NURSING CARE MANAGEMENT FOR PATIENT

WITH RENAL
PROBLEMS

A Case Study presented to the

College of NURSING

Southville International School and Colleges

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

Urinary tract infection (UTI) is caused by pathogenic microorganisms in

the urinary tract (kidney, bladder, and urethra). Most of these urinary
infections are caused by the bacteria Escherichia coli (E. Coli) and are
normally found in our digestive system. In some instances bacteria can
overcome the natural and immune defenses in our body and lead to the
infection. In pediatric patients is described by the presence of a single
pathogen in urine culture, supported by findings in history taking, physical
examination, and tests such as a urinalysis and urine culture to identify
appropriate treatment.
In the case of patient ZC, while further
work-up is needed to aid in diagnosis, upper
UTI is the assumed case. In relatively normal
urinary tracts, the most common UTI-causing
pathogens are strains of Escherichia coli.
Pharmacological treatment includes
antibiotics for this reason.
OBJECTIVES

General objective

This group case study aims to enhance our comprehension as nursing

students for Urinary Tract Infection (UTI).

Specific objective

a. To increase general knowledge and improve critical thinking with

regard to approach on Urinary Tract Infection as one of the major renal
problems
b. To be able to understand laboratory and diagnostic studies in UTI
c. To formulate the appropriate Nursing Care Plans and Prioritization
listing
d. To identify the appropriate intervention required for the client after UTI
e. To enhance our understanding about the drugs/medication presented
in the case
f. To properly illustrate and break down the pathophysiology of Urinary
Tract Infection
 CHIEF COMPLAINT
Patient ZC went to the emergency room at 8:45 PM with a chief complaint of fever since the night
before, and abdominal pain. The patient stated that he has been experiencing pain upon urination
and groin pain.

PATIENT’S PROFILE
DIAGNOSTIC AND LABORATORY EXAMINATIONS
DIAGNOSTIC AND LABORATORY EXAMINATIONS

VOIDING CYSTOGRAPHY

KIDNEY ULTRASOUND
CLINICAL FINDINGS AND SIGNIFICANT
SIGNS AND SYMPTOMS

Patient ZC manifested significant signs and

symptoms:

Fever
Abdominal pain
Pain upon urination (dysuria)
Groin pain
 Ascending infection of the
urinary tract
(Escherichia Coli)
BACTERIA

High Salt Diet

The habit of holding
back of urine
Gender
Race Lifestyle

Nonmodifiable Modifiable
Factors Factors
ACUTE PYELONEPHRITIS

ASCENSION

Uroepithelium
penetration

Colonization
 Inflammation of renal
pelvis and kidney

Acute Pylenophritis

Fever, Chills Low back pain

Nausea, vomiting Flank Pain
Weakness Dysuria, Frequency
PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems

Dysuria

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems

Abdominal pain

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems

Fever

NURSING CARE PLAN

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

3. The nurse should

encourage the patient to
drink liberal amounts of
fluid to promote renal
blood flow and to flush
bacteria from the
urinary tract

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

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication Side Effects
Action responsibilities

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

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication Side Effects
Action responsibilities

Generic Name: Cefuroxime is a Zinacef is indicated Zinacef is Most common side Patient should be
Cefuroxime bactericidal agent for the treatment of contraindicated in effects reminded to avoid
that acts by inhibition patients with urinary patients with known Swelling, redness, or other β-lactam
Brand Name: of bacterial cell wall tract infections allergy to the pain at the injection antibacterial drugs.
Zinacef synthesis. caused by Escherichia cephalosporin group site may occur Monitor renal,
coli and Klebsiella of antibiotics. hepatic, and
Classification: spp. Serious side effects hematologic
Cephalosporin Easy function periodically
antibiotic bruising/bleeding with prolonged
Unusual tiredness therapy.
Dosage: Uncontrollable Monitor signs of
75-150 mg/kg/d movements pseudomembranous
Mental/mood colitis, including
Route: changes diarrhea, abdominal
Intravenous route Seizures pain, fever, pus or
Signs of kidney mucus in stools, and
Frequency: problems other severe or
Every 8 hours (Q8) (3x Signs of liver prolonged GI
day) problems problems (nausea,
vomiting,
heartburn). Notify
physicians or
nursing staff
immediately of
these signs.
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
DRUG STUDY

Nursing
responsibilities

(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
Instruct patient and
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

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication
Action Side Effects responsibilities

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 take
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 to not
Classification: like UTI. lactam antibacterial Serious side effects exceed the maximum
Cephalosporin drugs (e.g., penicillins Severe stomach 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).
DRUG STUDY

Nursing
responsibilities

Notify physician or
nursing staff
immediately if these
reactions occur.
Instruct patient
and
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

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication Side Effects
Action responsibilities

Amoxicillin Act by binding to Amino-penicillin, Amoxicillin is nausea Before:

penicillin-binding created by adding an contraindicated in vomiting Monitor Vital signs
Generic Name: proteins that inhibit a extra amino group to patients with a known diarrhea The guardian of the
Amoxicillin trihydrate process called penicillin to battle serious hypersensitivity changes in taste Patient should be
Clavulanate transpeptidation antimicrobial reaction (i.e., headache reminded to take
(Amoxycillin) Amoxicillin resistance. Amoxicillin anaphylaxis) to other rash OTC meds
administration can also covers a wide variety beta-lactams. Patients skin blisters or appropriately as
Brand Name: be in combination with of gram-positive with allergies or atopic peeling prescribed and to
Amoxiclav a beta-lactamase bacteria, with some conditions including itching not exceed the
inhibitor. Some added gram-negative asthma, eczema, hives hives maximum dose.
Classification examples of these are coverage compared to (urticaria), or hay fever wheezing Nurses must ensure
Penicillin like clavulanic acid and penicillin. Like may have a greater risk difficulty antibiotics are
antibiotics sulbactam. penicillin, it covers for hypersensitivity swallowing or monitored and
most Streptococcus reactions to penicillins. breathing administered
Therapeutic: species and is also correctly.
Antibiotic effective against
Listeria
Pharmacologic : monocytogenes and
Aminopenicillins Enterococcus species.

Dosage:
20-40 mg/kg/d
DRUG STUDY

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication Side Effects
Action responsibilities

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

Mechanisms of Indication Adverse/ Nursing

Drug Name Contraindication Side Effects
Action responsibilities

These drugs do not Amoxicillin may cause Expect to start

have inherent other side effects. therapy before
bactericidal activity; Inform physician for culture and
however, they may any unusual problems sensitivity results
broaden amoxicillin's while taking this are known.
spectrum to organisms medication. PATIENT TEACHING:
that produce the beta- Instruct the
lactamase enzyme guardian of the
when combined with patient to
amoxicillin refrigerate
reconstituted
suspension and to
shake well before
each use.
 Discharge planning
M.E.T.H.O.D.S

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.

SECIVRES ERACHTLAEH NITRUC

Health education
Inform the patient to allow voiding of urine as demanded by the body. Holding urine
in the bladder may cause additional pain and infection.
Inform the patient and family on proper hygiene practices concerning his condition.
Educate the patient and family that each prescribed medication should be finished
within the proper timeline.
Have the child wear loose cotton clothing during the day.
Lead Researcher
Encourage the child to take plenty of fluids and to hydrate generously everyday

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.