SAINT TONIS COLLEGE, INC.

(Formerly: Kalinga Christian Learning Center)

United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

A Case Study
on
Acute Pyelonephritis
In partial fulfilment
In the subject
NCM

BUMANGOL, CURINA
PASCUAL, ESTHER
DELOS SANTOS, JANE
GUIWAN, SHIRRA
LUMASOC, MAILYN JEWEL
TANDING, EVA GRACE
BANYA-AO, JOYCE
ALYONG, JOANE
BOCLONGAN, CLARCK
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

TABLE OF CONTENTS

I. Introduction ----------------------------------------------- 1
II. Biographic Data ---------------------------------------------- 4
III. Admission Data --------------------------------------------- 4
IV. Nursing Health History --------------------------------------- 5
V. Patterns of Health Functioning ------------------------------ 7
VI. Course in the Ward -------------------------------------- 13
VII. Physical Assessment ------------------------------------ 20
VIII. Diagnostic Procedures and Medical Management ---- 37
IX. Anatomy and Physiology -------------------------------- 53
X. Pathophysiology ------------------------------------------- 63
XI. Nursing Care Management -------------------------------- 64
XII. Discharge Plan --------------------------------------------- 71
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

I. INTRODUCTION
Acute pyelonephritis is a severe and potentially life-threatening infection that affects the kidneys.
It is characterized by the inflammation of the renal parenchyma (the functional tissue of the
kidneys) and the renal pelvis (the central collecting system of the kidneys). This condition
typically occurs as a result of a bacterial infection, most commonly due to the ascent of bacteria
from the lower urinary tract into the kidneys. Pyelonephritis is more common in women than
men, and it often affects individuals who have a pre-existing urinary tract infection (UTI). Acute
pyelonephritis can affect patients of all ages, however the highest incidence occurs in women
aged 15-29. The most common causative agent is Escherichia coli (E. coli), a bacterium
commonly found in the gastrointestinal tract. Other bacteria such as Klebsiella pneumonia,
Proteus mirabilis, and Enterococcus species can also cause acute pyelonephritis. The infection
usually begins in the lower urinary tract and then ascends to the kidneys through the ureters,
which are the tubes that connect the kidneys to the bladder. Risk factors for developing acute
pyelonephritis include urinary tract abnormalities, such as kidney stones or structural
abnormalities, urinary catheterization, pregnancy, diabetes, weakened immune system, and
sexual intercourse. The typical symptoms of acute pyelonephritis include high fever, chills, flank
pain (pain in the lower back or side), frequent and urgent urination, pain or burning sensation
during urination, cloudy or foul-smelling urine, and general feelings of malaise. In severe cases,
individuals may experience nausea, vomiting, and even confusion. Prompt diagnosis and
treatment of acute pyelonephritis are crucial to prevent complications and reduce the risk of
kidney damage. The diagnosis is often based on a combination of clinical symptoms, physical
examination findings, and laboratory tests, such as urine analysis and urine culture to identify the
causative bacteria. Imaging studies, such as a kidney ultrasound or a CT scan, may be performed
to evaluate the extent of kidney involvement. Treatment for acute pyelonephritis typically
involves antibiotics to eradicate the bacterial infection. The choice of antibiotics depends on the
severity of the infection, local antibiotic resistance patterns, and individual patient factors. In
some cases, hospitalization may be necessary, especially for individuals who are severely ill,
unable to tolerate oral fluids or medications, or have complicating factors. In conclusion, acute
pyelonephritis is a serious kidney infection caused by bacteria that ascend from the lower urinary
tract. It presents with symptoms such as fever, flank pain, and urinary symptoms.
Acute pyelonephritis can be divided into uncomplicated and complicated. Complicated
pyelonephritis includes pregnant patients, patients with uncontrolled diabetes, kidney transplants,
urinary anatomical abnormalities, acute or chronic kidney failure, as well as
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

immunocompromised patients, and those with hospital-acquired bacterial infections. It is

important to make a distinction between complicated and uncomplicated pyelonephritis, as
patient management and disposition depend on it. Uncomplicated, when present in a structurally
or functionally normal urinary tract in a non-immunocompromised host.
Compared with uncomplicated acute pyelonephritis, complicated acute pyelonephritis is
characterized by a broader spectrum of clinical presentations, a wider variety of infecting
organisms (including a greater likelihood of antimicrobial resistance), and a greater risk of
progression to a complication, such as intrarenal or perinephric abscess or emphysematous
pyelonephritis. According to Faye Glenn Abdellah, to maintain good hygiene presence of disease
or bacteria primarily affects the person’s health. One of the reason why people easily got infected
because of poor hygiene. Poor hygiene is the cause of infection that may worsen if not giving
attention. Maintaining our good hygiene is our defense in the bacteria or in a disease. Providing
care in the patient by adding their knowledge on ways how to maintain a good hygiene .To
facilitate maintenance of elimination. In the case of our patient she does not have a good hygiene
pattern. A person must have maintained his/her hygiene practices in its good condition.
RATIONALE FOR CHOOSING THE CASE
Medical Diagnosis and Treatment: Acute pyelonephritis is a serious bacterial infection of the kidneys,
typically caused by the ascent of bacteria from the lower urinary tract. By studying this condition,
healthcare professionals can improve their ability to diagnose and treat it effectively. Understanding the
symptoms, risk factors, and diagnostic techniques allows for early detection and appropriate
management, including the administration of appropriate antibiotics. Patient Management and Care:
Knowledge about acute pyelonephritis helps in managing and caring for patients who are affected by
the condition. This includes understanding the complications that can arise, such as sepsis or kidney
abscess, and implementing appropriate interventions to prevent and manage these complications.
Studying the condition equips healthcare providers with the necessary tools to ensure optimal patient
care and outcomes. Education and Awareness: Education about acute pyelonephritis is essential for
both healthcare professionals and the general public. Healthcare providers need to stay updated on the
latest research and treatment guidelines to provide evidence-based care. Raising awareness among the
public about the symptoms, risk factors, and preventive measures helps in early recognition of the
condition and encourages individuals to seek timely medical attention. In summary, studying acute
pyelonephritis is crucial for medical diagnosis and treatment, patient management, public health
interventions, research advancements, and educational purposes. By understanding this condition, we
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

can improve patient outcomes, prevent complications, and work towards reducing its burden on
individuals and society.

Learning Objectives
This case presentation seeks to provide different information about the disease to be presented
and about the client being considered with the following specific objectives.
1. Give a brief introduction about Acute Pyelonephritis together with its signs and
symptoms.
2. Discuss the theoretical framework that is related to the client’s condition.
3. Present the client’s demographic data and health history with its Gordon’s pattern
of functioning.
4. Present the abnormal results of the Physical Assessment made on the client.
5. Present the different laboratory results or test done to the client with its interpretation.
6. Discuss the normal Anatomy and Physiology of the Urinary system.
7. Explain the Pathophysiology of Acute Pyelonephritis.
8. Discuss the drugs prescribed to the client by a Drug Study.
9. Present an appropriate Nursing Care Plan for the most prioritized problem.
10. Give a Discharge Plan that the client may use upon discharge to the hospital.

II. Biographic Data

Name of Client: PATIENT M
Age: 22 YEARS OLD
Sex: FEMALE
Address: MASABLANG, TABUK CITY, KALINGA
Nationality: FILIPINO
Birth date: JANUARY 28, 2001
Birth place: MASABLANG TABUK CITY
Religion: UCCP
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Educational Attainment: STUDENT 2ND YEAR COLLEGE

Occupation: STUDENT
Civil Status: MARRIED
Height: 4’11
Weight: 65.5

III. Admission Data

Chief Complaint: HEADACHE, FEVER, BODY PAIN
Date of Admission: APRIL 24,2023
Provisional Diagnosis: ACUTE PYLONEPHRITIS
Attending Physician: CLIFFORD JOHN R. GACUYA, M.D
IV. Nursing Health History
Prior to admission, the patient had been having numbness and muscle cramps on her arms, legs,
and back area for 2 days. According to the patient, she took a pain reliever tablet with the brand
name Biogesic 500mg to ease the pain, but after 4 hours, the pain reoccurred with headaches,
joint pain, and fever. On April 24, 2023, the patient decided to go to the hospital with a chief
complaint of joint and body pain, headache, and fever for 3 days. Upon admission, the patient
appeared irritable. Upon assessment, she reported signs and symptoms of body weakness,
dysuria, and anorexia, with the vital signs as follows: BP of 100/60 mmHg, pulse rate of 74 bpm,
respiratory rate of 20 bpm, temperature of 37.4 degrees Celsius, weight of 65.5 kg, and height of
150 cm.

The patient was admitted at 6:45 a.m. on April 20, 2023, to Kalinga Provincial Hospital by the
resident on duty, Dr. Clifford John Gacuya. The attending physician diagnosed her with the
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

admitting diagnosis of Systemic Viral Infection and arrived at the principal diagnosis of Acute
Pyelonephritis.

b. Past Medical History (Other)

She had a long history of recurring urinary tract infections that began when she was 12 years
old. On July 30, 2015, she was confined at Saint Peter Claver Hospital. Her physician, Dr. Ariel
D. Cayadan diagnosed her with UTI and prescribed Coamoxiclav. She tried birth control
methods and had her Intrauterine Device (IUD) on her uterus after the delivery of her second
baby for six months, as suggested by her physician. From that time on, she stops having her
menstrual periods. After one month from the time of her IUD's removal, her physician suggested
that she return to the hospital in January to have her IUD placed in her left arm for a maximum
of three years.

She had two pregnancies and was delivered via Lower Segment Cesarean Section because she
was unable to experience labor pain. She had no history of abortions or miscarriages. She was 19
years old when she had her first pregnancy in 2020, and then she had her second pregnancy in
2022. She was ten years old when she had her menarche. She also had no known allergies to
food or drugs.

C. FAMILY MEDICAL HISTORY AND GENOGRAM

Grandmother Grandfather

Father Mother
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Mother Father

Patient Husband

Son Son

Legend:

Male Female

Kidney Failure Asthma Acute pyelonephritis

 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

V. PATTERNS OF HEALTH FUNCTIONING (GORDON’S FUNCTIONAL

Pattern of Health Before During Analysis
Functioning Hospitalization Hospitalization
Health Patient The patient Health is a
Perception verbalized appeared to be way of
HealthSAINT TONIS COLLEGE, well and INC. no thinking,
Management (Formerly:
“Ako ay Kalinga Christian Learning Center)
pain at all. revolves
United Church of Christ in the Philippines
Pattern malakas
Purok dahil
4, Bulanao
She’s taking around
Centro, Tabuk City, Kalinga
a
wala naman all
Philippines 3800 the philosophy of
Tel. No. (074)akong
627-5930, Email Address: prescribed wholeness,
[email protected]
nararamdaman, medications. and wellbeing.
nagagagawa ko (Fundamentals
nga mga of Nursing by
Kozier p.271)
gawaing bahay
at pag aalaga
ng mga anak
ko”.
Nutrition- The patient Patient stated An
Metabolic stated that she that her individual’s
Pattern has a good appetite is the health status
appetite and same. She greatly affects
she eat meals drinks 1.5 eating habits
three times per liters of water and nutritional
day with one throughout the status
day. She is (Fundamentals
snack in the
also placed in of Nursing by
afternoon
low salt, low Kozier
between 3pm. fat diet. p.1178).
Her favorite Patient’s
snack is French nutritional
fries and bread. status has been
She usually eats changed due
fried chicken, to her
meat por. She confinement
has no allergy and diet.
in food. She
only drink 2
glasses of water
a day and she
drinks more
softdrinks and
consumed 1
liter 3x a week.
She drinks 1
glass of coffee
between 5-
6pm.
Elimination The patient During her Elimination is
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

VI. Course in the Ward (Doc Orders)

Date and Time Doctors Order Rationale Nursing Responsibilities

April 24, 2023 Admit patient to For further monitoring.  Admitted the
FM ward management, and patient as ordered
6:45 am
evaluation of patient's  Prepared and filled
condition. out necessary
documents
 Obtained initial vital
signs and recorded
 Assisted the patient
to room of choice

Secure Consent For legal purposes and to  Served as a witness

ensure that the patient  Validated
understands the nature of understanding of
the treatment the patient & SO
about the
importance of
signing consent.

TPN every shift TPN is a nutritional solution  Maintain aseptic

that is infused into the technique in
body through a vein or is catheter
consumed by mouth. TPN is maintenance and
given intravenously in order TPN administration
to bypass the digestive  Glucose should be
tract and feed directly into
monitored several
the bloodstream. The goal
times a day until
of TPN is to prevent or treat
stable, and then at
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

malnutrition related to least daily.

various health conditions  Monitored intake
by ensuring that all daily and output as well
nutritional requirements as weight daily.
are met.

DAT To maintain patient’s  Informed and

nutritional status. explained to the
patient and
significant others
about the ordered
diet.
 Informed the
dietary department
regarding the diet
of the patient.

Diagnostics:  Verified doctor's

order
CBC -To evaluate alterations in
blood components  Informed the
patient about the
VA diagnostic exams
 Filled out necessary
request forms
ECG  Informed the
laboratory
____ department about
the exams
-To measure the nitrogen  Followed up results
BUN
fraction of urea and would and attached it to
aid in the diagnosis of the patient's chart.
Acute glumerulonephritis.

-To assess creatinine levels

 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Crea that would diagnose

presence of Acute
glomerulopehritis

-To assess presence of uric

BUA acid level in the blood

-To determine alterations

in urine components
UA

IVF: PNSS 1L x 16 For hydration and to  Verified doctor's

hours facilitate fluid and order
electrolyte replacement  Regulated IVF
and serve as an access for correctly and
IV medications. labeled it.

TF: PLRS 1L x 16 Plain Lactated Ringer's  Verified doctor's

hours solution. Maintenance of order
fluids and electrolytes  Regulated IVF
correctly and
labeled it.

Medications:  Verified doctor's

order
Ceftriaxone IV - For bacterial infection
every 12 hours __  Clean the IV port
prior to
Paracetamol administration of
--To decrease fever
300mg IV for T-38°c drugs
Paracetamol  Monitor patient for
500mg/tab per -To relief fever, headache adverse effects
orem every 4 hours and pain  Assessed patient's
fever or pain.
 Instructed patient
to take prescribed
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

medications with
the right time, right
route and right
dosage.

V/S every 2 hours To monitor deviation from  Monitored V/S

normal values every 2 hours,
recorded and
reported
immediately any
deviations.

Refer For further assessment and  Referred and

treatment. endorsed
accordingly.

April 25, 2023 _______

5:55 am
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

VII. Physical Assessment

A. Review of System
SYSTEM NORMAL ACTUAL INTERPRETATION
FINDINGS FINDINGS & ANALYSIS
Respiratory System Normal breathing No specific findings
pattern and effort. directly related to
acute pyelonephritis.
Absence of
respiratory symptoms
such as cough or
shortness of breath.
Musculoskeletal - Erect posture The patient has good
System with good postural stability.
There is no presence
balance and of swelling, broken
normal gait bones, serious sprains
while walking. and arthritis.
Joints and
muscles are
symmetrical
with no
swelling,
redness, or
deformity.
Active range of
motion of all
joints without
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

difficulty. No
spine
curvature.
Integumentary The skin is typically No specific findings
System intact, without any directly related to
signs of infection or acute pyelonephritis.
inflammation
Normal heart rate and Elevated heart rate:
rhythm due to the body’s
Cardiovascular
response to infection,
system Normal blood
an increased heart
pressure
rate (tachycardia)
may be present.

Endocrine system The patient increased The patient’s appetite

appetite increased
Is change and drinks
thirst increased urine,
more water, increased
production heat or
urine production, no
cold intolerance,
change in sweating
excessive sweating
Cardiovascular In a normal Some patients with
system cardiovascular system, acute pyelonephritis
heart rate and blood may have an elevated
pressure remain within heart rate (tachycardia)
the normal range for due to the systemic
the individual. response to infection.
Blood pressure can be
normal or occasionally
elevated.

Central nervous Urinary tract infection Actual findings of acute

system (UTI) symptoms: pyelonephritis
Patients may involving the central
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

experience symptoms nervous system are

such as frequent extremely uncommon.
urination, urgency, If CNS involvement
pain or burning does occur, it may
sensation during present with the
urination, cloudy or following: Meningitis:
foul-smelling urine, and In rare cases, the
lower abdominal or infection can spread to
back pain. the meninges (the
protective membranes
Fever: Patients may
surrounding the brain
have an elevated body
and spinal cord),
temperature, often
leading to bacterial
accompanied by chills
meningitis. This can
and sweating. Flank
cause symptoms such
pain: Severe pain in the
as severe headache,
lower back or side of
neck stiffness, fever,
the abdomen,
confusion, and
specifically in the area
sensitivity to light.
of the affected kidney,
Encephalitis: CNS
is a common symptom
involvement can result
of acute pyelonephritis.
in encephalitis, which is
Elevated white blood
inflammation of the
cell count (WBC): A
brain. Encephalitis may
complete blood count
cause neurological
(CBC) may show an
symptoms such as
increase in the number
altered mental status,
of white blood cells,
seizures, focal
indicating an immune
neurological deficits,
response to the
and behavioral
infection. Positive urine
changes. Abscess
culture: A urine sample
formation: A kidney
may be collected for
abscess is a rare
culture and sensitivity
complication of acute
testing to identify the
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

specific bacteria pyelonephritis, and if it

causing the infection. extends into the CNS, it
can lead to localized
brain infections or
brain abscesses. This
can cause focal
neurological symptoms
based on the affected
area of the brain.

Respiratory system Normal chest shape, Normal respiration The patient has a
with no visible for an adult person at normal function of
deformities, such as rest 12-20 breaths per respiratory system.
a barrel chest, minute.
kyphosis, or
scoliosis. No muscle
retractions when
breathing. Quiet,
unlabored
respirations with no
use of accessory,
neck, shoulder, or
abdominal muscles.
A regular respiratory
rhythm, with
expiration taking
about twice as long
as inspiration.

Gastrointestinal In a normal Nausea, vomiting, and

system gastrointestinal loss of appetite may be
system, individuals do present in acute
not experience pyelonephritis. These
persistent nausea, symptoms can result
vomiting, or appetite from the systemic
loss. effects of the infection.
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Peripheral vascular In a normal state, body Patients with acute

temperature remains pyelonephritis may
within the normal appear generally
range (typically around unwell, fatigued, or
36-37°C or 96.8- malaise. They may
98.6°F), and there are have a flushed or pale
no associated chills or complexion.
sweats.

Nervous system The patient is The patient

alert and speaks
oriented to normally and is
person, place, awake and
and time with oriented to
normal person, place,
speech. No and time.
motor deficits
are noted, with
muscle strength
5/5
bilaterally. Sens
ation is intact
bilaterally.
Hematologic The red blood cell, The patient has no
white blood cell, anemia, bleeding or
platelets are normal past transfusions.
Psychiatric There are no issues The patient doesn’t
anxiety, depression, experience stress
suicidal, thoughts anxiety, depression,
memory loss, sleep suicidal thoughts or
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(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
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Philippines 3800
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issues or any history other uncommon

of psychiatric issues. The patient
therapy. has no sleep issues
Genitourinary system The kidneys would The patient urine has In acute pyelonephritis,
appear normal on a little amount. There urinalysis often reveals
imaging studies such as is no blood in the the presence of
ultrasound, with no urine and no signs of leukocytes (white
signs of enlargement, pain when urinating. blood cells), which
scarring, or other indicates an
abnormalities. Normal inflammatory response
renal blood flow: Blood to the infection.
flow to the kidneys Additionally, bacteria
would be normal, may be seen in the
indicating proper urine, indicating an
perfusion and active infection. Red
oxygenation of the blood cells (hematuria)
renal tissue. Intact may also be present.
urinary tract: The
urinary tract, including
the ureters and
bladder, would be
structurally intact with
no evidence of
blockages or
abnormalities that
could impede urine
flow and contribute to
infection. Absence of
urinary tract stones:
There would be no
presence of kidney
stones or other
obstructions within the
urinary tract that could
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

serve as a nidus for

infection or contribute
to urinary stasis. No
urinary reflux: Reflux of
urine from the bladder
back into the ureters or
kidneys would not be
present. Urinary reflux
can increase the risk of
bacterial
contamination and
subsequent infection.

Reproductive system No obstruction and The patient has no Acute pyelonephritis

abnormalities, normal abnormalities in her primarily affects the
size and shape in reproductive organs. kidneys, and the direct
ovaries, fallopian She is having a impact on the
tubes, uterus, cervix shorter periods or respiratory system is
and vagina. Regular light menstrual flow limited. However, in
normal duration of due to her intra severe cases or in
menstrual bleeding uterine device. individuals with pre-
and no excessive existing respiratory
pain. No difficulties conditions, the
in sexual infection can spread
performance, through the
adequate vaginal bloodstream and
potentially cause lung
lubrication.
complications, such as
pneumonia. Bacterial
pathogens from the
kidneys can reach the
lungs, leading to
respiratory symptoms
and complications.
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(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
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Immune system Inflammation: The B and T lymphocytes When bacteria invade

immune system are involved in the kidneys, the
triggers an recognizing and immune system
inflammatory response targeting specific responds through
to combat the bacterial antigens. various mechanisms to
infection. This leads to Antibodies produced eliminate the infection.
the characteristic by B cells can help in
symptoms of neutralizing bacteria,
pyelonephritis, such as while T cells can
fever, pain in the flank directly kill infected
or lower back, and cells or help coordinate
urinary symptoms like the immune response.
frequent urination and
urgency. Neutrophil
infiltration:
Neutrophils, a type of
white blood cell, are
the first line of defense
against bacterial
infections. In acute
pyelonephritis, there is
an increased number
of neutrophils that
migrate to the infected
kidney tissue to
combat the bacteria.
This can be observed in
laboratory tests as an
elevated white blood
cell count, specifically
an increase in the
number of neutrophils
(neutrophilia).
Activation of immune
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cells: In response to the

infection, immune cells
such as macrophages
and natural killer (NK)
cells are activated to
help eliminate the
bacteria. Macrophages
phagocytose (engulf
and digest) the
bacteria, while NK cells
target and kill infected
cells. Increased acute-
phase reactants:
During an infection, the
liver produces acute-
phase reactants, such
as C-reactive protein
(CRP) and erythrocyte
sedimentation rate
(ESR), which are
markers of
inflammation. These
markers may be
elevated in acute
pyelonephritis.
Antibody response: The
immune system
produces antibodies to
target the specific
bacteria causing the
infection. These
antibodies help in
neutralizing the
bacteria and aiding in
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their elimination.
Antibodies can be
detected in blood tests,
such as a urine culture
or serological tests. It's
important to note that
while these findings are
commonly observed in
acute pyelonephritis,
they may vary
depending on the
individual's immune
response and the
severity of the
infection.

B. Physical Assessment (Please refer to Kozier’s Physical Assessment Format)

Area Assessed Normal Findings Actual Findings Interpretation

a. SKIN Varies from light to Varies light to deep Normal

deep brown, from brown, from ruddy
.
ruddy pink to light pink to light pink,
pink, from yellow from yellow overtones
overtones to olive, to olive, generally
generally uniform warm to touch
skin temperature.
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b. HAIR Thick, silky, Thin silky, resilient, Normal

resilient, free from evenly distributed and
infestation evenly is able to cover the
distributed and whole scalp. There is
covers the whole no infestation noticed
scalp

c. NAILS Convex curvature Convex curvature Normal

smooth texture, smooth texture, highly
highly vascular and vascular and pink,
pink, prompt return capillary refill of 3
of pink less than 3 seconds. With a nail
seconds. polish on her finger
toe nails.

d. NECK Symmetrical and Symmetrical and Normal

REGION straight, no palpable straight, with papable
lumps, and supple lumps.
trachea is on midline
of neck, and spaces
are equal on both
sides.

e. LUNGS Symmetrical chest Symmetrical chest Normal

expansion, clear expansion, clear
breath sounds. breath sound

f. HEART Normal rate, regular No palpitation, Normal

rhythm no murmur murmur
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g. PERIPHERAL Symmetrical pulse Symmetrical pulse Normal

volume full volume, full pulsation
pulsation.

h. BREAST Round shaped, Symmetrical, slightly Normal

slightly unequal in unequal in size,
size, generally without tenderness or
symmetrical, no masses, no discharge.
tenderness, masses,
nodules or nipple
discharge

Uniform color No scars seen upon Normal

rounded symmetrical inspection. Uniform in
i. ABDOMEN contour, audible color, abdomen is
bowel sounds, distended.
tenderness liver and
bladder are not
palpable

J. VAGINA No inflammation Not inspected Normal

swelling or
discharge
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K. UPPER LOWER Equal size on both Equal size on both Normal

EXTREMITIES sides of the body sides of the body,
weakness on the wuth slightly
lower and upper weakened lower
extremities. extremities and
varicosities
FACE Oblong or round or Round shaped, Normal
square or heart symmetrical with no
shaped, symmetrical, involuntary muscle
facial expression that movements. She has
is dependent on the facial grimace and
mood or true feeling or discomfort
feelings and no
involuntary muscle
movements
Nose Midline symmetrical Midline symmetrical Normal
and patent, no and patent, no
discharge discharge.
Mouth Symmetrical, gums, Symmetrical, gums Normal
pinkish in color, lips pinkish in color, lips
margin is margin is
symmetrical no symmetrical, no lesion
lesion and and tenderness, with a
tenderness, without jacket on the 2 upper
involuntary incisors
movement
Eyes Parallel and evenly Parallel and evenly Normal
spaced symmetrical, spaced pupils are
non- protruding, bluish gray in color,
pink palpebral
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conjunctiva and equal in size.

pupils black in color,
equal in size, round
and constricts in
response to light
EARS Parallel symmetrical, Parallel symmetrical Normal
proportional to the proportional to the
size of the head, size of the head, bean-
bean-shaped, skin is shaped, skin is same
same color as the color as the
surrounding color, surrounding color,
clean firm cartilage clean and firm
cartilage.

VIII. Diagnostic Procedure & Medical Management

A. Diagnostic Procedure
Date Diagnostic Actual Findings Normal Interpretation &
procedure Findings Analysis

April 23,2023 Blood Urea 3.94 3.0 – 8.82 The result of the
Nitrogen mmol/L patients Blood
Urea Nitrogen is
in the normal
range.
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Serum Creatinine 68.80 44 – 105 The result of the

µmol/L patient’s Serum
Creatinine is in
the normal
range.

Blood Uric Acid 232.51 155 – 357 The result of the

µmol/L patient’s Blood
Uric Acid is in
the normal
range.

Hemoglobin 1.52 120 – 160 g/l The actual

findings of the
patient’s
Hemoglobin is in
the normal
range.

Hematocrit 0.42 0.37– 0.43 The result of the

patient’s
Hematocrit is in
the normal
range.

RBC Count 4.70 4.0- The result of the

5.4x10^12/L patient’s RBC
Count is in the
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normal range.

MCV 89 80 – 100 fl The result of the

patients Mean
Corpuscular
volume is in the
normal range.

MCH 32 27 – 31 pg The result of the

patients Mean
Corpuscular
Hemoglobin is in
the normal
range.

MCHC 364 310 – 360 g/l The result of the

patients Mean
Corpuscular
Hemoglobin
Concentration is
in the normal
range.

WBC Count 4.1 4.0 – 10 The result of the

0x10^9/L patient’s WBC is
in the normal
range.
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Neutrophil 0.72 0.55-0.65 The result of the

patient’s
Neutrophil is
above normal
this is a sign that
your body has
an infection.

Lymphocytes 0.24 0.25-0.35 The result of the

Lymphocytes
patient’s is in
the normal
range

Monocytes 0.04 0.03-0.06 The result of the

Monocytes
patient’s is in
the normal
range

Platelet Count 229 NB: 84- The result of the

478x10^9/L Platelet Count
150- patient’s is in
400x10^^9/L the normal
range

Transparency Hazy Clear The result of the

patient’s urine
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transparency is
above normal
which is a sign of
urinary tract
infection caused
by blood cells or
mucus in the
urine.

Color Yellow Yellow The result of the

(light/pale to patient’s urine
dark/deep color is in the
amber normal range

Epithelial Cells Moderate Few The result of the

patient’s
epithelial cells is
above normal
which indicate a
yeast or urinary
tract infection

Pus Cell 12-15 0-5/hpf The result of the

patient’s pus cell
is above normal
which indicate a
urinary tract
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infection

Red Blood Cell 3-5 4 RBCs/HPF The result of the

patient’s red
blood cells is
above normal
known as
hematuria which
indicate an
urinary tract
infection or
kidney disease

Mucus Threads Many Small or The result of the

moderate patient’s mucus
threads is above
normal maybe a
sign of urinary
tract infection

B. MEDICAL MANAGEMENT

Drug name Classification Indication Mechanism of Side effect Nursing

action consideration
Ceftriaxone Antibiotic Is used for Works by inhibiting - Head ache -Do skin
cephalosporin the the mucopeptide - Dizziness testing
treatment of synthesis in the - Pain
infection bacterial cell wall. -Asses
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(respirator, The beta-lactam - Induration patients

skin, soft moiety of - Phlebitis previous
tissue, UTI, ceftriaxone binds to - Rash sensitivity
ENT0 carboxypeptidases, - diarrhea reaction to
caused by and transpeptidases, - Thrombocytosis penicillin or
susceptible endopeptidases in - Respiratory other
organism. the bacterial superinfection cephalosporin
cytoplasmic
membrane. These -Assess
enzyme that involve patient sign
cell wall synthesis and symptoms
and cell division. of infection
By binding to these before and
enzymes, during the
Ceftriaxone results treatment
in the formation of
defective cell walls -Monitor
and cell death. hematologic,
electrolytes,
renal and
hepatic
reaction

-Monitor sign
of allergic
reaction

Paracetamol Analgesic Used for the Thought to produce - Rash -Assess

treatment of analgesics by - Swelling patient fever
mild to blocking pain - Nausea or pain
moderate impulses by - Vomiting
pain and inhibiting synthesis - Constipation -Assess
reduction of of prostaglandin in allergic
fever the CNS or of other reaction
substances that
sensitize pain -Assess and
receptor to monitor vital
stimulation. sign

-Report any
unusual
swelling,
severe
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dizziness
And trouble
breathing

Cefixime Antibiotic Used to Like all beta-lactam - Diarrhea -Asses overall

treat antibiotics, - Stomach pain condition of
infections cefixime binds to - Rash patient
caused by specific penicillin- - Itching especially for
bacteria binding proteins - Trouble sign of
such as (PBPs) located breathing infection
pneumonia, inside the bacterial - Nausea
bronchitis, cell wall, causing - vomiting -Assess for
gonorrhoea the inhibition of the allergic
and urinary third and last stage reaction and
tract of bacterial cell anaphylaxis
infection wall synthesis
-Assess renal
function
before and
during therapy
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IX. Anatomy & Physiology

The urinary system's function is to filter blood and create urine as a waste by-product. The
organs of the urinary system include the kidneys, renal pelvis, ureters, bladder and urethra.

The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep
chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods
containing protein, such as meat, poultry, and certain vegetables, are broken down in the body.
Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other
wastes in the form of urine.
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Other important functions of the kidneys include blood pressure regulation and the production of
erythropoietin, which controls red blood cell production in the bone marrow. Kidneys also
regulate the acid-base balance and conserve fluids.

Kidney and urinary system parts and their functions

 Two kidneys. This pair of purplish-brown organs is located below the ribs toward the
middle of the back. Their function is to:

o Remove waste products and drugs from the body

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o Balance the body's fluids

o Release hormones to regulate blood pressure

o Control production of red blood cells

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each
nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small
tube called a renal tubule. Urea, together with water and other waste substances, forms the urine
as it passes through the nephrons and down the renal tubules of the kidney.

 Two ureters. These narrow tubes carry urine from the kidneys to the bladder. Muscles in
the ureter walls continually tighten and relax forcing urine downward, away from the
kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop.
About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from
the ureters.

 Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in
place by ligaments that are attached to other organs and the pelvic bones. The bladder's
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walls relax and expand to store urine, and contract and flatten to empty urine through the
urethra. The typical healthy adult bladder can store up to two cups of urine for two to five
hours.

 Two sphincter
muscles. These
circular muscles help
keep urine from
leaking by closing
tightly like a rubber
band around the
opening of the bladder.

 Nerves in the bladder. The nerves alert a person when it is time to urinate, or empty the
bladder.

 Urethra. This tube allows urine to pass outside the body. The brain signals the bladder
muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain
signals the sphincter muscles to relax to let urine exit the bladder through the urethra.
When all the signals occur in the correct order, normal urination occurs.

https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-of-the-urinary-
system#:~:text=The%20urinary%20system's%20function%20is,and%20converts
%20them%20to%20energy.
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X. Pathophysiology
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Nursing Care Management

XI. Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective Deficient -After 8 -Ascertain level of -After 8 hours
data: knowledge hours of knowledge, including of nursing
Insufficient related to nursing anticipatory needs. intervention,
knowledge insufficient intervention -Determine the The patient
interest in the patient client’s ability, verbalized
Objective Data: learning. will verbalize readiness and barriers understanding
-Inaccurate understandin to learning. of the
follow through g of -Be alert to signs of condition,
of instructions condition, avoidance . disease process
or performance disease -Identify support and treatment.
on a test or process and individuals/significant
procedure. treatment. other requiring
-Inappropriate information
behavior. -Determine blocks of
-Alteration in learning to learning.
cognitive -Assess the level of
functioning or the client's
memory. capabilities and the
-Vital signs possibilities of the
taken as follow: situation.
BP- -Identify motivational
100/60mmHg factors.
PR-74bpm -Provide information
RR-20cpm relevant only to the
Temp-38.4 situation
degrees -Provide position
Celsius. reinforcement.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective -Hyperthermia -After 2 -Identify -After 2 hours
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Data: related to hours of underlying cause. of nursing

“Nag ngatu inflammation nursing -Note intervention the
fever ku” as and infectious intervention chronological and patient
verbalized by process the patient developmental verbalized
the patient. secondary to will be able age of client. temperature is
pyelonephritis to maintain -Monitor core within normal
Objective Data: , as evidenced a core temperature, note range.
-Abnormal by an increase temperature the presence of
posturing. in body that is temperature
-Flushed skin temperature within elevation.
-Irritability on an above normal -Assess whether
-Vital signs normal range. range. the temperature
taken as reflects
follows; heatstroke.
BP- -Provide Tepid
100/60mmHg. sponge bath.
PR-74bpm -Encouraged to
RR-20cpm increase oral fluid
Temp-38.4 intake.
degrees Celsius -Assess
neurological
response, noting
the level of
consciousness and
orientation,
reaction to
stimuli, reaction
of pupils and
presence of
posturing or
seizure.
-Monitor
respirations.
-Auscultate breath
sounds, noting
adventurous
sounds such as
crackles.
-Monitor and
record all source
of fluid loss such
as urine.
-Note the
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presence of
absence of
sweating as the
body attempts to
increase heat loss
by evaporation.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective -Hyperthermia -After 2 -Identify -After 2 hours
Data: related to hours of underlying cause. of nursing
“Nag ngatu inflammation nursing -Note intervention the
fever ku” as and infectious intervention chronological and patient
verbalized by process the patient developmental verbalized
the patient. secondary to will be able age of client. temperature is
pyelonephritis to maintain -Monitor core within normal
Objective Data: , as evidenced a core temperature, note range.
-Abnormal by an increase temperature the presence of
posturing. in body that is temperature
-Flushed skin temperature within elevation.
-Irritability on an above normal -Assess whether
-Vital signs normal range. range. the temperature
taken as reflects
follows; heatstroke.
BP- -Provide Tepid
100/60mmHg. sponge bath.
PR-74bpm -Encouraged to
RR-20cpm increase oral fluid
Temp-38.4 intake.
degrees Celsius -Assess
neurological
response, noting
the level of
consciousness and
orientation,
reaction to
stimuli, reaction
of pupils and
presence of
posturing or
seizure.
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-Monitor
respirations.
-Auscultate breath
sounds, noting
adventurous
sounds such as
crackles.
-Monitor and
record all source
of fluid loss such
as urine.
-Note the
presence of
absence of
sweating as the
body attempts to
increase heat loss
by evaporation.

I. Discharge Plan (either METHOD OR METHODS)

II. Medication Health teaching
III. 04/24/2023 -instructed patient to take prescribed medications the
IV. .Cefixime 200mg/tab 2x a day for 7days (8 following right dose,time,and route
-Discussed every medication's side effects and how to
am-6 pm) manage when experienced
V. . paracetamol 500 mg/tab 1 tab every 4 hours -Adviced the patient not to stop taking them just
for fever because she feel better not finishing the medication
make the infection comeback it may also make future
infection harder to treat.
-Emphasized the importance of consulting a physician
prior to taking any medication
-Instructed the importance for follow check up on the
date stated.
Exercise/environment -Emphasized the importance of rest and comfort
-Adviced the patient activities of daily living
household chores.
-Demonstrated deep breathing exercises to promote
lung capacity and re demonstrated by the patient.
-Allowed exercise such as walking gradually or as
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tolerated.
-Encouraged patient to engage herself to have
moderate exercise
-Adviced the patient to maintain quiet and clean
environment.

Health education -Educated patient about the possible health outcome

when proper health teaching specified for her condition
is not observed.
-Emphasized the importance of full strict health
regimen that helps boost her immune system since the
patient is prone to opportunistic bacteria.
-Encouraged the patient to maintain good hygiene
including washing hands, avoid using irritating
cosmetics or chemicals in the area of the vagina such
as strong soap.
Diet -Instructed patient to maintain eating healthy diet such
as vegetable and fruits.
-Encouraged patient to drink enough fluids such as
water to keep urine light yellow in color this may help
flush the infection from the system.
-Adviced the patient to avoid carbonated drinks and
caffeine.
Sexual activities -Instructed to maintain relationship with her husband
but sexually activity is yet to be abstained if still be
desirable to them instructed to always urinate after
having sex helps clear bacteria from the urethra this
lower the risk of infection.
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