Case Study On Apn

ARELLANO UNIVERSITY College of Nursing S. Y. 2009 – 2010

CASE STUDY ON Acute Pyelonephritis (APN) PEDIA WARD - OSPITAL NG MAKATI SUBMITTED BY: JUN CARY V. SUITOS, SN GROUP – 64 III – MUSCARINICS

SUBMITTED TO: PROF. CRISTINA T. TIANELA, RN, MAN CLINICAL INSTRUCTOR

28 JULY 2009

I.

PERSONAL DATA

NAME : Patient ABC AGE : 17 yrs. old DATE OF BIRTH : February 14, 1992 GENDER : Female ADDRESS : Brgy. Poblacion, Makati City PRIMARY DIALECT SPOKEN: Tagalog ETHNIC GROUP : None RELIGION : Roman Catholic OCCUPATION : College Student HIGHEST EDUCATIONAL ATTAINMENT: High School MARITAL STATUS : Single MOTHER : Virginia FATHER : Carlito

II.

MEDICAL HISTORY When she was a child, she have had experienced measles and chicken pox but was not medically diagnosed. According to the patient’s mother, the patient has the BCG, Hepa B, Typoid, Tetanus & Diphtheria vaccines at childhood. Last July 10, 2009, the patient was admitted at the Ospital ng Makati due to complaint of severe headache, muscle pain, fever, and rashes. On that date, she was medically diagnosed of Dengue.

In July 19, 2009 she was returned to the Emergency room having the chief complaint of difficulty in urinating, intolerable abdominal pain, and fever. She was diagnosed of Acute Pyelonephritis. Since the time of her admission up until to date, the patient is experiencing imbalance body temperature.

III.

PHYSICAL ASSESSMENT – VITAL SIGNS

JULY 21, 2009 (3:00pm) Pulse Rate : 101 bpm Blood Pressure : 110/80 mmHg Respiratory Rate: 24 cpm Temperature : 37.7º C IV.

MEDICATION

Medications 1. Ibuprofen 250 mg/cap for fever T> 37.7º C 2. Paracetamol 300mg PIV 3. Gentamycin 115mg TIV 4. Ranitidine 500mg/amp 1amp

V.

JULY 21, 2009 (4:05pm) Pulse Rate : 96 bpm Blood Pressure : 90/60 mmHg Respiratory Rate: 22 cpm Temperature : 38.2º C

Frequency q6h q4h q8h q8h

Time 8:00am; 2pm 8:00am; 12nn; 4pm; 8pm 8:00am; 4pm 8:00am; 4pm

CASE STUDY

Patient ABC was diagnosed of Acute Pyelonephritis (APN) at the Ospital ng Makati after she complained for difficulty in urinating, intolerable abdominal pain, and fever last July 19, 2009. Her attending physician ordered for her confinement at the aforementioned hospital. Acute pyelonephritis is an infection of the upper urinary tract, specifically the renal parenchyma and renal pelvis (Figure 1). Acute pyelonephritis is considered uncomplicated if the infection is caused by a typical pathogen in an immunocompetent patient who has normal urinary tract anatomy and renal function. Misdiagnosis can lead to sepsis, renal abscesses, and chronic pyelonephritis that may cause secondary hypertension and renal failure. Risk factors for complicated acute pyelonephritis are those that increase susceptibility or reduce host response to infections In more than 80 percent of cases of acute pyelonephritis, the etiologic agent is Escherichia coli.

Approximately 250,000 cases of acute pyelonephritis occur each year, resulting in more than 100,000 hospitalizations.3 Women are approximately five times more likely than men to be hospitalized with this condition (11.7 versus 2.4 hospitalizations per 10,000 cases, respectively); however, women have a lower mortality rate than men (7.3 versus 16.5 deaths per 1,000 cases, respectively). There are four acute pyelonephritis occurs in one to two percent of pregnant women, increasing the risk for premature labor and low-birth-weight infants. Pathogenesis Most renal parenchymal infections occur secondary to bacterial ascent through the urethra and urinary bladder. In men, prostatitis and prostatic hypertrophy causing urethral obstruction predispose to bacteriuria. Hematogenous acute pyelonephritis occurs most often in debilitated, chronically ill patients and those receiving immunosuppressive therapy. Metastatic staphylococcal or fungal infections may spread to the kidney from distant foci in the bone or skin. In more than 80 percent of cases of acute pyelonephritis, the etiologic agent is Escherichia coli. Other etiologic causes include aerobic gramnegative bacteria, Staphylococcus saprophyticus, and enterococci. The microbial spectrum associated with different types of urinary tract infections (UTIs) is wide. In elderly patients, E. coli is a less common (60 percent) cause of acute pyelonephritis. The increased use of catheters and instruments among these patients predisposes them to infections withother gram-negative organisms such as Proteus, Klebsiella, Serratia, or Pseudomonas.

Patients who have diabetes mellitus tend to have infections caused by Klebsiella, Enterobacter, Clostridium, or Candida. They also are at an increased risk of developing emphysematous pyelonephritis and papillary necrosis, leading to shock and renal failure.1,10 Bacteriuria, which frequently is polymicrobial, develops in more than 50 percent of patients who require catheterization for more than five days, and in virtually all patients who have indwelling urinary catheters for more than one month.

Immunosuppression favors the development of subclinical (silent) pyelonephritis and infections caused by nonenteric, aerobic, gram-negative rods and Candida. Acute pyelonephritis occurs within two months following renal transplant in 30 to 50 percent of patients because of concomitant immunosuppression and postsurgical vesicoureteric reflux.2 Acute pyelonephritis is considered complicated in men because they have a higher probability of urinary tract abnormalities, prostatic enlargement causing urethral obstruction with incomplete voiding, or an age-related decrease of antibacterial activity in prostatic secretions. Findings and observations show client’s poor hygienic practices as evidenced by not doing handwashing after using a public toilet, not changing untidy clothes, poor oral hygiene. This disease is commonly to women. Anatomically means, women have shorter urethra than men. Secondly, anus as a sort of e. coli reservoir is close to vaginal canal which is the traveling point of e. coli from the anus thru urethra, bound for bladder to the kidney. In which kidney is the human’s physiological asset responsible for waste elimination. A severe damage to kidney causes APN. A justification to conclude the patient’s case for having APN.