Professional Documents
Culture Documents
WITH RENAL
PROBLEMS
College of NURSING
In partial fulfillment of the requirements for the course Care of Clients with Problems in Oxygenation, Fluid & Electrolytes,
Infectious, Inflammatory, Immunologic, Cellular Aberrations (acute & chronic) RLE
CASE SCENARIO
Patient ZC, is a 4-year-old boy who was brought to the
emergency room of Las Piñas Doctors Hospital (LPDH) on January
22, 2019 at 8:45 PM with the chief complaint of fever since the night
before, and abdominal pain. He took paracetamol at 6 PM on the
same day. Initial assessment of vital signs and weight are as
follows:
● Temperature of 39.1°C,
● Pulse rate of 153 bpm,
● Respiratory rate of 28 cycles per minute,
● Oxygen saturation of 98%, and
● Weight of 18kg
Further assessment by the ER physician revealed that he has
been experiencing pain upon urination or dysuria, and groin pain.
He has no cough, cold, nor loose bowel movement. Monitoring of his
temperature shows a decreasing trend from 40.5°C at 10 PM to
38.3°C at 5:35 AM. Student nurse handled patient ZC in the
emergency room on January 23, at 7AM. His temperature reading
was 37.9°C. The initial diagnosis is T/C UTI. The urinary tract can be
divided into two sections: the upper portion of the tract consisting
of the kidneys and ureters, and the lower portion of the tract
consisting of the bladder and the urethra.
INTRODUCTION
General objective
Specific objective
PATIENT’S PROFILE
DIAGNOSTIC AND LABORATORY EXAMINATIONS
DIAGNOSTIC AND LABORATORY EXAMINATIONS
VOIDING CYSTOGRAPHY
KIDNEY ULTRASOUND
CLINICAL FINDINGS AND SIGNIFICANT
SIGNS AND SYMPTOMS
Fever
Abdominal pain
Pain upon urination (dysuria)
Groin pain
Attachment of the bacteria
to the urethra
High Salt Diet
The habit of holding
back of urine
Gender
Race Lifestyle
Nonmodifiable Modifiable
Factors Factors
Inflammation of renal tubules and
parenchyma
ASCENSION
Introduction of the
bacteria to the bladder
Colonization
Fever, Chills Low back pain
Nausea, vomiting Flank Pain
Weakness Dysuria, Frequency
ACUTE
PYELONEPHRITIS
PROBLEM LIST (PRIORITIZATION OF PROBLEMS)
Actual Problems
Dysuria
Actual Problems
Abdominal pain
Actual Problems
Fever
Nursing
Assessment Planning Rationale Evaluation
Diagnosis Implementation
Subjective Data: Acute pain related to After nursing 1.Assess client's pain 1. Pain associated with After Nursing
infection within the intervention, by the use of faces UTI described as Intervention,
urinary tract as pain scale (Wong abdomen
Abdominal Pain The patient pain will
evidenced by Baker) discomfort, painful The patient's pain is
Pain upon urination be relieved and
abdominal pain and urination etc that relieved
(Dysuria) other complications
dysuria 2. Use of non- will help determine Other complications
Groin Pain will be prevented
pharmacological the choice of are prevented
techniques for pain intervention Prevention and
Patient's gaurdian treatment of UTI are
management as
knowledge about explained to the
Objective Data: appropiate 2. Alternative
preventive gaurdian.
therapies such as
measures and
T: 39.1 3. Encourage fluid relaxation, massage,
treatment
P: 153bpm intake guided imagery or
modalities will
R: 28 cycles per increase distraction may
minute 4. Encourage patient decrease pain and
SpO2: 98% to void frequently provide comfort
W: 18kg
Rationale
4. Encourage frequent
voiding every 2 to 3
hours to empty the
bladder completely
because this can
significantly lower urine
bacterial counts, reduce
urinary status and
prevent reinfection
NURSING CARE PLAN
Nursing
Assessment Planning Rationale Evaluation
Diagnosis Implementation
Upon Assessment Impaired urinary After nursing 1. Ask the patient's 1. Assessing the After Nursing
elimination related to intervention, guardian to verify pattern provides Intervention,
PT has been experiencing urinary tract infection symptoms of the a basis for other
Assess the pattern of PT would have relief
as evidenced by Pain child's frequency, nursing
Pain upon urination elimination of pain from UTI
upon urination urgency and pain interventions and
(Dysuria) (Dysuria) 2. Determine any serves as a useful
Groin Pain Encourage to drink PT family is well-
presence of pain in aid to determine
cranberry juice briefed about nature
the bladder. factors that led to
of UTI and how easy
3. Assess how much UTI.
it is to developed
Encouragge regular and how often the 2. Certain
urination instead patient eliminates compounds
PT family is well-
of catheterization the urine. present in
informed of the
4. Recommend the cranberry juice
prevention of UTI
daily intake of help
cranberry juice decrease/remove
Aggravation and
along with strong bacteria in the
other complicatiton
rehydration of digestive tract
for UTI is prevented
water thus preventing
bacterial
adhesion
Implementation Rationale
NURSING CARE PLAN
5. Inform patient's 3. May increase risk
guardian that certain for infection and may
measures for also cause fear to the
eliminating urine i.e. child. If
catheterization also catheterization is
posses risks necessary promote
strict intervention and
guidance to preven
urosepsis
DRUG STUDY
Ampicillin Ampicillin is a penicillin Used to treat certain *hypersensitivity to G.I: glossitis, stomatitis, Monitor signs of allergic
derivative used for the infections that are ampicillin or other nausea, vomiting, reactions and
Brand Names: treatment of a variety caused by bacteria penicillins enterocolitis, anaphylaxis:
Sulbactam of infections caused by such as meningitis; pseudomembranous
gram-positive and and infections of the *Cephalosporin colitis, and diarrhea. pulmonary symptoms
Antibiotic Class: gram-negative bacteria throat, sinuses, hypersensitivity (tightness in the throat
Penicillin as well as some lungs, reproductive * Patients with and chest, wheezing,
(aminopenicillin) anaerobes. organs, urinary tract, mononucleosis are cough dyspnea) or skin
and gastrointestinal more likely to develop reactions (rash,
Therapeutic uses: interference with cell tract. a skin rash pruritus, urticaria).
Treat certain infections wall synthesis by
that are caused by attachment to Drug Interactions Notify physician or
bacteria penicillin-binding nursing staff
proteins (PBPs), -Allopurinol -Atenolol - immediately if these
Dosage: Contraceptive reactions occur.
100-200 mg/kg/d Q6 -Lansoprazole
-Live Typhoid Vaccine -
Route: Omeprazole
Intramuscular or -Pantoprazole
Intravenous -Probenecid
-Rabeprazole
Frequency:
Infusion over 10-15 min
DRUG STUDY
Generic Name: Cefuroxime is a Zinacef is indicated Zinacef is Most common side The
Cefuroxime bactericidal agent for the treatment of contraindicated in effects parents/guardians
that acts by inhibition patients with urinary patients with known Swelling, redness, or should be reminded
Brand Name: of bacterial cell wall tract infections allergy to the pain at the injection to avoid other β-
Zinacef synthesis. caused by Escherichia cephalosporin group site may occur lactam antibacterial
coli and Klebsiella of antibiotics. drugs.
Classification: spp. Serious side effects Monitor renal,
Cephalosporin Easy hepatic, and
antibiotic bruising/bleeding hematologic
Unusual tiredness function periodically
Dosage: Uncontrollable with prolonged
75-150 mg/kg/d movements therapy.
Mental/mood
Route: changes
Intravenous route Seizures
Signs of kidney
Frequency: problems
Every 8 hours (Q8) (3x Signs of liver
day) problems
DRUG STUDY
Nursing
responsibilities
Monitor signs of
pseudomembranous
colitis, including
diarrhea, abdominal
pain, fever, pus or
mucus in stools, and
other severe or
prolonged GI problems
(nausea, vomiting,
heartburn). Notify
physicians or nursing
staff immediately of
these signs.
Monitor signs of
allergic reactions and
anaphylaxis, including
pulmonary symptoms
(tightness in the throat
and chest, wheezing,
cough dyspnea) or skin
reactions (rash,
pruritus, urticaria).
Notify physician or
nursing staff
immediately if these
reactions occur
DRUG STUDY
Nursing
responsibilities
Instruct
family/caregivers to
report other
troublesome side
effects such as
severe or prolonged
skin problems (rash,
hives, dermatitis) or
GI problems
(nausea, vomiting,
diarrhea, cramps).
DRUG STUDY
Generic Name: Cefuroxime is a Ceftin is indicated for Ceftin is Most common side The guardian of the
Cefuroxime bactericidal agent the treatment of contraindicated in effects patient should be
that acts by inhibition adult patients and patients with a known Diarrhea reminded to give
Brand Name: of bacterial cell wall pediatric patients hypersensitivity (e.g., Nausea medication
Ceftin synthesis. with mild to anaphylaxis) to Vomiting appropriately as
moderate infections CEFTIN or to other β- prescribed and do
Classification: like UTI. lactam antibacterial Serious side effects not exceed the
Cephalosporin drugs (e.g., penicillins Severe stomach maximum dose.
antibiotic and cephalosporins). pain Monitor renal,
Painful urination hepatic, and
Dosage: Fever hematologic function
20-30 mg/kg/d periodically with
prolonged therapy.
Route:
Oral route
Frequency:
Every 12 hrs (Q12) (2x
day)
DRUG STUDY
Nursing
responsibilities
Monitor signs of
pseudomembranous
colitis, including
diarrhea, abdominal
pain, fever, pus or
mucus in stools, and
other severe or
prolonged GI problems
(nausea, vomiting,
heartburn). Notify
physicians or nursing
staff immediately of
these signs.
Monitor signs of
allergic reactions and
anaphylaxis, including
pulmonary symptoms
(tightness in the throat
and chest, wheezing,
cough dyspnea) or skin
reactions (rash,
pruritus, urticaria).
Notify physician or
nursing staff
immediately if these
reactions occur
DRUG STUDY
Nursing
responsibilities
Instruct
family/caregivers
to report other
troublesome side
effects such as
severe or
prolonged skin
problems (rash,
hives, dermatitis)
or GI problems
(nausea,
vomiting,
diarrhea, cramps)
DRUG STUDY
Amoxiclav Combinations of
Amoxicillin + Clavulanic 2 anti-bacterial: Amino-penicillin, -Do not administer to ADVERSE EFFECTS: Before:
Acid Amoxicillin - inhibits created by adding an Penicillin allergic Gastrointestinal Monitor Vital signs
bacterial cell wall extra amino group to patient with history of disturbances The guardian of the
Brand Name: mucopeptide synthesis penicillin to battle hepatic disorder during Diarrhea patient should be
Augmentin Clavulanic acid- antimicrobial a previous treatment of Allergic reaction reminded to take
inactivates a wide resistance. Amoxicillin Augmentin. Jaundice and OTC meds
Classification covers a wide variety - Administer with cholestatic appropriately as
range of beta lactam
Extended spectrum of gram-positive caution to patients hepatitis with prescribed and to
enzymes found in
Augmented penicillin bacteria, with some allergic to prolonged tretment not exceed the
bacteria resistant to
penicillin and added gram-negative cephalosphorins (cross more than 10-15 maximum dose.
Therapeutic: coverage compared to sensitivity may happen days Nurses must ensure
Antibiotic
cephalosphorin
penicillin. Like -patient with hepatic SIDE EFFECTS: antibiotics are
Pharmacologic : penicillin, it covers impairment nausea monitored and
Aminopenicillins Amoxicillin/clavulanic
most Streptococcus -Reduce dosage and give vomiting administered
Dosage: acid is a penicillin-type
species and is also every 12-24 hr irritant dermatitis correctly.
20-40 mg/kg/d antibiotic used to treat
effective against headache
1-6 yrs old: 5ml a wide variety of Listeria dizziness
augmentin 156 mg bacterial infections. It monocytogenes and
suspension 3 times a works by stopping the Enterococcus species.
day growth of bacteria.
-each 25 mg of Extends its spectrum of
augmentin provide 20 activity to cover beta
mg amoxicillin and 5 lactams producing G+
mg clavulanate and G- organism
including G anaerobes.
DRUG STUDY
Route: These beta-lactamase It also covers swelling of the face, Monitor hepatic and
Oral inhibitors work by Haemophilus influenza, throat, tongue, lips, renal function and
binding irreversibly to some Escherichia coli, and eyes CBC, as ordered, in
Frequency: the catalytic site of an Actinomyces species, severe diarrhea patients on
organism’s beta- Clostridium species, (watery or bloody prolonged therapy
Every 8 hours (Q8) lactamase enzyme, Salmonella species, stools) that may
which causes Shigella species, and occur with or
resistance to the Corynebacteria species without fever and
original beta-lactam stomach cramps
ring of amoxicillin. (may occur up to 2
months or more
after your
treatment)
DRUG STUDY
Medication
Advice the patient’s guardian to take the prescribed medications on the prescribed time.
Instruct the patient’s guardian to read and review directions for accurate use of medication
Educate the patient’s guardian about what the prescribed medications are and how they
function
Explain what are the possible side effects; what is normal and what is not.
Do advise to go seek medical attention immediately if any adverse effects take place.
Exercise
Encourage the patient to walk from time to time. Walking is a low-impact exercise and is
accessible by everyone. This also helps to regulate blood pressure.
Kegel exercises
Activity restrictions - Instruct the patient and guardian to take it easy for the following several
days. Avoid lifting, pulling, and other strenuous activities as recommended by the doctor.
Treatment
Encourage the patient's guardian to follow the treatment methods that were
ordered by the doctor.
Provide the patient about the proper use of prescribed medications.
Encourage family members to provide emotional support and to gain knowledge
about the disease and treatment regimen for the patient.
Encourage the patient and family to seek proper care and medical attention if the
patient experiences unmanageable signs and symptoms.
Outpatient
Remind the patient and family about the follow up check up
with their physician.
Advise the patient’s family to evaluate progress of the
treatment
Diet
Encourage the patient to increase fluid intake. As well as to
drink cranberry juice.
Encourage the patient to avoid processed food, dairy
products, and food high in sodium or msg.
Thank you!
Ms Astrid
Ms Chin
&
Ms FIdes