Week 9: Course Task- Case Analysis Renal Disorders

GROUP A
AGUSTIN, DOMINIC
ARCEO, DAVE
ATENDIDO, LEI ALEXIS
CASTAÑEDA, JOHN PAUL
BUSALPA, MARYJO
CASTILLO, KARL

A. PYELONEPHRITIS
A patient arrived at the emergency room complaining of a 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

Co-trimoxazole (Bactrim) 800/160mg tablet TID for 14 days and phenazopyridine (Pyridium)
200 mg tablet TID for 3 days were prescribed by the doctor. Given the above case, answer the
following questions:

1. WHAT LABORATORY VALUES POINT TOWARDS THE DIAGNOSIS OF PYELONEPHRITIS?

- Increased neutrophils due to an increased WBC count and the presence of hematuria in
the urine are laboratory values that point to Pyelonephritis.

2. WHAT IS THE MOST COMMON CAUSATIVE AGENT OF URINARY TRACT INFECTIONS?

- Foremost familiar causative agent of urinary tract infections is Escherichia coli; it is the
most common pathogen in acute pyelonephritis, and there has been an increase in E.
coli over the last decade. Resistance to extended-spectrum beta-lactam antibiotics in E.
 coli Though it is less common in older adults, the infection is contracted by 82% of
women and 73% of men.

3. GIVE AT LEAST TWO (2) HEALTH TEACHING POINTS THAT WILL HELP THE
PREVENTION OF RECURRENCE OF UTI?

- Consume a lot of fluids, particularly water. Drinking water dilutes your urine and
encourages you to urinate more frequently by flushing bacteria from your urinary tract
before an infection develops. Wipe from the front to the back. Doing so after urinating
and having a bowel movement helps prevent bacteria from spreading from the anal
region to the vagina and urethra.

4. CREATE A DRUG STUDY FOR THE MEDICATION: CO-TRIMOXAZOLE SPECIFYING THE

FOLLOWING:

A. Drug classification: Sulfonamides

B. MOA: Sulfamethoxazole inhibits bacterial folic acid synthesis and growth by inhibiting the
formation of dihydrofolic acid from para-aminobenzoic acid; trimethoprim inhibits dihydrofolic
acid reduction to tetrahydrofolate, resulting in the sequential inhibition of folic acid pathway
enzymes.
C. Indication: Use to treat urinary bladder or urinary tract infections (water infections)
D. Contraindications: Patients with recognized oversensitivity to trimethoprim or
sulfonamides, as well as those with documented megaloblastic anemia caused by a lack of
folate.
E. Adverse reactions:
CNS: headache, mental depression, aseptic meningitis, apathy, seizures, hallucinations, ataxia,
nervousness, fatigue, vertigo, insomnia.
CV: thrombophlebitis.
EENT: tinnitus.
GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, stomatitis, pancreatitis,
pseudomembranous colitis.
GU: toxic nephrosis with oliguria and anuria, crystalluria, hematuria, interstitial nephritis.
Hematologic: agranulocytosis, aplastic anemia, megaloblastic anemia, thrombocytopenia,
leukopenia, hemolytic anemia, pancytopenia.
Hepatic: jaundice, hepatic necrosis.
Musculoskeletal: arthralgia, myalgia, muscle weakness.
Respiratory: pulmonary infiltrates.
Skin: erythema multiforme (Stevens-Johnson syndrome), generalized skin eruptions, epidermal
necrolysis, exfoliative dermatitis, photosensitivity, urticaria, pruritus.
Other: hypersensitivity reactions (serum sickness, drug fever, anaphylaxis), rhabdomyolysis.

F. Nursing considerations:

 Drink plenty of fluids to avoid crystalluria.

  Keep track of your CBC, renal function test, liver function test, and urinalysis results.

5. Create a drug study for the medication: PHENAZOPYRIDINE specifying the following:

A. Drug classification: Urinary Tract Analgesic

B. MOA: The mechanism is unknown. It has a local anesthetic effect on the mucosa of the
urinary tract.
C. Indication: This medication is used to treat symptoms caused by urinary tract irritation, such
as pain, burning, and the need to urinate urgently or frequently.
D. Contraindications: Contraindicated in patients with Hypersensitivity. Glomerulonephritis,
Severe hepatitis, uremia, or renal failure, Renal insufficiency, G6PD deficiency
E. Side Effects:
CNS: headache.
GI: nausea, GI disturbances.
Hematologic: hemolytic anemia, methemoglobinemia.
Skin: rash, pruritus.
Other: anaphylactoid reactions.

F. Nursing considerations:

 In patients on long-term therapy or with impaired kidney function, obtain periodic

blood work and kidney function tests.
 Be aware that the drug will color urine orange to red and may stain fabric.
 Discontinue drug and notify physician immediately if a yellowish tinge appears on the
skin or sclerae. This could indicate drug accumulation due to renal impairment.
 Stop taking the medication once the pain and discomfort have been relieved (usually 3–
15 d). Keep your doctor informed.

B. GLOMERULONEPHRITIS
A patient with facial deformity and bronchial asthma presented to the emergency department
with the chief complaint of low-grade fever, morning puffiness of the face and eyes, +2 edema
on both feet, and tea-colored urine. Urinalysis revealed numerous RBC and a degree of
proteinuria, as well as an Antistreptolysin-O titer of more than 300 todd units. Acute
Glomerulonephritis was diagnosed by the doctor (AGN).

1. WHAT HISTORY-TAKING QUESTION SHOULD BE ASKED BY THE NURSE TO

STRENGTHEN THE DIAGNOSIS OF AGN?

- The nurse's background question to improve the diagnosis of AGN is whether the
patient had a post-pharyngeal strep infection for 1-2 weeks or a post-dermal strep
infection for 2-4 weeks prior to AGN.
 2. EXPLAIN THE PATHOPHYSIOLOGICAL TRACING ON THE DEVELOPMENT OF AGN.

- The pathophysiological trace on the development of AGN is a Streptococcus infection

that the immune system complexes, producing antigen-antibody product that is
deposited in glomeruli, causing increased production of epithelial cells lining the
glomerulus. The leukocytes then infiltrate the glomerulus, causing thickening or
inflammation of the glomerular infiltration membrane. Proliferation of mesangial and
endothelial cells causes renal capillary blockage, indicating decreased glomerular
infiltration rate, which leads to glomerular basement damage and leakage of blood
elements, resulting in hematuria, proteinuria, oliguria, and red blood cell casts,
indicating edema and hypertension, which can lead to chronic heart and kidney failure if
left untreated.

3. THE DOCTOR ORDERED HYDROCORTISONE TIV, CREATE A DRUG STUDY SPECIFYING

THE FOLLOWING:

A. Drug classification: Glucocorticoid, Mineralocorticoid

B. Mechanism of action: Corticosteroids reduce vasodilation and capillary permeability in the
short term, as well as leukocyte migration to sites of inflammation. Corticosteroids bind to the
glucocorticoid receptor, causing changes in gene expression that have multiple downstream
effects that can last for hours or days.
C. Indication (for the above-mentioned patient): Hydrocortisone (or cortisone) is typically the
drug of choice for replacement therapy in patients with adrenal insufficiency.
D. Contraindications: Not recommended for patients who are allergic to any component of the
formulation or have systemic fungal infections.
E. Side effects:
CNS: euphoria, insomnia, psychotic behavior, pseudotumor cerebri, vertigo, headache,
paresthesia, seizures.
CV: heart failure, hypertension, edema, arrhythmias, thrombophlebitis, thromboembolism.
EENT: cataracts, glaucoma.
GI: peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting.
Metabolic: hypokalemia, hyperglycemia, altered thyroid function test results.
Musculoskeletal: muscle weakness, osteoporosis
Skin: delayed wound healing, acne, various skin eruptions, easy bruising, hirsutism.
Other: susceptibility to infections, cushingoid state (moonface, buffalo hump, central obesity),
carbohydrate intolerance, acute adrenal insufficiency with increased stress (infection, surgery,
trauma) or abrupt withdrawal (after long-term therapy).
F. Nursing Considerations:

 Collect baseline and ongoing data on blood pressure, weight, fluid and electrolyte
balance, and blood glucose.
 Periodic serum electrolytes, blood glucose, Hct and Hgb, platelet count, and differential
WBC.
  Keep an eye out for any negative effects.

C. RENAL CALCULI
An elderly patient with osteoporosis consulted in an Out-patient Department with complaints of
severe lower back pain. She is taking 1000 mg of calcium carbonate once a day and reports of
poor hydration due to her mobility problems. Ultrasound of the Kidneys, ureters, and bladder
reveal several calculi in both kidneys and is counselled to be a candidate for nephrolithotomy.

Answer the following questions:

1. What pertinent data in the patient’s history may have contributed with the development
of renal calculi, defend your answer?

Renal calculi are a common cause of blood in the urine (hematuria) and pain in the
abdomen, flank, or groin. Urolithiasis occurs when solutes crystallize out of urine to form stones.
Urolithiasis may occur due to anatomic features leading to urinary stasis, low urine volume,
dietary factors (e.g., high oxalate or high sodium), urinary tract infections, systemic acidosis,
medications, or uncommonly genetic factors such as cystinuria. The most common cause of
stone disease is inadequate hydration and subsequent low urine volume. The other four most
common factors contributing to urinary stone formation are hypercalciuria, hyperoxaluria,
hyperuricosuria, and hypocitraturia.

2. Identify three (3) priority nursing diagnoses in relation to the patient’s condition and
create a hypothetical Nursing Care Plans for each nursing diagnosis.

Assessment Diagnosis Planning Intervention Evaluation

Subjective Data: Acute Pain
Short term Document the Client has a
goal: pain in terms of satisfactory pain
“I am really related to Client will be location, relief as
bothered by this Increased able to report duration, evidenced by
and demonstrate intensity (1-10 the absence of
pain” frequency or behaviors pain scale), and urinary
force or ureteral signaling a radiation. Also, symptoms and
relief or control observe for decrease in pain
Rates pain as 8/10 contractions
of pain. nonverbal cues score.
when asked to rate like BP and
pain on a scale of 1 Long term pulse rate
goal: elevation,
to 10, with 10 as the Client will be restlessness,
highest. able to know crying or
and perform moaning.
Objective Data: activities that do
 Guarding not only provide Encourage to
relief from pain verbalize pain,
behavior/
but are helpful also noting for
protective in dealing with the pain
  Restlessness
the disease threshold of the
condition. client; let the
 Sweating client explain
 Creasing how the pain
occurs or for
eyebrows any changes in
 Tensed characteristics.
muscles
Educate and
 Frequent encourage client
grimacing in diversional
activities like
 Autonomic focused
responses: breathing and
guided imagery.

Blood pressure Provide

scheduled
ranging from 140/90
resting periods
– 130/ 100 for the client
and also provide
a peaceful
Pulse rate ranging environment.
from 95 – 105 beats
Assist client in
per minute daily ambulation
and encourage
increasing fluid
Respiratory rate
intake of at least
ranging from 18 – 3 L per day as
22 breaths per tolerated.

minute  Instruct client

to report for
persistent or
increased
abdominal pain.

 If indicated, a
warm compress
may be applied
to the back.

Insert and
maintain the
patency of the
urinary catheter
Subjective Data: Impaired The patient will Assess the The patient
N/A Urinary be able to patient’s current verbalize
Elimination achieve a elimination understanding
Objective Data: related to normal pattern and of the condition.
 Weak in mechanical elimination compare it with
appearance obstruction amount and the patient’s The patient
 Dehydrated secondary to pattern. normal demonstrate
 Vital Signs renal calculi elimination improvement in
formation as The patient will pattern before urine
Bp: evidenced by verbalize the elimination as
110/70bmmHg oliguria and techniques to manifestation of evidenced by
distended prevent urinary symptoms. fewer episodes
Temp: 38°C bladder. retention. of incontinence.
Monitor
RR: 118 bpm patient’s intake The patient
and output. improve sense
of energy.
Palpate the
bladder. The patient
return of normal
Encourage an voiding pattern
increase in water as evidenced by
intake. no episodes of
incontinence
Assist the and improved
patient with urine
frequent elimination.
ambulation.

Encourage the
patient to void
every 2 to 3
hours.

Instruct the
patient to strain
every urine
voided and
document the
characteristics
of the stones and
urine.

Insert an
indwelling
catheter as
ordered.
 Educate on
bladder training
and pelvic floor
exercises.
Subjective Data: Risk for The patient will Document the The patient can
“ I vomit 9 times deficient fluid be able to frequency and tolerate fluids
and I defecate 3 volume related tolerate fluids the without
times and it is to vomiting without characteristics vomiting within
slightly watery and secondary to the vomiting within of the patient’s 24 hours.
it has a bad smell.” presence of 24 hours. vomitus as well
As verbalized by renal calculi. as precipitating The patient had
the patient. The patient will factors or adequate and
have an events. equal amount of
Objective Data: adequate and intake and
 Excessive equal amount of Monitor intake output within 24
urination intake and and output along hours.
 Thirst output within 24 with the
 Glycosuria hours. patient’s daily
 Dry weight.
mucous
membrane Assess the
 Poor skin patient’s mental
turgor status and skin
integrity every 2
 Nails are
hours.
pale
Monitor vital
signs frequently.

Assess the
patient’s
readiness for
clear liquids
within 4 hours.

Administer
intravenous
fluid as ordered.

Instruct the
patient on
gradual oral
intake as
tolerated.

Educate the
 patient about
fluid
replacement
therapy.

3. Identify at least two (2) health teaching points on the prevention of recurrence of renal
calculi for the patient.

Drinks like tea, coffee and fruit juice can count towards your fluid intake, but water is the
healthiest option and is best for preventing kidney stones developing. You should also make sure
you drink more when it’s hot or when you’re exercising to replace fluids lost through sweating.
Another is advice the patient to eat less sodium. A high-salt diet increases your risk of calcium
kidney stones. According to the Urology Care Foundation, too much salt in the urine prevents
calcium from being reabsorbed from the urine to the blood. This causes high urine calcium,
which may lead to kidney stones. Eating less salt helps keep urine calcium levels lower. The
lower the urine calcium, the lower the risk of developing kidney stones. To reduce your sodium
intake, read food labels carefully.

D. RENAL FAILURE
A patient with uncontrolled Type 2 Diabetes consulted in the emergency department due to
shortness of breath, bipedal edema, palpitation, and decreased urinary output during the past 2
days. The following laboratory test values are presented:
Serum Creatinine –2.5 mg/dL
BUN level –30 mg/dL
Serum potassium –5.9 mEq/L
HBA1C –8%

A diagnosis of Acute Renal Failure secondary to DM Nephropathy was made by the doctor.
Sodium polyesterene sulfonate (Kayexalate) was ordered to normalize potassium level. Oral
hypoglycemic agents were revised, and insulin therapy was started to manage the blood sugar
level. Urine output is closely monitored for possible hemodialysis.

Answer the following questions:

1. Explain the relationship of diabetes mellitus on the development of acute renal failure
using a flow chart.
2. Identify three (3) nursing diagnoses pertinent to the patient’s condition and create
hypothetical Nursing Care Plans (NCPs) for each nursing diagnosis.

Assessment Diagnosis Planning Intervention Evaluation

Subjective Impaired gas After 8 hours of Manifestation of After 8 hours of
Data: exchange RT nurse-patient respiratory nurse-patient
Client reports collection of interventions the distress are interventions the
she “finds it mucus in patient will be able
dependent on and patient was able
difficult to airways. to: indicative of to:
breathe. degree of lung
1. Maintain involvement and 1. Maintain
Objective optimal gas underlying optimal gas After
Data: exchange as general health 8 hours of nurse-
Dyspnea evidenced by usual status as patients patient
Abnormal mental status, will adapt their interventions the
breath sounds unlabored breathing patterns patient will be
Heart rate: 128 respirations, to facilitate able to:
bmp normal oximetry effective gas
Restlessness results. exchange. 2. Demonstrate
Productive techniques to
cough 2. Demonstrate These measures improve gas
techniques to promote exchange.
improve gas maximum chest
exchange. expansion z
mobilize
secretions and
improve
ventilation.
Subjective Risk for Patient will Provide a simple Patient
Data: Ineffective demonstrates explanation of the demonstrates
N/A therapeutic knowledge of treatment knowledge of
regimen diabetes self-care regimen. diabetes self-care
management. measures. measures.
Objective Provide positive
Data: Patient will reinforcement of Patient verbalize
The patient verbalize changed self-care understanding of
shows understanding of behaviors. the diabetes
positivity the diabetes diseases process
towards the diseases process Determine and and potential
treatment and potential ensure the complications.
complications. patient’s
knowledge about Patient correctly
Patient will the symptoms, perform
correctly perform causes, treatment, necessary
necessary and prevention of procedures and
procedures and hyperglycemia. explain reasons
explain reasons for for the actions.
the actions.

Subjective Imbalanced The Patient ingest Review the The patient

Data: Nutrition: Less appropriate carbohydrate ingest
N/A Than Body amounts of counting method appropriate
Requirements calories/nutrients. with the patient. amounts of
Objective calories/nutrients.
Data: Display usual Educate the Display usual
Patient appears energy level. patient on the energy level and
weak and dangers of demonstrate
drowsy Demonstrate consumption of stabilized weight
Pale stabilized weight alcohol with gain toward
Weight:45 kg or gain toward diabetes usual/desired
usual/desired mellitus. range with
range with normal normal
laboratory values. Provide liquids laboratory
containing values.
  nutrients
and electrolytes as
  soon as the
patient can
  tolerate oral
fluids, then
progress to a
portion of more
solid food as
tolerated.
 Identify food
preferences,
including ethnic
and cultural
needs.

Include SO
in meal
planning as
indicated.

Observe for signs

of hypoglycemia:
changes in LOC,
cold and clammy
skin, rapid pulse,
hunger,
irritability,
anxiety,
headache,
lightheadedness,
shakiness.

Consult a
dietician and/or
physician for
further
assessment and
recommendation
regarding food
preferences and
nutritional
support.

3. Create a drug study for the medication: SODIUM POLYESTERENE SULFONATE

specifying the following:

SODIUM POLYESTERINE SULFONATE

Drug Mechanism Indication Contraindicat Side Nursing
Classificati of Action ion Effects Considerations
on
Potassium- Sodium Sodium Sodium Diarrhea Because sodium
removing polystyrene Polystyrene Polystyrene nausea polystyrene sulfona
agents. sulfonate Sulfonate is Sulfonate vomiting te is not absorbed
(SPS) is an indicated should not be gloss of into the
insoluble for the used as an appetite. bloodstream, this
polymer treatment emergency Some side medicine is not
cation- of treatment for effects expected to be
exchange hyperkalem life-threatening can be harmful during
resin. After ia. hyperkalemia serious. If pregnancy or while
ingestion of because of its you nursing a baby
the oral delayed onset experienc
formulation of action e any of
or these
application symptoms
through the , stop
rectal route, taking or
this using
resin exchan sodium
ges sodium polystyren
with e
potassium sulfonate
ions from the and call
intestinal your
cells. doctor
immediate
ly
constipati
on
seizures
unusual
bleeding
confusion
muscle
weakness
abdominal
pain fast,
pounding,
or
irregular
heartbeat