COLLEGE OF NURSING

A CASE STUDY OF

PATIENT WITH

ACUTE PYELONEPHRITIS

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

Submitted to:
DENNISON JOSE C. PUNSALAN, RN, MN

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 FROM THE CHART) .................................................................................. 13 First Nurse-Patient Interaction ........................................................................................................... 14 7. DIAGNOSTIC AND LABORATORY PROCEDURES .................................................................................. 17 III. ANATOMY AND PHYSIOLOGY ............................................................................................................... 24 SCHEMATIC DIAGRAM (CLIENT-CENTERED) .......................................................................................... 30 IV. THE PATIENTS ILLNESS ......................................................................................................................... 31 Synthesis of the disease ......................................................................................................................... 31 1. Definition of the disease ................................................................................................................. 31 2. Predisposing/Precipitating Factors ................................................................................................. 33 3. Signs and Symptoms ....................................................................................................................... 34 2|Page

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. CLIENTS DAILY PRORGESS IN THE HOSPITAL ...................................................................................... 63 1. Clients Daily Progress Chart ............................................................................................................... 63 VII. CONCLUSION AND RECOMMENDATIONS ........................................................................................... 68 VIII. LEARNING DERIVED ............................................................................................................................ 68 IX. BIBLIOGRAPHY ...................................................................................................................................... 71 Books .................................................................................................................................................... 71 Websites ............................................................................................................................................... 71

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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 bodys 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.

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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 directionfrom 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 prostatethe 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.

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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.

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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 lifealtering 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
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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 familys 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 clients 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 clients 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
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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 D10 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, Kitkats 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 hasnt 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 familys 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.
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Their family uses herbal medications such as oregano. They also believe in quack doctors (albularyos) but they still prefer medical treatment.

c. Environmental factors Kitkats 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

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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 lines 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 Kitkats 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 didnt do any home management. The patient then was diagnosed

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to have acute pyelonephritis. Initial vital signs were taken and as follows: T of 38.2C, 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 Daily Vital Signs Date Temperature Axilla (C) Pulse rate (bpm) Respiratory Rate(bpm) Blood Pressure (mmHg) Physical Examination: General : conscious, coherent Skin: (-) pallor, (-) cyanosis HEAD - HEENT: (-) colds Chest/Lung: CBS Rectum: (+) CVA tenderness Musculoskeletal: (-) weakness ADMITTING IMPRESSION: Acute Pyelonephritis
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August 14 38.2C

August 15 39.7C

96 bpm

96 bpm

25 bpm

18 bpm

90/60 mmHg

100/60 mmHg

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 39.7C, PR of 96bpm, RR of 18bpm, BP of 100/60mmHg Vital Signs: T: 39.7C PR: 96bpm RR: 18bpm BP: 100/60mmHg

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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
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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

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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
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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

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6. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostics/ Laboratory Procedures

Date ordered; Date results

Indication(s) Or Purpose

Results

Normal Values

Creatinine

Potassium

The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly DO&DR: reliable 08/14/13 indicator of kidney function. Elevated creatinine level signifies impaired kidney function or kidney disease. A potassium test checks how much potassium is in the blood. Potassium is both an electrolyte a nd a mineral. It DO&DR: helps keep the 08/14/13 water (the amount of fluid inside and outside the body's cells) and electrolyte balance of the body. Potassium is also

60.5 umol/l

58-120 umol/l

Analysis and Interpreta tion Of results (clientcentered) The result was normal which means that the patients kidneys are working well

The patient has hypokale mia indicating electrolyte imbalance 3.49 mmol/l 3.50-5.50 mmol/l

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important in how nerves and muscles work. A test for sodium in the urine is a 24hour 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 DO&DR: helps keep the 08/14/13 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. RBC count is used to evaluate any type of decrease or DO&DR: increase in the 08/14/13 number of red blood cells as measured per liter of blood. A hemoglobin determination is DO&DR: used to evaluate 08/14/13 the hemoglobin content (and thus the iron The patient has normal sodium level

Sodium

140.3 mmol/l

135-145 mmol/l

Red blood cells

7.86 mmol/l

4-9 mmol/l

The patient has normal red blood cells

Hemoglobin

115

M:125-175g/L F:115-155g/L

The hemoglobi n level of the patient is normal.

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Hematocrit

DO&DR: 08/14/13

status and oxygen-carrying capacity) of erythrocytes by measuring the number of grams of hemoglobin per liter of blood 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

Thus, indicating normal oxygenati on in the blood.

0.34

M: 0.40-0.52 F: 0.38-0.48

White blood cells

DO&DR: 08/14/13

Helpful in the evaluation of the patient with infection, neoplasm, allergy or immunosuppres sion

1.65

5-10109/L

The result was below the normal range which indicates low RBC/hemo globin to the plasma level. It indicates anemia and oxygen insufficien cy. The patients WBC count falls below the normal range, it is usually an indication of an underlying disease. She is immunosu ppressed.
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Neutrophils

Lymphocytes

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 DO&DR: there duty to 08/14/13 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. Determine if there is enough cell that produces antibodies and other chemicals responsible for DO&DR: destroying 08/14/13 microorganisms; contributes to allergic reactions, graft rejection, tumor control, and regulation of the immune

The patients neutrophil s are within normal range.

0.60

0.45-0.65

0.40

0.20-0.35

The patient has elevated lymphocyt es which compromi ses her immunity and increases susceptibil ity to further infections.
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system

Platelet count

Urinalysis

Platelets, which are also called thrombocytes, are small diskshaped blood DO&DR: cells produced 08/14/13 in the bone marrow and involved in the process of blood clotting. 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. DO&DR: Urinalysis 08/14/13 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

104

The patient has thromboc ytopenia 150-400109/L which predispos es him to risks for bleeding. 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 RBCs or WBCs bacteria, fat, or chyle, if
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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

examined microscopically for RBCs WBCs, 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 kidneys functioning well.

may reflect renal infection. Albumin no proteinuri a in urine Reaction: The patient has positive reaction indicating bacterial invasion. Specific gravity: The patients specific gravity is higher than normal range which indicates the concentra ted urine. Pus cells, RRC, Epithelial cells and Bacteria: The patient has
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elevated levels which confirms the presence of microorga nism in the urine

Nursing Responsibilities: Obtain blood sample from brachial artery Mainstream clean catch urine

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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 beanshaped 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.

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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 patients 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

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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 kidneys 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 bladders 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
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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----Obstruction of urinary outflow -Vesicoureteral reflux -Neurogenic bladder -Renal disease -Metabolic disturbances

--PREDISPOSING FACTORS--gender -older age -lifestyle -environment -pregnancy -instrumentation -chronic analgesic abuse

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Bacteria gain access to blood Systematic arteries

intestinal m.o

exogenous m.o

genitor-urinary m.o

Urethra Systemic circulation Ureters and bladder

Kidney Infection Increase WBC and platelet Inflammation of renal tissue small abscess in the calyx surface fever pain

pain, fever, bladder irritation pain, pyuria

Suppuration (Pus Formation) change of abscess to lesions bleeding in the mucous Increase polymorphonuclea leukocytes in the tubules and in the interstitium surrounding the tubules membrane of the adjacent collecting system

Necrosis of renal tissue Destruction of segments of tubules

dysuria

leukocyte casts (Accumulation of WBC)

may lead to renal failure

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PATHOPHYSIOLOGY OF THE DISEASE (PATIENT CENTERED)

----PRECIPITATING FACTORS----

--PREDISPOSING FACTORS--gender -lifestyle

Bacterial invasion

intestinal m.o

exogenous m.o

genito-urinary m.o

Urethra

Ureters and bladder

Kidney

Infection

Increase WBC & Inflammation of renal tissue

Pain, fever, chills, bladder irritation

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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 -gender -older age -lifestyle -environment -pregnancy -instrumentation -chronic analgesic abuse PRECIPITATING FACTORS -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.

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B. PLANNING (NURSING CARE PLAN)

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Problem #1: Acute pain related to frequency of urination

Assessment Nursing diagnosis Scientific explanation S> Acute pain related to frequency of O>patient manifested: >guarding behavior >facial grimaces urination Atrophied parenchyma brought about by narrowing of the calyx neck and scarring of parenchyma causes The pt. May urine retention and which further causes unpleasant sensation to the patient thereby by resulting to pain. Long term goal: after 3 days of nursing interventions the patient will be able to report less pain or increase pain tolerance. >Eliminate additional stressors or sources of discomfort whenever possible. >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 will be able to verbalize ways to decrease pain. >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 >To identify extent of pain. Short-term goal: after 3 hours of nursing interventions, >Some people deny the experience of pain when it is present. patient shall have verbalized ways to decrease pain. Objective Interventions Rationale Expected outcome

manifest: >suprapubic tenderness >low back pain or flank pain >fever >chills >fatigue >anorexia

Long term goal: >Early intervention may decrease the total amount of analgesia required. after 3 days of nursing interventions the patient shall have reported less pain or increase pain tolerance.

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>Provide rest periods to facilitate comfort, sleep and relaxation.

>The pts experiences of pain may become exaggerated as the result of fatigue. >Decreases ones awareness and experience of pain. Some methods are breathing modifications and nerve stimulation.

>Use nonpharmacologic painrelief methods: distraction techniques, relaxation techniques, music therapy.

>Notify physician if interventions are unsuccessful or if current complaint is significant change from past experience.

>To prescribe medication if possible.

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Problem #2: Hyperthermia

Cues Nursing diagnosis Nursing objective Planning Nursing intervention Rationale Evaluation

Subjective Cues: Nung isang araw pa mainit ang pkramdam ko as verbalized by the client Objective Cues: Body temperature above normal range. T-38.3 P-105Bpm R-24 bpm BP-130/90 mmHg Warm to touch. Flushed skin Tachycardia Diaphoresis

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

Identify underlying cause.

To assess causative factors to the clients fever thus formulati on of appropri ate nursing intervent ion.

After 2 hours of nursing intervention The clients body temperature is decreased to a normal range

Put local ice packs especially in groin and axillae.

Formulate health teachings that would be helpful to lessen the clients temperature.

Provide tepid sponge bath. Teach client to increase fluid intake.

Establish cool environment by opening air vents and window panes.

This areas has high blood flow and

Advise

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relatives not to cover the client with a blanket, and use less restrictive clothings Administer Anti pyrectics as prescribed

putting ice packs 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

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of clients temperat ure. For immediat e alteratio n of body temperat ure

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Problem #3: Impaired urinary elimination related to disease conditions.

Assessment Nursing diagnosis Scientific explanation S> Panay ang ihi ko Impaired urinary elimination related to disease O> patient manifested: >Frequency of urination (5-6x/day) >Body malaise >A febrile The organism triggers an inflammatory response in the lining of the urinary Patient may manifest: >dysuria >Incontinence tract. Long term: After 2 days of nursing intervention the patient will be able to demonstrate behavior techniques to prevent urinary tract infection >Instruct client to increase fluid intake >To adjust care as indicated >Encourage client to verbalize fear and concern >To provide comfort >Determine client usual daily fluid intake >To obtain baseline data conditions. The most common mechanism by which a UTI develops is via ascending and invading bacteria. Short term: After 1-3 hours of nursing interventions patient will be able to verbalize understanding on the health teachings given >Determine client previous pattern of elimination and compare with current situations Long term: The patient shall have demonstrated behavior and techniques to prevent urinary infection >Contribute to immobility >Note the age and sex of the client (UTIs are prevalent among women and older men) >To gather baseline data Short term: the patient shall have verbalized understanding of the condition Objective Interventions Rationale Expected outcome

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>Recommend avoidance of 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 S> Report of pain and Impaired physical mobility r/t O> irritability >Gait changes >pain ranges from 6 out of 10 acute pain Scientific Explanation Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical Long Term: After 3 days of Nursing Intervention, the patient >Schedule activities with adequate rest >to reduce fatigue Long Term: After 3 days of Nursing Intervention, the Short Term: After 3hrs of NPI, the patient will be able to verbalize willingness to and demonstrate participation in activities. >Observe patients movements >to note any incongruence with reports of abilities. >Monitor V/S and Record >to obtain baseline data Short Term: After 3 hrs of NPI, the patient shall have verbalized willingness to and demonstrate participation Objectives Interventions Rationale Expected Outcome

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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 enable activities. resumption that of

periods during the day

patient shall have demonstrated techniques/behaviors that

>Encourage participation in self-care, occupational, diversional, recreational activities

>enhances selfconcept and sense of independence.

enable resumption of activities.

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C. IMPLEMENTATION 1. MEDICAL MANAGEMENT a. IVFs

Medical Management/ Treatment PNSS 1L fast drip 500cc; then 200cc/hour

Date ordered; Date performed; Date changed DO:08/14/13 8:15pm DP:08/14/13 DC: -

General Description

Patients response to the treatment It is a sterile, To replace fluid Patient nonpyrogenic loss and tolerated IV solution for fluid electrolyte loss, infusion. He and electrolyte r maintain does not eplenishment patients complain of and caloric hydration, any pain or supply in single nutritional status irritation. dose containers and fluid for intravenous a balance. It is use dministration. It to supply the contains necessary no antimicrobial nutrient to the agents. patient.

Indication/ Purpose

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
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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)

Ceftriaxone BRAND NAME Rocephin CLASSIFICATION Antibiotic Cephalosporin (third generation)

Date ordered; Date started; Date changed DO: 08/14/13 DS: 08/14/13 DC: -

Route of General action Administration; Dosage; Frequency

Indications

Clients response to the medication

IV 1gram + 30cc D5W x 30 min. infusion every 12 hours

Ceftriaxone binds to one or more of the penicillinbinding 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 UTIs 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.

Nursing Interventions: Assess patients previous sensitivity reaction to penicillin or other cephalosphorins. Assess patient for signs and symptoms of infection before and during the treatment Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated.
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Report signs such as petechiae, cchymotic areas,epistaxis or other forms of unexplained bleeding. Monitor hematologic, electrolytes, renal and hepatic function. Assess for possible super infection, itching fever Date ordered; Date started; Date changed Route of General Administration; action Dosage; Frequency Indications Clients response to the medication

Name of Drugs (Generic name, Brand name)

Omeprazole BRAND NAME Losec

DO: IV 40mg now 08/14/13

DS: 08/14/13 9 pm

CLASSIFICATION Gastrointestinal agent; proton pump inhibitor

DC: 08/14/13 1:20 am

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 -gastroesophageal 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.
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Do not breast feed while taking this drug. Date ordered; Date started; Date changed Route of Administration ; Dosage; Frequency General action Indications Clients response to the medicatio n

Name of Drugs (Generic name, Brand name)

Metoclopromid e

DO: 08/14/13

IV 40mg now

BRAND NAME Reglan

DS: 08/14/13 ; 9 pm

CLASSIFICATION GI stimulant, Antiemetic, Dopaminergic blocker DC: 08/14/13 1:20 am

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.

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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). Date ordered; Date started; Date changed Route of General action Administration; Dosage; Frequency Indications Clients response to the medication

Name of Drugs (Generic name, Brand name)

Paracetamol

DO: 08/14/13

BRAND NAME Biogesic DS: 08/14/13; 9 pm CLASSIFICATION Anti-pyretic 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 hypothalamicheat-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.

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Nursing Interventions: 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

Clients
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ordered; Date started; Date changed NPO 4 hours DO: 08/14/13

Description

foods taken

response or reaction to diet

No food intake for 4 hours.

The patient complied.

DS: 08/14/13; 9 pm

DC: 08/14/13 1:20 am To DAT

2. ACTUAL SOAPIEs SOAPIE #1 (August 15, 2013)

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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 37.7C, 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 patients 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 clients 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 patients ultrasound E: Goal met AEB patient participated in measures to improve urinary function

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V.

EVALUATION

1. Clients Daily Progress Chart

DAYS Nursing Problems 1. Acute pain 2. Hyperthermia 3. Impaired urinary elimination 4. Impaired physical mobility Vital signs: Temperature Pulse rate Respiratory rate Blood pressure Diagnostic or Lab Procedures Hematology Test

ADMISSION (08/14/13)

(08/15/13)

38.2 90 bpm 28 bpm 90/60mmHg

37.7 96 18 100/60mmHg

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
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Clinical chemistry

Urine Analysis

Albumin: Negative Reaction: Positive Specific Gravity: 1.030 Pus cells: 20-25/HPF RRC: 18-20/HPF Epithelial cells: Many Bacteria: Heavy Medical Mgmt.: 1. IVF Drugs 1. Ceftriaxone 2. Paracetamol 3. Omeprazole 4. Metoclopromide Diet Activity/Exercise Surgical Management

IVF #1 1L PNSS

IVF #2 1L PNSS

*** *** *** NPO 4 hours DAT -

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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 patients vital signs were within normal limits. For the diagnostic tests, the result of the patients 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 patients platelet count is 104109/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 RBCs or WBCs bacteria, fat, or chyle, if may reflect renal infection. The patient has positive reaction indicating bacterial invasion. The patients 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 patients 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
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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 bloodfiltering 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.
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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.

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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.
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Until now I have only realized that sometimes, these data arent enough so its 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 patients 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, its hard to get it back, or if you do get it back, oftentimes, you cant 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
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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.

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