CARALOS, CARLA MAE M.

BSN 3YA-4

A.PYELONEPHRITIS

A patient consulted in the emergency department with complaints of high fever, chills,
dysuria, and back pain. Laboratory results are as follows:

WBC –13,000 cells/mcL

Neutrophils –10,000 per mm3

Lymphocytes –3,500 per mm3

Serum Sodium –136 mEq/L

Serum Potassium –3.7 mEq/L

Urinalysis:

Color: Hazy yellow

Bacteria: Too many to count

Pus cells: >100 cells/hpf

RBC: >100 cells/hpf

Specific gravity: 1.280

The doctor ordered co-trimoxazole (Bactrim) 800/160mg tablet TID for 14 days and
phenazopyridine (Pyridium) 200 mg tablet TID for 3 days. Given the above case, answer
the following questions:

1. What laboratory values point towards the diagnosis of Pyelonephritis?

• Urine analysis report showing presence of bacteria, increased pus cells and increased
RBCs points towards the diagnosis of pyelonephritis. Elevated WBC count is also
suggestive of infection.

2. What is the most common causative agent of urinary tract infections?

•The main cause of acute pyelonephritis is gram-negative bacteria, the most common being
Escherichia coli. Other gramnegative bacteria which cause acute pyelonephritis include
Proteus, Klebsiella, and Enterobacter.
3. Give at least two (2) health teaching points that will help the prevention of
recurrence of UTI?

•Drink plenty of liquids, maintain personal hygiene

4. Create a drug study for the medication: CO-TRIMOXAZOLE specifying the following

CONTRA NURSING
NAME ACTION INDICATION INDICATION SIDE EFFECTS CONSIDERATION
Generic Name: Sulfamethoxazole Uncomplicat - Contraindicated Skin: Mild to •Should be taken
Co-Trimaxole interferes with ed UTI with allergy to moderate with
Therapeutic Class: bacterial folic acid caused by trimethoprim and rashes food (Best taken
• Antibiotics synthesis and susceptible sulfamethoxazole, (including fixed after
Pharmacologic growth via strains pregnancy drug meals w/ an
Class: inhibition of (teratogenic in eruptions), adequate amount of
•Sulfonamidesfola of dihydrofolic acid Escherichiac preclinical toxic epidermal fluid.).
te formation from oli, studies), necrolysis. •Advise patient to
antagonists paraamino benzoic Proteus megaloblastic GI: Nausea, complete full course
Dose: Adult dose: acid; trimethoprim mirabilis, anemia due to vomiting,diarrh of therapy.
800 mg of inhibits Klebsiella folate ea,anorexia, •Encourage patient
sulfamethoxaz ole dihydrofolic pneumoniae, deficiency. -Use hepatitis, to
and 160 mg acid reduction to Enterobacter cautiously with pseudomembra maintain adequate
trimethoprim tetrahydrofolate species, and hepatic or renal nous fluid intake to
once a resulting in coagulase impairment, enterocolitis, prevent
day or 400 mg of sequential negative lactation stomatitis,gloss crystalluria
sulfamethoxaz ole inhibition of staphylococc itis, abdominal •Advise patient to
and 80 mg of enzymes of the us pain. take tablet with full
trimethoprim folic acid pathway. species Urogenital: glass of water.
every including S. Kidney failure, •Educate patient
12 hours for 10- saprophyticu oliguria, anuria, and
14 s. crystalluria. family to report any
days Hematologic: signs of
Agranulocytosis superinfection such
(rare), aplastic as fever, vaginitis,
anemia (rare), oral candidiasis,
megaloblastic and
anemia, fatigue.
hypoprothromb •Instruct patient to
inem report these
ia,thrombocyto symptoms to health
penia care provider: skin
(rare). rash, sore throat,
Body as a fever, unusual
Whole: bruising or
Weakness, bleeding.
arthralgia, •Caution patient to
myalgia, avoid exposure to
photosensitiviy, sunlight and to use
allergic sunscreen or wear
myocarditis. protective clothing
Hypersensitivit to avoid
y to photosensitivity
TMP,SMZ, reaction
 sulfonamides,
or bisulfites;
group A
beta-hemolytic
streptococcal
pharyngitis;
megaloblastic
anemia due to
folate
deficiency;
creatinine
clearance
<15mL/min;
pregnancy(cate
gory
C), lactation.
Not
recommended
for infants
<2mo.

B. GLOMERULONEPHRITIS

A patient with cleft lip and bronchial asthma was brought to the emergency department
with chief complaint of low-grade fever, puffiness of the face and eyes in the morning, +2
edema on both feet, and tea-colored urine. Urinalysis revealed numerous RBC andcertain
degree of proteinuria and Antistreptolysin-O titer reaches more than 300 todd units. The
doctor came up with the diagnosis of Acute Glomerulonephritis (AGN). Answer the
following questions:

1. What history-taking question should be asked by the nurse to strengthen the diagnosis of
AGN?

•Family history and history of recent infection

2. Explain the pathophysiological tracing on the development of AGN.

•Structurally, cellular proliferation leads to an increase in the number of cells in the

glomerular tuft because of the proliferation of endothelial, mesangial, and epithelial cells.

•The proliferation may be endocapillary (i.e., within the confines of the glomerular capillary
tufts) or extracapillary (ie, in the Bowman space involving the epithelial cells).

• In extracapillary proliferation, proliferation of parietal epithelial cells leads to the

formation of crescents, a feature characteristic of certain forms of rapidly progressive GN.

•Leukocyte proliferation is indicated by the presence of neutrophils and monocytes within

the glomerular capillary lumen and often accompanies cellular proliferation.
 • Glomerular basement membrane thickening appears as thickening of capillary walls on
light microscopy. Electron-dense deposits can be subendothelial, subepithelial,
intramembranous, or mesangial, and they correspond to an area of immune

3. The doctor ordered hydrocortisone TIV, create a drug study specifying the following:

NURSING
NAME ACTION INDICATION CONTRAINDICATION SIDE EFFECTS CONSIDERATIO
N
Generic Name: Decreases Endocrine - Untreated serious • Increased • Determine
hydrocortisone inflammation disorders: infections (except appetite whether
Therapeutic , mainly Acute tuberculous • Irritability patient is
Class: by stabilizing adrenocortical meningitis or septic • Difficulty sensitive to
•Corticosteroids leukocyte insufficiency; shock) sleeping other
Pharmacologic lysosomal congenital - Idiopathic (insomnia) corticosteroids.
Class: membranes; adrenal thrombocytopenic • Stomach • Always adjust
•Glucocosteroid suppresses hyperplasia; purpura - upset lowest
s immune hypercalcemia Intrathecal (take with effective dose
Dose: response; associated with administration food) • Monitor
•100 to 500 mg stimulates cancer; (injection) • Impaired patient’s
succinate I.V; bone nonsuppurativ - Documented wound weight, BP, and
repeat every 2, marrow; and e hypersensitivity healing electrolyte
4, or 6 hours. influences thyroiditis; - Administration of • Increased levels.
protein, primary live or live, blood • Tell the
fat, a or secondary attenuated sugar levels patient not
carbohydrate adrenocortical vaccines (persons to stop
metabolism. insufficiency; is contraindicated with abruptly or
preoperatively in diabetes without
and in patients receiving may need prescriber’s
the event of immunosuppressiv to have consent.
serious e blood sugar • Warn
trauma or doses of the drug levels patients about
illness, in monitored easy bruising
patients with more closely • Warn patient
known and on
adrenal possible long term
insufficiency adjustments therapy
or when to about
adrenocortical diabetes cushingoid
reserve is medications effects and
doubtful; ) need to
shock • Mood notify the
unresponsive swings prescriber.
to
 conventional
therapy if
adrenocortical
insufficiency
exists
or is suspected.

C.RENAL CALCULI

An elderly patient with osteoporosis consulted in an Out-patient Department with complaints

of severe lower back pain. She is taking 1000 mg of calcium carbonate once a day and reports
of poor hydration due to her mobility problems. Ultrasound of the Kidneys, ureters, and
bladder reveal several calculi in both kidneys and is counselled to be a candidate for
nephrolithotomy. Answer the following questions:

1. What pertinent data in the patient’s history may have contributed with the development
of renal calculi, defend your answer?

• Extra calcium can build up in the bloodstream and, when excreted through kidneys in urine, it
can cause a kidney stone. It can also cause the bones to weaken. It is important to include the
right amount of calcium in your diet. Some people may think they can keep stones from
forming by avoiding calcium, but the opposite is true.

2. Identify three (3) priority nursing diagnoses in relation to the patient’s condition and create
a hypothetical Nursing Care Plans for each nursing diagnosis.

• Acute Pain

•Impaired Urinary Elimination

• Risk for Deficient Fluid Volume

3. Identify at least two (2) health teaching points on the prevention of recurrence of renal
calculi for the patient.

•Stay hydrated. Drinking more water is the best way to prevent kidney stones. If you don’t
drink enough, your urine output will be low. Low urine output means your urine is more
concentrated and less likely to dissolve urine salts that cause stones.

• Eat more calcium-rich foods. The most common type of kidney stone is the calcium oxalate
stone, leading many people to believe they should avoid eating calcium. The opposite is true.
Low-calcium diets may increase your kidney stone risk and your risk of osteoporosis.
 D. RENAL FAILURE

A patient with uncontrolled Type 2 Diabetes consulted in the emergency department due to
shortness of breath, bipedal edema, palpitation, and decreased urinary output during the past
2 days. The following laboratory test values are presented:

Serum Creatinine –2.5 mg/dL

BUN level –30 mg/dL

Serum potassium –5.9 mEq/L

HBA1C –8%

A diagnosis of Acute Renal Failure secondary to DM Nephropathy was made by the doctor.
Sodium polyesterene sulfonate

(Kayexalate) was ordered to normalize potassium level. Oral hypoglycemic agents were revised,
and insulin therapy was started to manage the blood sugar level. Urine output is closely
monitored for possible hemodialysis. Answer the following questions:
1. Explain the relationship of diabetes mellitus on the development of acute renal failure
using a flow chart.

2. Identify three (3) nursing diagnoses pertinent to the patient’s condition and create
hypothetical Nursing Care Plans

(NCPs) for each nursing diagnosis.

•Excess Fluid Volume

• Risk for Decreased Cardiac Output

• Risk for Imbalanced Nutrition: Less Than Body Requirements

ASSESSMEN NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

T DIAGNOSTIC KNOWLEGDE

SUBJECTIVE: Excess fluid Nephrotic After 48 hours 1. The nurse After 48 hours
“Apat na volume Syndrome of nursing will monitor 1. Accurate of nursing
araw na related to intervention the patient monitoring intervention
akong hindi compromised Renal the client will: intake and of I&O is theclient was
nakakaihi ng regulatory Resistance to - The patient output every necessary able to: The
maayos, mechanisms ANP will have shift. for goal was met
kung secondary to Intravascular negative or 2. The nurse determining - The patient
meron man acute renal volume equal intake will assess the renal was able to
ay failure as expansion and output patient’s function maintain
pakonti-konti evidence by Increased during peripheral and fluid normal fluid
lang at ang peripheral intravascular hospitalization. edema every replacement balance as
kulay edema and hydrostatic - The patient shift. needs and evidenced by
ay dark weight gain pressure will have 3. Monitor reducing risk equal intake
brown” decreased urine specific of fluid and output.
as verbalized Edema peripheral gravity overload. - The patient
by edema of 1+ or 4. The nurse 2. Periorbital have
the client. Continued salt less within 48 will call any edema may decreased
and water hours. abnormal BUN be a peripheral
OBJECTIVE: intake - The patient and creatinine presenting edema of 1+
• 4+ pitting will have 30 cc result to the sign of this within 48
edema in or greater of MD. fluid shift hours.
pt’s urinary output 5. The nurse because - The patient
legs during a 24 will weigh the these have 30 cc or
•fine hour period. patient daily. fragile urinary
crackles in - The patient 6. The nurse tissues output
lungs will verbalize will educate are easily during a 24
•BP 180/110, the the patient distended by hour period.
HR importance of about the even minimal - The patient
110, oxygen daily weights importance of fluid wasable to
saturation and limiting daily weights accumulation verbalize
89% salt intake by and limiting of the the
on RA, and discharge. salt intake by burned area. importance
dyspnea - The patient discharge. 3. To of daily
•labs: will verbalize 7. The nurse measure weights
potassium understanding will kidney’s and limiting
6.0, Hgb 8.0, about how educate the ability to salt intake by
Hct hemodialysis patient about 5 concentrate discharge.
29.3, BUN works before foods that urine. -The patient
6.5, dialysis. contain high 4. Indicators was able to
and salt of verbalize
Creatinine intake to avoid nutritional understanding
52 by needs, about how
• cold, discharge. restrictions, hemodialysis
clammy 8. The nurse and works before
skin/poor will necessity for dialysis.
capillary refil educate the and
fruritus. patient about effectiveness
how of
hemodialysis therapy.
works before 5. Daily body
patient has weight is
dialysis. best monitor
 of fluid
status. A
weight gain
of more
than 0.5
kg/day
suggests
fluid
retention.
6. Health
teaching is
important to
prevent
further
renal
damage
during the
recovery
phase.
7. To
educate the
client about
what foods
to avoid to
prevent
further renal
damage.
8. Informed
consent is
important in
every
surgical
procedures
ASESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATIO
DIAGNOSI KNOWLEGE N
S
SUBJECTIVE: Risk for Short-term: 1. Note skin 1. Cold, Outcome
“ang sakit decreased Disproportiona Within 8 color, clammy, met.
ng dibdib ko cardiac te reduction in hours of temperature, and pale skin is Within 3
nurse” output renal perfusion nursing and secondary to days of
As related to care, moisture. compensatory nursing
verbalized increased Diminished patient will 2. Check for any increase in care, the
by the cardiac glomerular be able to alterations in sympathetic patient was
client. load filtration rate participate level of nervous able to
 in activities consciousness. system report and
OBJECTIVE: Risk for that reduce 3. Closely stimulation demonstrat
• 4+ pitting decreased the monitor for and low ea
edema in cardiac output workload of symptoms of cardiac decrease in
pt’s the heart heart failure output and episodes of
legs such as and oxygen dyspnea.
•fine therapeutic decreased desaturation.
crackles in medication cardiac output, 2. Decreased T: 36. 3ºC P:
lungs regimen, including cerebral 96
•BP weight diminished perfusion and bpm R: 23
180/110, reduction, quality of hypoxia are cpm
HR110, and peripheral reflected in BP: 120/90
oxygen balanced pulses, cold and irritability, mmHg
saturation activity/rest clammy skin and restlessness,
89% plan. extremities, and
on RA, and increased difficulty
dyspnea Long-term: respiratory rate, concentrating.
•labs: Within 3 presence of Aged patients
potassium days of paroxysmal are particularly
6.0, Hgb 8.0, nursing nocturnal susceptible to
Hct 29.3, care, dyspnea or reduced
BUN 6.5, patient will orthopnea, perfusion.
and be able to increased heart 3. As these
•Creatinine report or rate, neck vein symptoms of
52 demonstrat distention, heart failure
cold, e decreased level progress,
clammy decreased of cardiac output
skin/poor episodes of consciousness, declines.
capillary dyspnea and presence of 4. These
refill edema. actions
•pruritus 4. If chest pain is can increase
present, have oxygen
patient lie delivery
down, to the
monitor cardiac coronary
rhythm, give arteries and
oxygen, run a improve
strip, medicate patient
for pain, and prognosis.
notify the 5. Atrial
physician. fibrillation is
5. Place on common in
cardiac monitor; heart
monitor for failure.
dysrhythmias, 6. Depending
especially atrial on
fibrillation. etiological
6. Administer factors,
medications as common
prescribed, medications
noting side include
effects and digitalis
toxicity. therapy,
7. Position diuretics,
patient in vasodilator
semiFowler’s to therapy,
highFowler’s antidysrhythmi
8. Administer cs,
oxygen therapy angiotens
as prescribed. inconverting
9. During acute enzyme
events, ensure inhibitors, and
patient remains inotropic
on bed rest or agents.
maintains 7. Upright
activity position is
level that does recommended
not compromise to reduce
cardiac output. preload and
ventricular
filling when
fluid
overload is the
cause.
8. The failing
heart may not
be
able to
respond
to increased
oxygen
demands.
Oxygen
saturation
need
to be greater
than 90%.
9. In severe
 heart
failure,
restriction
of activity
often
facilitates
temporary
recompensatio
n.

ASSESMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSTIC KNOWLEDGE
SUBJECTIVE: Impaired Pruritus After 48 1. Inspection of 1. Indicates After 48
“ang kati kati Skin hours of the skin to areas poor hours
ng katawan Integrity Broken Skin nursing change color, circulation of nursing
ko hidi related intervention turgor, or damage intervention
Ako to pruritus. Trauma on the client vascular, that may the
makatulog” the skin will: note any lead to the client was
as verbalized - Maintain redness. formation able
by the client Risk for skin intact of pressure to: The goal
integrity skin. 2. Monitor sores / was met
OBJECTIVE: -Show the fluid infections.
• 4+ pitting behavior / intake and - Maintained
edema in pt’s technique hydration of 2. Detecting skin
legs to prevent the the integrity
•fine crackles skin skin and presence of
in damage. mucous dehydration - Shows the
lungs membranes. or over behavior and
•BP 180/110, hydration technique to
HR 3. Inspection of affecting prevent skin
110, oxygen the area circulation damage.
saturation depends on and skin
89% the integrity
on RA, and edema.
dyspnea 3. Tissue
•labs: 4. Change edema
potassium position as is more
6.0, Hgb 8.0, often likely to
Hct as possible. be
29.3, BUN damaged or
6.5, 5. Give skin torn
and care.
•Creatinine 4. Lowering
52 6. Maintain a pressure on
cold, clammy dry linen edema,
skin/poor poorly
capillary refill 7. Instruct the perfused
•pruritus patient to use tissue
a damp and to reduce
cold ischemia.
compresses to
pressure on 5. Reduce
the area of drying, skin
pruritus. tears

6.Lowering
dermal
irritation
and the risk
of skin
damage

7. Eliminate
discomfort
to reduce
skin injury.

3. Create a drug study for the medication: SODIUM POLYESTERENE SULFONATE

specifying the following

Generic Name: KAYEXALATE KAYEXALATE is SPS is Mild adverse •Lab tests:

Sodium increases fecal indicated for contraindicated effect: Determine
Polystyrene potassium the in - Diarrhea Serum
Sulfonate excretion treatment of the following - Nausea potassium
Therapeutic Class: through hyperkalemia. conditions: - Vomiting levels daily
Potassiumremoving binding of - Loss of throughout
resins potassium in - Hypokalemia appetite therapy.
Pharmacologic thelumen of - Previous Serious side
Class: the history of effects Monitor acid–
Cation-exchange gastrointestinal hypersensitivity are: base balance,
resins tract. Binding to polystyrene - Ischemic electrolytes,
Dose: of potassium sulfonate resins colonic and minerals in
15 g (60 mL) to 60 g reduces the - Bowel necrosis patients
(240 mL) concentration Obstruction - Constipation receiving
of free - Neonates - Seizures repeated
potassium in with - Confusion doses.
the reduced gut - Muscle
gastrointestinal motility weakness •Serum
lumen, - Abdominal potassium
resulting in a pain levels do not
reduction of - Irregular always
serum heartbeat reflect
potassium intracellular
levels potassium
deficiency.
Observe
patient
closely for
early
clinical signs of
severe
hypokalemia
(see Appendix
F).
ECGs are also
recommended.

•Consult
physician
About
restricting
sodium
content from
dietary and
other
sources since
drug
contains
approximately
100
mg (4.1 mEq)
of sodium per
gram (1
tsp, 15 mEq
sodium).