ROVERO, JOHN MARK LORENZANA

BSN 3-YA-4
NCMB 312 LEC

Week 9: Course Task- Case Analysis Renal Disorders

Study Questions:
A.PYELONEPHRITIS
A patient consulted in the emergency department with complaints of high fever, chills, dysuria, and back pain. Laboratory results are
as follows:
WBC –13,000 cells/mcL
Neutrophils –10,000 per mm3
Lymphocytes –3,500 per mm3
Serum Sodium –136 mEq/L
Serum Potassium –3.7 mEq/L
Urinalysis:
Color: Hazy yellow
Bacteria: Too many to count
Pus cells: >100 cells/hpf
RBC: >100 cells/hpf
Specific gravity: 1.280

The doctor ordered co-trimoxazole (Bactrim) 800/160mg tablet TID for 14 days and phenazopyridine (Pyridium) 200 mg
tablet TID for 3 days.Given the above case, answer the following questions:
1. What laboratory values point towards the diagnosis of Pyelonephritis?
- Bacteria: Too many to count
- WBC –13,000 cells/mcL

2. What is the most common causative agent of urinary tract infections?

- Uropathogenic Escherichia coli (UPEC)

3. Give at least two (2) health teaching points that will help the prevention of recurrence of UTI?
 - Instruct patients to follow some steps to reduce the recurrence of UTI one example is by wiping from front to back.
- Instruct patients to increase water intake. Drinking water helps dilute your urine and ensures that you’ll urinate more
frequently allowing bacteria to be flushed from your urinary tract before an infection can begin.

4. Create a drug study for the medication: CO-TRIMOXAZOLE specifying the following:

Drug Mechanism of action Indication Contraindicatio Side effects Nursing Considerations

classification n

-Is a - Co-trimoxazole is a - Co-trimoxazole -Contraindicated - Skin: Mild to moderate rashes -Monitor coagulation tests and
combination of synthetic antibacterial is used to treat in patients (including fixed drug eruptions), prothrombin times in patients also
trimethoprim combination product. certain bacterial hypersensitive to toxic epidermal necrolysis. receiving warfarin. Change in
and Sulfamethoxazole inhibits infections, such trimethoprim or GI: Nausea, vomiting, diarrhea, warfarin dosage may be
sulfamethoxazol bacterial synthesis of as pneumonia, sulfonamides anorexia, hepatitis, indicated.
e and is in a dihydrofolic acid by bronchitis, and and in patients pseudomembranous -Monitor I&O volume and pattern.
class of competing with infections of the with enterocolitis, stomatitis, glossitis, Report significant changes to
medications para-aminobenzoic acid urinary tract, ears documented abdominal pain. forestall renal calculi formation.
called (PABA). Trimethoprim and intestines. megaloblastic Urogenital: Kidney failure, Also report failure of treatment
sulfonamides blocks the production of anemia due to oliguria, anuria, crystalluria. (i.e., continued UTI symptoms).
tetrahydrofolic acid from folate deficiency Hematologic: Agranulocytosis -Be alert for overdose symptoms
dihydrofolic acid by binding (rare), aplastic anemia (rare), (no extensive experience has
to and reversibly inhibiting megaloblastic anemia, been reported): Nausea,
the required enzyme, hypoprothrombinemia, vomiting, anorexia, headache,
dihydrofolate reductase. thrombocytopenia (rare). Body dizziness, mental depression,
Thus, co-trimoxazole as a Whole: Weakness, confusion, and bone marrow
blocks two consecutive arthralgia, myalgia, depression.
steps in the biosynthesis of photosensitivity, allergic
nucleic acids and proteins myocarditis
essential to many bacteria.

5. Create a drug study for the medication: PHENAZOPYRIDINE specifying the following:
 Drug Mechanism of action Indication Contraindication Side effects Nursing Considerations
classification

- is an oral -The mechanism of action -Phenazopyridine is - Phenazopyridine is - Body as a Whole: - Lab tests: Obtain periodic
urinary analgesic of phenazopyridine is not an azo dye excreted contraindicated in Headache, vertigo. blood work and kidney
(pain relieving fully elucidated, however, in urine, where it patients with renal GI: Mild GI disturbances. function tests in patients
medication). It is it is reported to exert a exerts a topical insufficiency, severe Urogenital: Kidney stones, on prolonged therapy or
available direct topical analgesic analgesic effect on liver disease, severe transient acute kidney failure. with impaired kidney
over-the-counter effect on the mucosal urinary tract mucosa. hepatitis or Metabolic: function.
(without a lining of the urinary tract Use of a urinary pyelonephritis of Methemoglobinemia,
prescription or via the inhibition of analgesic is indicated pregnancy and in hemolytic anemia.
OTC) in lower voltage-gated sodium when a patient has patients who are Skin: Skin pigmentation.
strengths, and channels and possibly dysuria to such an hypersensitive to the Special Senses: May stain
with a group A nerve fibers, as extent that it disrupts drug or its soft contact lenses.
prescription for suggested by the results activities of daily ingredients. It should
higher strengths of a study in rats. The living. These agents be used cautiously in
above actions likely lead relieve pain, the presence of GI
to the relief of unpleasant discomfort, and disturbances.
urinary symptoms. spasms of the
bladder.

B. GLOMERULONEPHRITIS
A patient with cleft lip and bronchial asthma was brought to the emergency department with chief complaint of
low-grade fever, puffiness of the face and eyes in the morning, +2 edema on both feet, and tea-colored urine. Urinalysis
revealed numerous RBC and a certain degree of proteinuria and Antistreptolysin-O titer reaches more than 300 todd units.
The doctor came up with the diagnosis of Acute Glomerulonephritis (AGN).
Answer the following questions:
1. What history-taking question should be asked by the nurse to strengthen the diagnosis of AGN?
- Family medical history
 2. Explain the pathophysiological tracing on the development of AGN.
- Acute glomerulonephritis comprises a specific set of renal diseases in which an immunologic mechanism triggers
inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane.

3. The doctor ordered hydrocortisone TIV, create a drug study specifying the following:

Drug Mechanism of Indication Contraindication Side effects Nursing Considerations

classification action

Therapeutic - Hydrocortisone - Hydrocortisone is - Hypersensitivity to Nausea, - Establish baseline and continuing

class: is an a natural glucocorticoids, idiopathic heartburn, data on BP, weight, fluid and electrolyte
corticosteroids anti-inflammatory substance made thrombocytopenic purpura, headache, balance, and blood glucose.
adrenocortical by the adrenal psychoses, acute dizziness, - Lab tests: Periodic serum electrolytes
Pharmacologic steroid. It is a gland. It is used to glomerulonephritis, viral or menstrual period blood glucose, Hct and Hgb, platelet
class: short acting treat conditions bacterial diseases of skin, changes, trouble count, and WBC with differential.
glucocorticoids glucocorticoid with such as arthritis, infections not controlled by sleeping, -Monitor for adverse effects. Older
mineralocorticoid blood/hormone/im antibiotics, active or latent increased adults and patients with low serum
activities. It has a mune system amebiasis, hypercorticism sweating, or acne albumin are especially susceptible to
very rapid action disorders, skin and (Cushing's syndrome), may occur. If any adverse effects.
eye conditions, smallpox vaccination or other of these effects -Be alert to signs of hypocalcemia
breathing immunologic procedures. persist or worsen, - Monitor for persistent backache or
problems, cancer Topical steroids tell your doctor or chest pain; compression and
and severe contraindicated in presence of pharmacist spontaneous fractures of long bones
allergies varicella, vaccinia, on surfaces promptly. and vertebrae present hazards.
with compromised circulation, -Monitor for and report changes in
and in children <2 y. Safe use mood and behavior, emotional
during pregnancy (category C) instability, or psychomotor activity,
or lactation is not established especially with long-term therapy.