CASE STUDY

ON

ACUTE PYELONEPHRITIS
PRESENTED BY:
JEAN ROSE ARGONZA

PRESENTED TO:

LIEZEL B. CAUILAN
DATE OF SUBMITTED: JANUARY 29, 2011

CASE STUDY OF ACUTE PYELONEPHRITIS

General Objectives:
I studied this case in order to broaden my knowledge on acute pyelonephritis are related the importance of effective caregiver management in dealing with the manifestation and complications of the disease.

Specific Objectives:
At the end, I will be able to define Acute Pyelonephritis. To determine signs and symptoms of the disease. Relate the anatomy and physiology of the disease. Identify appropriate caregivers management in providing quality health care to my patient. List the factors that predisposed patient to have acute pyelonephritis. Familiarize myself with the disease process and the treatment of acute pyelonephritis.

INTRODUCTION

Pyelonephritis is a bacterial infection of the renal pelvis, tubules and interstitial tissues of one or both kidneys. Causes involve either the upward spread of bacterial from the bladder or spread from systemic sources reaching the kidney via the bloodstream. Pathogenic bacteria from a bladder infection can ascend into the kidneys resulting in pyelonephritis. An incompetent ureterovesical valve or obstruction occurring in the urinary tract increases the susceptibility of the kidneys to infection, because static urine provides a good medium for

bacterial growth. That causes bladder tumor, strictures, benign prostatic hyperplasia, urinary stones, [there causes obstruction which can lead to infection], systemic infection such as tuberculosis [these can be spread to the kidneys and result in abscesses.

Pyelonephritis may be acute or chronic. Acute pyelonephritis is usually manifested by enlarged kidneys with interstitial infiltrations of inflammatory cells. Abscesses may be noted on or within the renal capsules and the corticomedullary junction. Atrophy and destruction of tubules and the glomeruli may result. When pyelonephritis becomes chronic the kidney become scarred, contracted and none functioning. Chronic pyelonephritis is a cause of chronic kidneys disease that can result in the need for renal replacement therapies such as transplantation or dialysis.

CENSUS Region II-85,350 Philippines- 2,587,250

CLINICAL MANIFESTATION
y y y y y y y y y Chills Flank pain Nausea and vomiting Headache Malaise Painful urination Pain and tenderness in the area of the costovertebral angle Urinary urgency Urinary frequency

PATIENT PROFILE
NAME: AGE: Mr. E 36 years old

BIRTH DAY: Sep. 5 1974 ADDERESS: Cataraun, Amulung GENDER: STATUS: RELIGION: Male Married Roman Catholic

CHIEF COMPLAINT: Left lower quadrant DATE OF ADMISSION: January 18 2011 TIME OF ADMISSION: 11 PM ATTENDING PHYSICIAN: Dra. Rowena Soliman and Dr. Thomas Uy

HISTORY
y History of Past illness He was been confined at the clinic of Dr.Velarde last year,December 30 2010 because he was been diagnosed of Urinary Tract Infection.

History of Present illness Few hours prior to admission patient complaint of his left lower quadrant pain. He was admitted at Tuguegarao City Peoples General Hospital in few days to cure the pain. y History of chief complaint He was been felt pain at the left lower quadrant of his kidney.

ANATOMY and PHYSIOLOGY

The principal function of the urinary system is to maintain the volume and composition of body fluids within normal limits. One aspect of this function is to rid the body of waste products that accumulate as a result of cellular metabolism. Other aspect of its function includes regulating the concentrations of various electrolytes in the body fluids in maintaining normal ph of the blood. In addition to maintaining fluids homeostasis in the body, the urinary systems control the red blood cell production by secreting the hormone erythropoietin. The urinary system also plays a role in maintaining normal blood pressure by secreting the enzyme rennin.

The urinary system consists of the kidneys, ereters, urinary bladder and urethra. The kidneys form the urine and account for the other function attributes to the urinary system. The kidneys are divided into an outer cortex and inner medulla which surround the renal sinus. The bases of several con-shaped renal pyramids are located at the boundary between the cortex and the medulla, and the tips of the renal pyramids project toward the center of the kidney. The ureters carry the urine away from kidney to the urinary bladder, which is a temporary reservoir for the urine. The urinary bladder is a hallow muscular container that lies the pelvic cavity just posterior to the public symphysis. It functions to stored urine, and its size depends on the quantity of urine present. The urinary bladder can hold from a few millimeters to a maximum of about 1000 ml of urine. The urethra is a tubular structure that carries the urine from the urinary bladder to the outside.

MEDICAL MANAGEMENT
Two weeks course of antibodies: ampicilin, contrimoxasole, ciprofloxacin Two or three day parenteral antibiotic therapy for pregnant women. Oral antibiotic agent may be prescribed once patient is a febrile and showing clinical movements Six weeks antibiotics therapy if relapse occurs them a follow up urine cultures is obtained two weeks after completion of antibodies therapy to document clearing of the infection

Hydration with oral or parenteral fluids for adequate kidneys function and these helps facilitate flushing of the urinary tract and reduces pain and discomfort.Complecation repeated about of acute pyelonephritis may lead to chronic pyelonephritis such complications of chronic pyelonephritis include end stage renal disease from progressive loss of nephrons secondary to chronic inflammation and scaring, hypertension and formation of kidney stones from chronic infection with urea splitting organism.

CAREGIVER MANAGEMENT
y y y y y Assess patient vital signs Active patient to verbalize concern Provide comfort Increased fluid intake Change Lifestyle of the patient and decrease fat, cholesterol and salt.

Case study of Acute Respiratory Infection

Objectives: General
I studied this case, to gain more knowledge about acute respiratory infection in order to apply and effective caregiver management in dealing with this disease.

Specific
In my own research I will be able to define acute respiratory infection, to determine the sign and symptoms and to be able to provide caregiver management on high quality health education.

Introduction:
The common cold is a viral infection of the upper respiratory system, including the nose,throat,sinuses,Eustachian tubes,trachea,larynx,and bronchial tubes .Although more than 200 different viruses can cause a cold, 30-50% are caused by a group known as rhino viruses or corona viruses infection, are the most common illness to strict any part of the body. It is estimated that the average person has more than 50 colds during a lifetime.any one can get a cold, although pre-school and grade school children can catch them more frequently than adolescent and adults. Repeated exposure to viruses causing colds creates partial immunity. Although most colds result on their on without complication, there are a leading cause of visits to the doctor and of time lost from work and school. Treating sympyoms of the common colds has given rise to a multimillion dollar industry in over the country medication. Colds season in the United States begins in early autumn and extend through early spring. Although it is not true that getting wet or being in a draft causes a colds ( a person has to come in contact with the virus to catch a colds), certain condition may lead to increase susceptibility. These include: y y y y y Fatigue and over work Emotional stress Poor nutrition Smoking Living or working in crowded condition

Colds make the upper respiratory system less resistant to bacterial infection. Secondary bacterial infection may lead to middle ear infection, bronchitis, pneumonia, sinus infection, strep throat. People with chronic lung disease, asthma, diabetes or a weaken immune system are more likely to develop this complication

PATIENT PROFILE
Name: Ms. A Age: 48 Birth day: December 20 1962 Address: Ugac Sur Gender: Female Status: Married Religion: Roman Catholic Chief Complaint: Cough and colds Date of Admission: January 19 2011 Time of Admission: 10:00 am Admitting Physician: Dr. Tallud

History
History of past illness
According to the patient she suffers cough, cold.She take neozep and amoxicillin.

History of present illness

6 days prior to admin patient complain of cough and colds few hours PTA worsen, hands patient sought consultation here at Tuguegarao City Peoples General Hospital.

History of chief complaint.

The patient complains of cough and cold.

Medical management
Avoiding intubation is a major goal in the management of respiratory failure, particularly in immunosuppressed patient.Neverless; there are only limited data on the efficacy of non invasive ventilation in these high risk patients. The medical management of patient with acute respiratory infection failure will vary depending on the cause and type of failure. Treatment should be targeted at the cause. Therapeutic goal should focus on preventing cellular damage and relieving patient s symptoms and distress. Airway obstruction is a clinical emergency. If this is the cause of respiratory failure it should be treated and safe airway maintained as a priority. This may require simple clearance such as the removal of foreign body, secretion using suction. Patient positioning and manipulation of the airway will be required to open it if obstructed.

Caregiver management
y y y y y y y Washing hand well and frequently, especially after touching the nose or before handling food. Covering the mouth and nose when sneezing Disposing of use tissues properly Avoiding close contact with someone who has a cold during the first two to four days of their infection Not sharing food, eating utensils or cups with anyone Avoiding crowded places where cold germs can spread Eating a healthy diet and getting adequate sleep