanga. She belongs to the Roman
Catholic religion and is going to church every Sunday together with her family.

10 | P a g e
Their family uses herbal medications such as oregano. They also believe
in quack doctors (albularyos) but they still prefer medical treatment.
c. Environmental factors
Kitkat’s family is living in a house made up of concrete wood structure
which they own. Their ventilation is adequate because they have 6 windows and
2 doors as their source of ventilation. According to Kitkat, they maintain
cleanliness in their house. Their usual meal is a rice meal. Her family use mineral
water as their source of drinking. She eats 3 to 4 times a day.
2. FAMILY HEALTH-ILLNESS HISTORY

12 | P a g e
EXPLANATION:
The genogram above shows that daddy Toblerone, father of Kitkat, is
already deceased. He died because of kidney problem, which is according to
mommy Cadbury that his kidney was “nalanta.” The mother of daddy Toblerone,
lola Mars, is hypertensive. On the other hand, mommy Cadbury, mother of
Kitkat, says that she also experiences dysuria, and also that of lola Crunch, the
mother of Cadbury. While lolo Snickers, father of Cadbury, had tuberculosis.
According to mommy Cadbury, problem in kidneys are their family line’s genetic
disease conditions. While daddy Toblerone was the first in his line to have a
kidney problem. The genogram presented up until the generation of Kitkat’s
grandmothers and grandfather both on the maternal and paternal side.
3. HISTORY OF PAST ILLNESS
The patient did not have any of the childhood illnesses such as
chickenpox, mumps, and measles. But already had fever, coughs, and colds. The
SO cannot remember about the immunizations of the patient, but verbalized
that it is incomplete. She has no allergies to certain drugs, food or any other
environmental agents. She had the same problem three years ago and was
hospitalized at Balitucan, Magalang. But she was also referred to JBL. She was
hospitalized at JBL for about six times because of the same problem too.
4. HISTORY OF PRESENT ILLNESS
On the 14th of August 2013, Kitkat experienced fever, nausea and
vomiting, malaise, difficulty of breathing, cannot eat, flank and back pain, and
dysuria; then his husband, Ferrero, immediately brought her to JBL at 6 in the
evening. They didn’t do any home management. The patient then was diagnosed

13 | P a g e
to have acute pyelonephritis. Initial vital signs were taken and as follows: T of
38.2⁰C, PR of 90bpm, RR of 28bpm, BP of 90/60mmHg
5. PHYSICAL EXAMINATION (CEPHALOCAUDAL APPROACH)
 Initial Assessment (LIFTED FROM THE CHART)
Date of Admission: August 14, 2013
Chief Complaint: Fever
Physical Examination:
 General : conscious, coherent
 Skin: (-) pallor, (-) cyanosis
 HEAD - HEENT: (-) colds
 Chest/Lung: CBS
 Rectum: (+) CVA tenderness
 Musculoskeletal: (-) weakness
 ADMITTING IMPRESSION: Acute Pyelonephritis
Daily Vital Signs
Date August 14 August 15
Temperature
Axilla (ºC)
38.2°C 39.7°C
Pulse rate
(bpm)
96 bpm 96 bpm
Respiratory
Rate(bpm)
25 bpm 18 bpm
Blood Pressure
(mmHg)
90/60 mmHg 100/60 mmHg

14 | P a g e
Review of systems:
 General: No at loss
 Skin: (-) rash
 HEENT: (-) colds
 Musculoskeletal: (-) weakness, (-) edema
 Respiratory: (-) cough
 Cardiovascular: (-) chest pain
 GI: (-) LBM
 First Nurse-Patient Interaction
Date of physical assessment: August 15, 2013
General Survey:
Received patient in a sitting position in the bed, conscious and coherent;
with ongoing IVF #2 PNSS 1L @ 600cc level regulated at 32gtts/min infusing
through the right metacarpal vein; with increased OFI but without output as of
9am, slightly febrile, good skin turgor, moist mucous membrane; VS as follows: T
of 39.7°C, PR of 96bpm, RR of 18bpm, BP of 100/60mmHg
Vital Signs: T: 39.7°C
PR: 96bpm
RR: 18bpm
BP: 100/60mmHg

15 | P a g e
SKULL AND FACE
 normocephalic shape skull with absence of nodules or masses upon palpation
 symmetrical facial features and facial movements
 was able to smile, frown, raise eyebrows, and puff her cheeks
HAIR AND SCALP
 hair is long, black and straight upon inspection
 evenly distributed with no lice and dandruff noted
SKIN AND NAILS
 cold and clammy skin with absence of edema and nodules
 fair skin complexion
 good skin turgor
 no presence of lesions
 has short fingernails and toenails
 without presence of pallor
EYES AND VISION
 dark eyebrows are evenly distributed and symmetrically aligned with equal
movements
 black pupil
 eyelashes are also equally distributed and curled slightly outward and upward
 eyelids close symmetrically with skin intact and no discharge or discoloration
 bulbar conjunctiva is transparent and sclera appears white
 without pale palpebral conjunctiva
 lacrimal ducts have no edema or tearing upon palpation
 cornea is transparent, shiny and smooth with visible details of iris

16 | P a g e
 pupils are equally round and reactive to light accommodation
 left and right eye can see clearly in the periphery when looking straight ahead
and is able to read newsprint at a given distance
 no discharges noted upon inspection
EARS AND HEARING
 no tenderness behind the ears
 auricles are same as the color of facial skin
 aligned with outer canthus of eyes
 not tender and recoil after being folded
 left and right ear can hear clearly a normal voice tones
NOSE AND SINUSES
 symmetrical and straight
 no discharges or flaring
 has uniform color and not tender
 nasal septum is intact and in midline
 air moves freely on both nares as client breathes
 facial sinuses are not tender
 no lesions
MOUTH AND OROPHARYNX
 without dry and pale lips
 without dental caries
 tongue is at the center and pinkish in color with no lesions, no tenderness noted
and moves freely

17 | P a g e
NECK
 muscles equal in size
 head centered
 can move her head smoothly and with no discomfort
 lymph nodes are not palpable
 trachea is in the midline of the neck
 thyroid gland is not visible upon inspection and ascends during swallowing upon
palpation
 carotid artery and jugular veins are not distended or visible
THORAX AND LUNGS
 chest symmetric volume
 no tenderness noted
 no masses noted
 full and symmetric chest expansion
 resonant sound upon percussion over the lungs
 breathing is rhythmic, quiet and effortless
 no adventitious breath sounds upon auscultation
 spine is vertically aligned
HEART
 presence of pulsation
 normal heart rate
 irregular in rhythm
 peripheral pulses are symmetrical with that of the apical pulse
ABDOMEN

18 | P a g e
 uniform in color, flat, soft
 non-tender and no masses
UPPER EXTREMITIES and LOWER EXTREMITIES
 muscles are equal in size
 no contractures
 no tremors
 no bone deformities
 no tenderness palpated
 can sense sharp and blunt objects was able to adduct her arm, supine and prone
her hands, shrug her shoulders against resistance, and flex and extend her arms

Page | 19
6. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnostics/
Laboratory
Procedures
Date
ordered;
Date
results
Indication(s)
Or
Purpose
Results
Normal
Values
Analysis
and
Interpreta
tion
Of results
(client-
centered)
Creatinine DO&DR:
08/14/13
The kidneys
maintain the
blood creatinine
in a normal
range.
Creatinine has
been found to
be a fairly
reliable
indicator of
kidney function.
Elevated
creatinine level
signifies
impaired kidney
function or
kidney disease.
60.5 umol/l
58-120
umol/l
The result
was
normal
which
means
that the
patient’s
kidneys
are
working
well
Potassium
DO&DR:
08/14/13
A potassium
test checks how
much potassium
is in the blood.
Potassium is
both
an electrolyte a
nd a mineral. It
helps keep the
water (the
amount of fluid
inside and
outside the
body's cells) and
electrolyte
balance of the
body. Potassium
is also
3.49 mmol/l
3.50-5.50
mmol/l
The
patient
has
hypokale
mia
indicating
electrolyte
imbalance

20 | P a g e
important in
how nerves and
muscles work.
Sodium
DO&DR:
08/14/13
A test for
sodium in the
urine is a 24-
hour test or a
one-time (spot)
test that checks
how much
sodium is in the
urine. Sodium is
both
an electrolyte a
nd a mineral. It
helps keep the
water (the
amount of fluid
inside and
outside the
body's cells) and
electrolyte
balance of the
body. Sodium is
also important
in how nerves
and muscles
work.
140.3 mmol/l
135-145
mmol/l
The
patient
has
normal
sodium
level
Red blood
cells
DO&DR:
08/14/13
RBC count is
used to evaluate
any type of
decrease or
increase in the
number of red
blood cells as
measured per
liter of blood.
7.86 mmol/l 4-9 mmol/l
The
patient
has
normal
red blood
cells
Hemoglobin
DO&DR:
08/14/13
A hemoglobin
determination is
used to evaluate
the hemoglobin
content (and
thus the iron
115
M:125-175g/L
F:115-155g/L
The
hemoglobi
n level of
the
patient is
normal.

21 | P a g e
status and
oxygen-carrying
capacity) of
erythrocytes by
measuring the
number of
grams of
hemoglobin per
liter of blood
Thus,
indicating
normal
oxygenati
on in the
blood.
Hematocrit
DO&DR:
08/14/13
Often used in
replacement of
the RBC count,
the hematocrit
is a measure of
the volume of
the RBCs in the
whole blood
expressed as a
percentage 0.34
M: 0.40-0.52
F: 0.38-0.48
The result
was below
the
normal
range
which
indicates
low
RBC/hemo
globin to
the
plasma
level. It
indicates
anemia
and
oxygen
insufficien
cy.
White blood
cells
DO&DR:
08/14/13
Helpful in the
evaluation of
the patient with
infection,
neoplasm,
allergy or
immunosuppres
sion 1.65 5-10×109/L
The
patient’s
WBC
count falls
below the
normal
range, it is
usually an
indication
of an
underlying
disease.
She is
immunosu
ppressed.

22 | P a g e
Neutrophils
DO&DR:
08/14/13
The neutrophil
white blood
cells are the first
ones on the
scene of an
injury and help
to tend the
initial wounds.
Like all white
blood cells
along with
fighting off
injuries, it is also
there duty to
attack bacteria
and other
intruders into
the body. While
they fight
disease
alongside other
white blood
cells, they do
not treat
infections like
antibiotics or
other
medications.
0.60 0.45-0.65
The
patient’s
neutrophil
s are
within
normal
range.
Lymphocytes
DO&DR:
08/14/13
Determine if
there is enough
cell that
produces
antibodies and
other chemicals
responsible for
destroying
microorganisms;
contributes to
allergic
reactions, graft
rejection, tumor
control, and
regulation of
the immune
0.40 0.20-0.35
The
patient
has
elevated
lymphocyt
es which
compromi
ses her
immunity
and
increases
susceptibil
ity to
further
infections.

23 | P a g e
system
Platelet
count
DO&DR:
08/14/13
Platelets, which
are also called
thrombocytes,
are small disk-
shaped blood
cells produced
in the bone
marrow and
involved in the
process of blood
clotting.
104 150-400×109/L
The
patient
has
thromboc
ytopenia
which
predispos
es him to
risks for
bleeding.
Urinalysis
DO&DR:
08/14/13
Urinalysis is part
of routine
diagnostic and
screening
evaluations. It
can reveal a
significant
amount of
preliminary
information
about the
kidneys and
other metabolic
processes.
Urinalysis
includes
remarks as to
the color,
appearance and
odor, pH, and
presence of
proteins,
glucose,
ketones, and
blood and
leukocyte
esterase. In
addition, the
urine is
Color:
Dark Yellow
Transparency:
Turbid
Albumin:
Negative
Reaction:
Positive
Specific Gravity:
1.030
Pus cells:
20-25/HPF
RBC:
18-20/HPF
Epithelial cells:
Many
Bacteria:
Heavy
Yellow, Clear
Clear
Negative
Negative
1.010-1.025
0-5/HPF
0-3/HPF
Few
None
Color:
-Urine
ranges
from pale
yellow to
amber
because of
the
pigment
urochrom
e
(productio
n of
bilirubin
metabolis
m)
Transpare
ncy
;-Patient
has turbid
urine that
may
contain
RBC’s or
WBC’s
bacteria,
fat, or
chyle, if

24 | P a g e
examined
microscopically
for RBC’s WBC’s,
casts, crystals
and bacteria
this procedure
was done to our
pt. to check test
if there is any
complication/in
gestion on her
kidney or if her
kidney’s
functioning well.
may
reflect
renal
infection.
Albumin –
no
proteinuri
a in urine
Reaction:
The
patient
has
positive
reaction
indicating
bacterial
invasion.
Specific
gravity:
The
patient’s
specific
gravity is
higher
than
normal
range
which
indicates
the
concentra
ted urine.
Pus cells,
RRC,
Epithelial
cells and
Bacteria:
The
patient
has

25 | P a g e
elevated
levels
which
confirms
the
presence
of
microorga
nism in
the urine
Nursing Responsibilities:
 Obtain blood sample from brachial artery
 Mainstream clean catch urine

26 | P a g e
7. ANATOMY AND PHYSIOLOGY
THE URINARY SYSTEM
I INTRODUCTION
Urinary System, system of organs that produces and excretes urine from the body. Urine
is a transparent yellow fluid containing unwanted wastes, mostly excess water, salts, and
nitrogen compounds. The major organs of the urinary system are the kidneys, a pair of bean-
shaped organs that continuously filter substances from the blood and produce urine. Urine
flows from the kidneys through two long, thin tubes called ureters. With the aid of gravity and
wavelike contractions, the ureters transport the urine to the bladder, a muscular vessel. The
normal adult bladder can store up to about 0.5 liter (1 pt) of urine, which it excretes through
the tubelike urethra.

27 | P a g e
An average adult produces about 1.5 liters (3 pt) of urine each day, and the body needs, at
a minimum, to excrete about 0.5 liter (1 pint) of urine daily to get rid of its waste products.
Excessive or inadequate production of urine may indicate illness and doctors often use
urinalysis (examination of a patient’s urine) as part of diagnosing disease. For instance, the
presence of glucose, or blood sugar, in the urine is a sign of diabetes mellitus; bacteria in the
urine signal an infection of the urinary system; and red blood cells in the urine may indicate
cancer of the urinary tract.
II STRUCTURE AND FUNCTION
The kidneys lie embedded in fat tissue on either side of the backbone at about waist level.
Each fist-sized kidney is reddish-brown, weighs 140 to 160 g (5 to 6 oz), and is similar in shape
to the kidney beans sold at the supermarket.
On the inner border of each kidney is a depression called the hilum, where the renal
artery, the renal vein, and the ureter connect with the kidney (the adjective renal is from the
Latin term renalis, meaning of or near the kidneys). The renal artery delivers over 1700 liters
(450 gal) of blood to the kidneys each day, which these organs filter and return to the heart via

28 | P a g e
the renal vein. Each kidney contains about 1 million microscopic coiled channels, called
nephrons, which perform this critical blood-filtering function and produce urine in the process.
The bulblike upper portion of the kidney’s nephrons filters water; urea, the nitrogen-
containing breakdown product of protein; salts; glucose; amino acids, the building blocks of
proteins; yellow bile compounds from the liver; and other trace substances from the blood. As
this material moves through a long, looped tubule, many of these filtered materials are
reabsorbed into the blood to be reused by the body to maintain normal body functions. Less
than 1 percent of the water and other materials remain behind to be excreted as waste
products in the urine.
These waste materials then pass from the nephrons into a funnel-shaped area called the
renal pelvis. From the renal pelvis, waste trickles out of the kidney into the ureter, which is
about 25 to 30 cm (10 to 12 in) long and about 0.5 cm (0.2 in) in diameter. The ureter empties
into a hollow, muscular sac called the urinary bladder. A valvelike flap of tissue at the point of
entry into the bladder prevents urine from flowing backward into the ureter. The urinary
bladder is able to expand and contract according to how much urine it contains. As it fills with
urine, the walls of the bladder stretch and become thinner, with the bladder itself lengthening
to 12.5 cm (5 in) or more and holding up to about 0.5 liter (1 pt) of urine. A ringlike sphincter
muscle surrounds the bladder’s outlet and prevents spontaneous emptying.
As the bladder becomes full, stretch-sensitive receptors in its walls are stimulated, and
the person becomes aware of the fullness. When the person is ready to urinate, or expel urine,
the sphincter relaxes and urine flows from the bladder to the outside through the urethra. In
females, the urethra is about 3.8 cm (1.5 in) long and is strictly a urinary passage. In males, the
urethra is about 20 cm (8 in) long; it passes through the penis and also serves to convey semen
during sexual intercourse.
In addition to their vital role in ridding the body of wastes through the production of
urine, kidneys play important regulatory roles. They maintain water balance, ensuring that the
amount of water in body tissues remains at a constant level. So, for example, if a person drinks

29 | P a g e
a lot of water one day, but little water the next, the kidneys are able to adapt by regulating the
water balance in the tissues. The kidneys also control calcium levels in the blood to maintain
healthy bones. They aid in regulating the acid-base balance of the blood and body fluids so that
all body processes can proceed smoothly. By controlling salt levels, the kidneys help regulate
blood pressure. Finally, they stimulate the body to make red blood cells, the primary
component of healthy blood. Properly functioning kidneys are so vital to health that if they
cease to function, death follows within days.
All vertebrates dispose of excess water and other wastes by means of kidneys. The
kidneys of fish and amphibians are comparatively simple, while those of mammals are the most
complex. Fish and amphibians absorb a great deal of water and, as a result, must excrete large
quantities of urine. In contrast, the urinary systems of birds and reptiles are designed to
conserve water; these animals produce urine that is solid or semisolid.
8. THE PATIENT AND HIS ILLNESS
a. Schematic Diagram
PATHOPHYSIOLOGY OF THE DISEASE (BOOK BASED)
----PRECIPITATING FACTORS---- --PREDISPOSING FACTORS--
-Obstruction of urinary outflow -gender
-Vesicoureteral reflux -older age
-Neurogenic bladder -lifestyle
-Renal disease -environment
-Metabolic disturbances -pregnancy
-instrumentation
-chronic analgesic abuse

30 | P a g e
Bacteria gain access to blood intestinal exogenous genitor-urinary
m.o m.o m.o
Systematic arteries
Urethra
Systemic circulation Ureters and bladder
Kidney
Infection Inflammation of renal tissue fever pain
Increase WBC and platelet small abscess in the calyx surface pain, fever,
bladder irritation
Suppuration (Pus Formation) change of abscess to lesions pain,
pyuria
bleeding in the mucous
Increase polymorphonuclea membrane of the adjacent
leukocytes in the tubules and collecting system
in the interstitium
surrounding the tubules
Necrosis of renal tissue dysuria
Destruction of segments of tubules
leukocyte casts may lead to renal failure
(Accumulation of WBC)

31 | P a g e
PATHOPHYSIOLOGY OF THE DISEASE (PATIENT CENTERED)
----PRECIPITATING FACTORS---- --PREDISPOSING FACTORS--
-gender
-lifestyle
Bacterial invasion
intestinal exogenous genito-urinary
m.o m.o m.o
Urethra
Ureters and bladder
Kidney
Infection
Increase WBC & Inflammation of renal tissue
Pain, fever, chills, bladder irritation

32 | P a g e
b. Synthesis of the disease
b.1. Definition of the disease
Acute Pyelonephritis – often occurs after bacterial contamination of the urethra or after
introduction of an instrument, such as a catheter or a cystoscope
b.2. Predisposing / Precipitating factors
PREDISPOSING FACTORS PRECIPITATING FACTORS
-gender
-older age
-lifestyle
-environment
-pregnancy
-instrumentation
-chronic analgesic abuse
-Obstruction of urinary outflow
-Vesicoureteral reflux
-Neurogenic bladder
-Renal disease
-Metabolic disturbances
b.3. Signs and symptoms with rationale
 Characterized by enlarged kidneys, focal parenchymal abscesses, and accumulation of
polymorphonuclear lymphocytes around and in the renal tubules
 Client seems to be in acute distress, although in some cases this disorder causes minimal
or on manifestations.
 High fevers, chills, nausea, flank pain on the affected side (costovertebral angle [CVA]
tenderness), headache, muscle pain, and general prostration.
 Pain commonly radiates down the ureter or toward the epigastrium and may be colicky
if the infection is complicated by calculi or sloughed renal papillae.
 Patients commonly experienced dysuria, frequency, urgency, and other evidence of
cystitis for several days.
 Urine may be cloudy or bloody, is foul smelling, and show a mark increase in WBCs.

33 | P a g e
B. PLANNING (NURSING CARE PLAN)

Page | 34
Problem #1: Acute pain related to frequency of urination
Assessment Nursing diagnosis Scientific
explanation
Objective Interventions Rationale Expected outcome
S>Ø
O>patient
manifested:
>guarding behavior
>facial grimaces
The pt. May
manifest:
>suprapubic
tenderness
>low back pain or
flank pain
>fever
>chills
>fatigue
>anorexia
Acute pain related
to frequency of
urination
Atrophied
parenchyma
brought about by
narrowingof the
calyx neck and
scarringof
parenchyma causes
urineretention and
which further
causes unpleasant
sensation to the
patient thereby by
resultingto pain.
Short-term
goal:after 3 hours
of nursing
interventions,
patient will beable
to verbalizeways to
decrease pain.
Long term goal:
after 3 days of
nursing
interventions the
patient will beable
to report less pain
or increasepain
tolerance.
>Assess pain
characteristics:
location, quality,
severity, onset and
duration.
>Observe and
monitor signs and
symptoms of pain
such as BP, heart
rate, temperature,
color and moisture
of the skin.
>Anticipate need for
pain relief
>Eliminate
additional stressors
or sources of
discomfort
whenever possible.
>To identify extent
of pain.
>Some people deny
the experience of
pain when it is
present.
>Early intervention
may decrease the
total amount of
analgesia required.
>Pt. May experience
exaggeration in pain
or a decreased
ability to tolerate
painful stimuli if
environmental,
intrapersonal
factors are further
stressing them.
Short-term goal:
after 3 hours of
nursing
interventions,
patient shall have
verbalized ways to
decrease pain.
Long term goal:
after 3 days of
nursing
interventions the
patient shall have
reported less pain
or increasepain
tolerance.

35 | P a g e
>Provide rest
periods to facilitate
comfort, sleep and
relaxation.
>Use non-
pharmacologic pain-
relief methods:
distraction
techniques,
relaxation
techniques, music
therapy.
>Notify physician if
interventions are
unsuccessful or if
current complaint is
significant change
from past
experience.
>The pt’s
experiences of pain
may become
exaggerated as the
result of fatigue.
>Decreases one’s
awareness and
experience of pain.
Some methods are
breathing
modifications and
nerve stimulation.
>To prescribe
medication if
possible.

36 | P a g e
Problem #2: Hyperthermia
Cues Nursing diagnosis Nursing
objective
Planning Nursing intervention Rationale Evaluation
Subjective Cues:
“Nung isangarawpa
mainitangpkramdam
ko” as verbalized by the
client
Objective Cues:
 Body
temperature
above normal
range.
 Warm to touch.
 Flushed skin
 Tachycardia
 Diaphoresis
T-38.3
P-105Bpm
R-24 bpm
BP-130/90 mmHg
Hyperthermia r/t
inflammatory
process as
evidenced by
increase body
temperature,flushed
and warm to touch
skin and increase
respiration rate.
______________
Scientific
Explanation:
Body temperature
elevated above
normal range.
After 2 hours
of nursing
intervention
The clients
body
temperature
will decrease
to a normal
range
 Plan ways on
how to lessen
clients body
temperature
 Formulate
health
teachings that
would be
helpful to
lessen the
clients
temperature.
 Identify
underlying
cause.
 Put local ice
packs
especially in
groin and
axillae.
 Providetepid
sponge bath.
 Teach clientto
increasefluid
intake.
 Establish cool
environment
by opening air
vents and
window panes.
 Advise
 To assess
causative
factors to
the
clients
fever
thus
formulati
on of
appropri
ate
nursing
intervent
ion.
 This
areas has
high
blood
flow and
After 2
hours of
nursing
intervention
The clients
body
temperature
is decreased
to a normal
range

37 | P a g e
relatives not to
cover the
clientwith a
blanket, and
use less
restrictive
clothing’s
 Administer
Anti pyrectics
as prescribed
putting
icepacks
would be
helpful.
 To
increase
heat loss
through
conducti
on
 To
support
circulatin
g volume
and
tissue
perfusion
.
 Heat loss
by
convectio
n.
 to avoid
further
increase

38 | P a g e
of clients
temperat
ure.
 For
immediat
e
alteratio
n of body
temperat
ure

39 | P a g e
Problem #3: Impaired urinary elimination related to disease conditions.
Assessment Nursing diagnosis Scientific
explanation
Objective Interventions Rationale Expected outcome
S>” Panay ang ihi
ko”
O> patient
manifested:
>Frequency of
urination
(5-6x/day)
>Body malaise
>A febrile
Patient may
manifest:
>dysuria
>Incontinence
Impaired urinary
elimination related
to disease
conditions.
The most common
mechanismby
which a UTI
develops is via
ascendingand
invadingbacteria.
The organism
triggers an
inflammatory
responsein the
liningof the urinary
tract.
Short term:
After 1-3 hours of
nursing
interventions
patient will beable
to verbalize
understandingon
the health
teachings given
Long term:
After 2 days of
nursing
intervention the
patient will beable
to demonstrate
behavior
techniques to
prevent urinary
tract infection
>Note the age and
sex of the client
(UTI’s are prevalent
among women and
older men)
>Determine client
previous pattern of
elimination and
compare with
current situations
>Determine client
usual daily fluid
intake
>Encourage clientto
verbalizefear and
concern
>Instructclientto
increasefluid intake
>To gather
baselinedata
>Contribute to
immobility
>To obtain
baselinedata
>To provide
comfort
>To adjustcareas
indicated
Short term: the
patient shall have
verbalized
understandingof
the condition
Long term:
The patient shall
have demonstrated
behavior and
techniques to
prevent urinary
infection

40 | P a g e
>Recommend
avoidanceof gas
forming foods in
presence of
uterosigmoidostomy
as flatus can cause
urinary incontinence
>For continuity of
care
Problem #4: Impaired physical mobility r/t acute pain
Assessment Nursing
Diagnosis
Scientific
Explanation
Objectives Interventions Rationale Expected Outcome
S> Report of
pain and
O> irritability
>Gait changes
>pain ranges
from 6 out of 10
Impaired
physical
mobility r/t
acute pain
Pain is an
unpleasant
sensation that
can range from
mild, localized
discomfort to
agony.Pain has
both physical
and emotional
components.
The physical
Short Term:
After 3hrs of NPI, the
patient will be able to
verbalize willingness to and
demonstrate participation in
activities.
Long Term:
After 3 days of Nursing
Intervention, the patient
>Monitor V/S and
Record
>Observe
patient’s
movements
>Schedule
activities with
adequate rest
>to obtain baseline
data
>to note any
incongruence with
reports of abilities.
>to reduce fatigue
Short Term:
After 3 hrs of NPI, the
patient shall have
verbalized willingness to
and demonstrate
participation
Long Term:
After 3 days of
Nursing Intervention, the

41 | P a g e
part of pain
results from
nerve
stimulation. Pain
is mediated by
specific nerve
fibers that carry
the pain
impulses to the
brain where their
conscious
appreciation
may be modified
by many factors.
will be able to demonstrate
techniques/behaviors that
enable resumption of
activities.
periods during the
day
>Encourage
participation in
self-care,
occupational,
diversional,
recreational
activities
>enhances self-
concept and sense
of independence.
patient shall have
demonstrated
techniques/behaviors that
enable resumption of
activities.

Page | 41
C. IMPLEMENTATION
1. MEDICAL MANAGEMENT
a. IVFs
Medical
Management/
Treatment
Date ordered;
Date performed;
Date changed
General
Description
Indication/
Purpose
Patient’s
response to
the treatment
PNSS 1L fast drip
500cc; then
200cc/hour
DO:08/14/13
8:15pm
DP:08/14/13
DC: -
It is a sterile,
nonpyrogenic
solution for fluid
and electrolyte r
eplenishment
and caloric
supply in single
dose containers
for intravenous a
dministration. It
contains
no antimicrobial
agents.
To replace fluid
loss and
electrolyte loss,
maintain
patient’s
hydration,
nutritional status
and fluid
balance. It is use
to supply the
necessary
nutrient to the
patient.
Patient
tolerated IV
infusion. He
does not
complain of
any pain or
irritation.
Nursing Interventions:
 Be aware that patients being treated for hypovolemia can quickly develop hypervolemia
(fluid volume overload) following rapid or overinfusion of isotonic fluids. Document
baseline vital signs, edema status, lung sounds, and heart sounds before beginning the
infusion, and continue monitoring during and after the infusion
 Frequently assess the patient's response to I.V. therapy, monitoring for signs and
symptoms of hypervolemia, such as hypertension, bounding pulse, pulmonary crackles,
dyspnea/shortness of breath, peripheral edema, jugular venous distention (JVD), and
extra heart sounds, such as S3. Monitor intake and output, hematocrit, and hemoglobin.
Elevate the head of bed at 35 to 45 degrees, unless contraindicated. If edema is present,
elevate the patient's legs. Note if the edema is pitting or nonpitting and grade pitting
edema. For an example, see Checking for pitting edema.
 Also monitor for signs and symptoms of continued hypovolemia, including urine output
of less than 0.5 mL/kg/hour, poor skin turgor, tachycardia, weak, thready pulse, and
hypotension.2

42 | P a g e
 Educate patients and their families about signs and symptoms of volume overload and
dehydration, and instruct patients to notify their nurse if they have trouble breathing or
notice any swelling. Instruct patients and families to keep the head of the bed elevated
(unless contraindicated)
b. Drugs
Name of Drugs
(Generic name,
Brand name)
Date
ordered;
Date
started;
Date
changed
Route of
Administration;
Dosage;
Frequency
General action Indications Client’s
response
to the
medication
Ceftriaxone
BRAND NAME
Rocephin
CLASSIFICATION
Antibiotic
Cephalosporin
(third
generation)
DO:
08/14/13
DS:
08/14/13
DC: -
IV 1gram +
30cc D5W x 30
min. infusion
every 12 hours
Ceftriaxone
binds to one or
more of the
penicillin-
binding proteins
(PBPs) which
inhibits the final
transpeptidation
step of
peptidoglycan
synthesis in
bacterial cell
wall, thus
inhibiting
biosynthesis and
arresting cell
wall assembly
resulting in
bacterial cell
death.
· Lower
respiratory
infections
· UTI’s cause
byE. coli
· Gonnorhea
· Intra
abdominal
infections
· Skin and
skin
structures
infection
· Septicemia
· Bone and
joint
infections
· Meningitis
·
Perioperative
prophylaxis
The patient
did not
manifest
adverse
effects.
 Assesspatient’s previoussensitivityreactionto penicillinorother cephalosphorins.
 Assesspatientforsignsandsymptoms ofinfectionbefore andduring thetreatment
 ObtainC&Sbefore beginning drug therapy to identifyif correct treatment hasbeen initiated.

43 | P a g e
 Report signssuchaspetechiae,cchymoticareas,epistaxisorother forms of unexplained bleeding.
 Monitor hematologic, electrolytes,renalandhepaticfunction.
 Assessforpossiblesuperinfection, itching fever
Name of Drugs
(Generic name,
Brand name)
Date
ordered;
Date
started;
Date
changed
Route of
Administration;
Dosage;
Frequency
General
action
Indications Client’s
response
to the
medication
Omeprazole
BRAND NAME
Losec
CLASSIFICATION
Gastrointestinal
agent; proton
pump inhibitor
DO:
08/14/13
DS:
08/14/13
9 pm
DC:
08/14/13
1:20 am
IV 40mg now An
antisecretory
compound
that is a
gastric acid
pump
inhibitor.
Suppresses
gastric acid
secretion by
inhibiting
the H+, K+-
ATPase
enzyme
system [the
acid (proton
H+) pump] in
the parietal
cells.
-gastric
(stomach)
and
duodenal
(intestinal)
ulcers
-Heartburn
-erosive
esophagitis
-gastro-
esophageal
reflux
disease
(GERD).
The
patient did
not
manifest
adverse
effects.
Nursing Interventions
 Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests
with prolonged use.
 Report any changes in urinary elimination such as pain or discomfort associated with
urination, or blood in urine.
 Report severe diarrhea; drug may need to be discontinued.

44 | P a g e
 Do not breast feed while taking this drug.
Name of Drugs
(Generic name,
Brand name)
Date
ordered;
Date
started;
Date
changed
Route of
Administration
; Dosage;
Frequency
response
to the
medicatio
n
Metoclopromid
e
BRAND NAME
Reglan
CLASSIFICATION
GI stimulant,
Antiemetic,
Dopaminergic
blocker
DO:
08/14/13
DS:
08/14/13
;
9 pm
DC:
08/14/13
1:20 am
IV 40mg now Metoclopramid
e enhances the
motility of the
upper GI tract
and increases
gastric
emptying
without
affecting
gastric, biliary
or pancreatic
secretions. It
increases
duodenal
peristalsis which
decreases
intestinal transit
time, and
increases lower
oesophageal
sphincter tone.
-Prophylaxis
of
postoperativ
e nausea and
vomiting
when
nasogastric
suction is
undesirable
-Single-dose
parenteral
use:
Facilitation of
small-bowel
intubation
when tube
does not pass
the pylorus
with
conventional
maneuvers
The
patient did
not
manifest
adverse
effects.
Nursing Interventions
 Monitor BP carefully during IV administration.
 Monitor for extrapyramidal reactions, and consult physician if they occur.

45 | P a g e
 Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic
control is compromised by alterations in timing of food absorption.
 WARNING: Keep diphenhydramine injection readily available in case extrapyramidal
reactions occur (50 mg IM).
 WARNING: Have phentolamine readily available in case of hypertensive crisis (most
likely to occur with undiagnosed pheochromocytoma).
Name of Drugs
(Generic name,
Brand name)
Date
ordered;
Date
started;
Date
changed
Route of
Administration;
Dosage;
Frequency
response
to the
medication
Paracetamol
BRAND NAME
Biogesic
CLASSIFICATION
Anti-pyretic
DO:
08/14/13
DS:
08/14/13;
9 pm
DC:
08/14/13
1:20 am
PO 500mg
every 4 hours
PRN fever of
38.2 C
-Decreases
fever by a
hypothalamic
effect leading
to sweating
and
vasodilation
-Inhibits
pyrogen effect
on the
hypothalamic-
heat-regulating
centers
-Inhibits CNS
prostaglandin
synthesis with
minimal effects
on peripheral
prostaglandin
synthesis
-
Symptomatic
relief of
fever and
pain
The
patient did
not
manifest
adverse
effects.

46 | P a g e
 Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children.
 Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3
days for fever in adults.
 Extended-Release tablets are not to be chewed.
 Monitor CBC, liver and renal functions.
 Assess for fecal occult blood and nephritis.
 Avoid using OTC drugs with Acetaminophen.
 Take with food or milk to minimize GI upset.
 Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of
toxicity.
 Report paleness, weakness and heart beat skips
 Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools.
 Phenmacetin may cause urine to become dark brown or wine-colored.
 Report pain that persists for more than 3-5 days
 Avoid alcohol.
 This drug is not for regular use with any form of liver disease.
c. Diet
Type of Diet Date General Indications Specific Client’s

47 | P a g e
ordered;
Date
started;
Date
changed
Description foods taken response
or reaction
to diet
NPO 4 hours DO:
08/14/13
DS:
08/14/13;
9 pm
DC:
08/14/13
1:20 am
To DAT
No food intake
for 4 hours.
- - The
patient
complied.
2. ACTUAL SOAPIEs
SOAPIE #1 (August 15, 2013)

48 | P a g e
S: “Nahihirapan akong umihi, tsaka masakit dito sa may puson ko tsaka tagiliran,” as verbalized
by the patient.
O: Received patient in a sitting position in the bed, conscious and coherent; with ongoing IVF #2
PNSS 1L @ 600cc level regulated at 32gtts/min infusing through the right metacarpal vein; with
increased OFI but without output as of 9am, slightly febrile, good skin turgor, moist mucous
membrane; VS as follows: T of 37.7°C, PR of 96bpm, RR of 18bpm, BP of 100/60mmHg
A: Impaired Urinary Elimination r/t altered renal function AEB imbalance intake and output 2°
Acute Pyelonephritis
P: After 4 hours of nursing interventions, the patient will be able to participate in measures to
correct abnormal elimination
I:
 Established therapeutic relationship
 Assessed patient’s general condition
 Vital signs taken and recorded
 Noted age and gender of patient
 Investigated pain, noted location, duration and intensity
 Noted frequency of urination
 Asked client’s previous pattern of elimination
 Encouraged patient to increase oral fluid intake
 Discussed possible dietary restrictions such as caffeinated beverages
 Assisted with developing toileting routines such as tined voiding
 Provided tepid sponge bath
 Reminded SO for patient’s ultrasound
E: Goal met AEB patient participated in measures to improve urinary function

Page | 49
V. EVALUATION
1. Client’s Daily Progress Chart
DAYS ADMISSION
(08/14/13)
(08/15/13)
Nursing Problems
1. Acute pain
2. Hyperthermia
3. Impaired urinary
elimination
4. Impaired physical
mobility
√
√
√
√
√
√
Vital signs:
Temperature
Pulse rate
Respiratory rate
Blood pressure
38.2
90 bpm
28 bpm
90/60mmHg
37.7
96
18
100/60mmHg
Diagnostic or Lab
Procedures
Hematology Test
Clinical chemistry
Urine Analysis
Hgb: 115
Hct: 0.34
WBC: 1.65
Neutrophils: 0.60
Lymphocytes: 0.40
Platelets: 104
ANALYTE:
*Creatinine:60.5
ELECTROLYTES:
*Potassium: 3.49
*Sodium:140.3
*RBS:7.86
Color:
Dark Yellow
Transparency:
Turbid

50 | P a g e
Medical Mgmt.:
1. IVF
Albumin:
Negative
Reaction:
Positive
Specific Gravity:
1.030
Pus cells:
20-25/HPF
RRC:
18-20/HPF
Epithelial cells:
Many
Bacteria:
Heavy
IVF #1 1L PNSS IVF #2 1L PNSS
Drugs
1. Ceftriaxone
2. Paracetamol
3. Omeprazole
4. Metoclopromide
√
√
√
√
√
***
***
***
Diet NPO 4 hours DAT
Activity/Exercise - -
Surgical
Management
- -

51 | P a g e
III. SUMMARY OF FINDINGS
Pyelonephritis is caused by a bacterium or virus infecting the kidneys. One of the most
common renal diseases, acute pyelonephritis is a sudden inflammation caused by bacteria. It
primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules.
Kitkat experienced fever, nausea and vomiting, malaise, difficulty of breathing, cannot
eat, flank and back pain, and dysuria. The patient then was diagnosed to have acute
pyelonephritis. The patient had cold clammy skin and irregular heart rhythm upon assessment.
The patient’s vital signs were within normal limits.
For the diagnostic tests, the result of the patient’s HCT level was 0.34% which is below
the normal range which indicates low RBC/hemoglobin to the plasma level. It indicates anemia
and oxygen insufficiency. The patient has elevated lymphocytes which is 0.40 that indicates that
her immunity compromises and increases susceptibility to further infections. The patient’s
platelet count is 104×109/L that suggests presence of thrombocytopenia which predisposes
him to risks for bleeding.
For the result of the urinalysis of the patient, the color of the urine ranges from pale
yellow to amber because of the pigment urochrome (production of bilirubin metabolism).
Patient has turbid urine that may contain RBC’s or WBC’s bacteria, fat, or chyle, if may reflect
renal infection. The patient has positive reaction indicating bacterial invasion. The patient’s
specific gravity is higher than normal range which indicates the concentrated urine. The patient
has elevated levels which confirm the presence of microorganism in the urine.
PNSS 1L was administered to the patient to replace fluid loss and electrolyte loss,
maintain patient’s hydration, nutritional status and fluid balance. It is used to supply the
necessary nutrient to the patient. Medications such as Ceftriaxone, Omeprazole,
Metoclopramide and Paracetamol were given to the patient. Ceftriaxone is an antibiotic that
inhibits biosynthesis and arrests cell wall assembly resulting in bacterial cell death, since
pyelonephritis is usually caused by bacteria affecting the kidneys. Omeprazole is a proton pump
inhibitor that suppresses gastric acid secretion. Metoclopramide is a GI stimulant, antiemetic,
and dopaminergic blocker that enhances the motility of the upper GI tract and increases gastric

52 | P a g e
emptying time. Paracetamol is an anti-pyretic that decreases fever by a hypothalamic effect
leading to sweating and vasodilation.
The patient manifested problems with acute pain and impaired urinary elimination.
Acute pain is due to the atrophied parenchyma brought about by narrowing of the calyx neck
and scarring of parenchyma causes urine retention and which further causes unpleasant
sensation to the patient thereby by resulting to pain. The patient then manifested guarding
behavior and facial grimaces. There was impaired urinary elimination because the most
common mechanism by which a UTI develops is via ascending and invading bacteria. The
organism triggers an inflammatory response in the lining of the urinary tract. The patient then
manifested frequency of urination (5-6x/day), dysuria, and body malaise.
The patient complied with the treatment regimen. For the IVF, the patient tolerated IV
infusion. There was no complaint of any pain or irritation. For the medications, there were no
adverse effects towards the patient.
IV. CONCLUSION
The Urinary System is a system of organs that produces and excretes urine from the
body. The major organs of the urinary system are the kidneys, a pair of bean-shaped organs
that continuously filter substances from the blood and produce urine. Each kidney contains
about 1 million microscopic coiled channels, called nephrons, which perform this critical blood-
filtering function and produce urine in the process.
In addition to their vital role in ridding the body of wastes through the production of
urine, kidneys play important regulatory roles. They maintain water balance, ensuring that the
amount of water in body tissues remains at a constant level.
The precipitating factors of the said condition are obstruction of urinary outflow,
vesicoureteral reflux, neurogenic bladder, renal disease, and metabolic disturbances. While for
the predisposing factors we have gender, old age, lifestyle, environment, pregnancy,
instrumentation and chronic analgesic abuse that could all lead to renal failure.

53 | P a g e
In the case of the patient, the genetic factor, gender as well as lifestyle contributed to its
progress. The bacterial invasion caused infection to the kidneys. The patient then manifested
Increased WBC, inflammation of renal tissue, pain, fever, chills, and bladder irritation.
V. RECOMMENDATIONS
 This study is recommended to all student nurses in order to have a broader knowledge
regarding the condition Acute Pyelonephritis for them to become more efficient in
providing interventions that are necessary.
 This study is recommended to all Health Care Professionals in order to gain more
knowledge and updates regarding the condition.
 This is recommended to the Department of Health of the Philippines in order to address
concerns regarding the condition for them to take appropriate measures in preventing
the occurrence of the disease.
 This is recommended to all concerned citizens in order to raise their awareness
regarding the information covering Acute Pyelonephritis.

Page | 54
VI. LEARNING DERIVED
At the end, the researcher realized that there is always something new to learn
that could help you be a better healthcare provider. It is indeed true that learning never stops.
And with the current trends that we have, it is part of the nurses’ responsibility to keep
themselves abreast with the new trends.
With the study made by the researcher, he had able to identify what acute
pyelonephritis is, its risk factors, signs and symptoms of the disease, diagnostic procedure that
can be done to diagnose the disease, its medical treatment, prevention and nursing care plan
specific for the disease. With the knowledge learned during the study, the researcher can be
able to promote wellness by health teachings to patients and to persons unfamiliar with the
disease and prevention of the disease.
During the course of the study, the importance of proper bacterial
contamination control and hand washing was found out for the prevention in the spread of
bacterial contamination especially in the hospital.
The researcher found out that proper knowledge of the staff regarding the
disease condition of a patient with acute pyelonephritis is vital for the betterment of his service
as one of the providers of care on a hospital.
- Camba, Ma. Liezel M.
Our case, acute pyelonephritis, had made a big challenge to our group. For it was
our first time in the medicine ward and our first time to encounter it. Though we poured all our
efforts in making these case a successful one, there were still errors which we cannot avoid. I
had already a mindset, since the first time I made a case study, that all data that will be
collected must be true and reliable. Because making a case study must come from facts all
throughout. They must come from a good source such as the chart and the SO of the patient.

55 | P a g e
Until now I have only realized that sometimes, these data aren’t enough so it’s better to
analyze deeply the acquired data. We must ask some professional advice, such as from our
clinical instructor or the physician, if there are data that seems to be confusing. It is also helpful
if the acquired data are studied very carefully such as the drugs that are given to a patient.
Handling the patient manifested dysuria and pain made me appreciate more and
comprehend better about the case. I was able to help my patient by performing proper
interventions, most especially wound care. And it is quite an overwhelming feeling knowing
that somehow, I made my patient’s condition better.
-Lumba, Chared Joy D.
“Health is like money, we never have a true idea of its value until we lose it.”
~Josh Billings
The quote stated above made an analogy between health and money. It is true
that we have to value health like how we do value money. It is for the reason that once
health is lost, like money, it’s hard to get it back, or if you do get it back, oftentimes, you
can’t make it twice as good as before. While we are still in the healthy state of our lives, let
us spend as much energy as we could in order to maintain it. It is really hard when you
regret at the end of not doing your part in making yourself healthy, especially when you
know you had the chance to work it out.
As a student nurse, this was the first time that I got exposed in the Medicine
ward, only for a short span of time though. But still, I was able to witness the struggles of
each patient in the ward, striving to get better each day. I have encountered different grave
disease conditions that I once only knew and heard about in our lecture class.
Through this case study that we have made, I have gained more knowledge regarding a
disease that involves one of the major organs of the body which are the kidneys. They truly
serve a serious purpose. As a student nurse, I was able to be educated about this matter. As
a future registered nurse, hopefully, I will be making use of all the things I have learned

56 | P a g e
about the said condition, since it is usually encountered in the field. I have gained not only
knowledge but as well as confidence in carrying out with this condition because of the
things I have learned from it. Little by little, I am being more equipped with the actual
experience of encountering a patient with such condition and making a study out of it.
-Masbang, Maria Elaine D.
This case gave us a peek of the wide range of debilitating diseases that could
harm vital organs. It is expected that we, student nurses, could deliver to the needs of our
patients accordingly but through this case study presentation, the specific care we must provide
to the patient was in detail with rationale. Dealing with patients with pain is an extreme test if
character but on the other side,to know that she was able to share her pain with you is
somehow relieving. It is a fulfilling task and a privilege as well.
-Pugeda, Bianca Camille P.

211382077 final-ap-case-study

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (13)

Similar to 211382077 final-ap-case-study

Similar to 211382077 final-ap-case-study (20)

Recently uploaded

Recently uploaded (20)

211382077 final-ap-case-study