Question

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?

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

3. Give at least two (2) health teaching points that will help the prevention of

recurrence of UTI?

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

following:

a. Drug classification

b. Mechanism of action

c. Indication (*for the case of the patient mentioned above)

d. Contraindication

e. Side effects

f. Nursing Considerations

5. Create a drug study for the medication: PHENAZOPYRIDINE specifying

the following:

a. Drug classification

b. Mechanism of action

c. Indication (*for the case of the patient mentioned above)

d. Contraindication

e. Side effects

f. Nursing Considerations

A. 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 and certain 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?

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

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

following:

a. Drug classification

b. Mechanism of action

c. Indication (*for the case of the patient mentioned above)

d. Contraindication

e. Side effects

f. Nursing Considerations

B. 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?

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.

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

of renal calculi for the patient.

C. 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.

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

SULFONATE specifying the following:

g. Drug classification

g. Mechanism of action

h. Indication (*for the case of the patient mentioned above)

i. Contraindication

j. Side effects

k. Nursing Considerations

Answer 1

PYELONEPHRITIS

1. Too many bacteria in the urinalysis

2. E. Coli, klebsiella pneumoniae, enterococcus faecalis

3. Drink plenty of liquids, maintain personal hygiene

4. CO-TRIMOXAZOLE

a. Sulphonamides

b. Bactericidal in action . Inhibits the bacterial synthesis of dihydrofolic acid

c. Indication :bacteria in urine

d. Contraindications: hypersensitivity, pregnant women, megaloblastic anaemia with folic acid deficiency

e. Side effects: rashes, itching, sore throat, fever,chills

f. Assess for side effects, enquire for last menstruation in females blood count assessment for patients with long term therapy

PHENAZOPYRIDINE

a. Urinary analgesic

b. Mechanism of action: it's an azo dye excreted through urine and causes local anaesthetic effect in the mucosal cells of urinary tract.

c. Indication: dysuria

d. Contraindications: , patient with renal insufficiency, severe liver diseases, pregnant women

e. Side effects: headache, dizziness, stomach upset.

f. Inform the patient that the drug causes reddish orange discoloration of urine.

GLOMERULONEPHRITIS

1. Do you have any history of hypertension? , Do you have any family history of renal diseases?

2. It comprises a set of renal diseases in which immunological mechanism triggers inflammation & proliferation of glomerular tissues.

3. HYDROCORTISONE

a. Short acting glucocorticoid with mineralocorticoid activities.

b. Anti inflammatory adrenocortical steroid.

C. As it is an allergic disorder

d contraindications: hypersensitivity, systemic fungal infection, neonates

e. Side effects: insomnia, stomach upset, increased appetite

f. Nursing consideration: advice patient to avoid contact with people who has contagious diseases.

RENAL CALCULI

1. poor hydration and regular calcium supplements.

2. Acute pain related to renal colic - assist with comfort measures

Impaired urinary elimination related to mechanical obstruction as evidenced by urgency and frequency

Knowledge deficit related to the treatment regimen as evidenced by anxiety

3. SODIUM POLYSTYRENE SILFONATE

a. Cation exchange resin

b. Releases sodium in exchange for other captions in gi tract

c. Indication: hyperkalemia

d. Contraindications: hypersensitivity, hypokalemia

e. Side effects: constipation, seizure unusual bleeding

F. Nursing consideration: observe for early signs of hypokalemia