Nsc6102 Sudden Kidney Infection Answers Assessment Answers

Answer:

Miss Adele is a 27 year old lady who is diagnosed with acute pyelonephritis and is admitted into a hospital into the emergency department. She is complaining pain during micturition. Pyelonephritis refers to the severe and sudden kidney infection. There are mainly two types of pyelonephritis, and they are acute and chronic. According to the case study, Ms.adele is diagnosed with an acute one.It is generally a common bacterial infection of the kidney and as well as renal pelvis.

The primary causal agent for the acute pyelonephritis is the gram-negative bacteria.Escherichia Coli ( E.Coli) is responsible for approx. 60% - 80% cases of acute pyelonephritis.The infection is mainly at the lower part of the urinary tract, and it is called the Urinary tract infection( UTI).The bacteria E.coli enters into the body via the urethra, and then they started to grow in the bladder (McGann et al.,2016).After that from bladder, the bacteria travel to the kidney. Bacteria reach kidney through uterus of the body.

This urinary tract infection is mainly seen in a woman because of the shorter length of urethras in comparison to a male.sometimes bacteria from the vagina or rectum may also travel to the urethras and can cause UTI (Gupta & Trautner, 2013). However, UTI can also occur from infected bloodstream also. The incidence of the acute Pyelonephritis is most common in a woman in the age group of 15-29.But it can also occur in men.As per the case study,Ms. Adele's age is 27, and it is quite evident that she can be a sufferer of Acute Pyelonephritis.

The pathophysiology of the Pyelonephritis  refers to the changes in urinary tract region due to  the disease.The changes start when E.coli enters into the system and begins to colonize in the bladder.After coming through the urethra, they travel upwards to the bladder.After entering the bladder, the fimbria of the  bacteria allows the attachment of bacteria with the bladder and cause cell penetration.After penetrating the cell,bacteria starts to replicate in the system.

After sufficient colonization, the bacteria may travel towards the kidney.In ascension, fimbriae play a crucial role and as well as bacterial toxins are also helping in this process by omitting the  peristalsis.In response to this renal parenchyma is infected by those bacteria and causes renal inflammation.This condition is referred to as pyelonephritis (Tarchouna et al.,2013).During obstruction in the urinary tract due  to urinary stones and tumors also results in pyelonephritis.

The primary clinical manifestation of Ms.Adele is that she is complaining severe pain during micturition that is the urinary bladder is contracted in a series during the release of urine.The flow of urine plays a key role in excitation when it passes through the urethra.The main reason for this acute pain on micturition is acute pyelonephritis.As she is complaining pain during micturition,She may have an obstruction in the urinary tract, and that is why she was diagnosed with acute pyelonephritis (Walsh & Collyns,2017).

The investigations that should be carried out to evaluate the condition of the patient are mainly urine tests,imaging tests , blood cultures and as well as radioactive imaging.Among the urine tests, there are two  types of tests, and they are urinalysis and urine culture (Hooton, Calderwood,& Bloom,2016).Urinalysis includes urine dipstick testing and also microscopic urinalysis.In this disease mainly leukocyte esterase test remains positive.Another method is urine culture, and it is done to detect the amount of  the colony of the gram-negative bacteria.However sometimes gram-positive cocci colony are also found.In acute pyelonephritis, generally, more than 10^5 colony of a single gram-negative bacteria may be recovered from the urine sample. Blood culture is another way out to identify the disease

Blood tests like serum creatinine tests,blood urea nitrogen( BUN) and estimated GFR could be done to evaluate the exact condition of the condition (Spoorenberg et al.,2014).As there is acute pyelonephritis,the chances of kidney damage are quite high as well.Lastly, the imaging tests can be done to detect the presence of tumors,cysts or any other obstruction in the urinary tract.If Ms.Adele would not respond in treatment within 72 hours, CT scan can be done to detect any obstacle in the urinary path.Another imaging test that is  dimercaptosuccinic acid ( DMSA) test may be performed.In this technique, a radioactive compound is injected into the vein, and it gradually enters into the kidney, and the imaging shows infection or inflammation in the kidney.The radioactive material that is injected shows specific colour when there is an obstruction (Shaikh et al.,2015).

There are several nursing cares that a nurse can follow while taking care of Ms.Adele. The main four ADLs are toileting,dressing,drinking and bathing.They should keep the patient complete clean and dry so that they can remain clean and there are no further chances of infection.As she is already infected with a disease,so there is a high chance of getting affected by other bacteria if there is the absence of proper dressing.They should tell the patient to clear the bladder completely each time she has a micturition.This is because of maintaining bladder distension.Nurses should encourage Ms Adele to drink 2-3 litres of water if there is no other further complication.Nurses should help the patient in bathing to maintain proper cleanliness (Lajiness & Quallich,2016).

Antibiotics are the main line of treatment for pyelonephritis. Initially, Ciprofloxacin 400mg can be given , and it will be continued until there is an improvement of the condition.If there is any progress in the patient's situation then, the dose  will be changed to 500mg per day for seven days, and the medicines should be given orally.Levofloxacin 250-500 mg can be used once per day, and it is also given intravenously. In following condition, if the patient responds,the dose will be changed to 750mg.It should be administered once per day and will continue for seven days.The most reported side effects of using a bacteria are the development of pyrexia in the patient.This is quite natural because antibiotics generally increase the body temperature.Other side effects of the antibiotics are nausea,vomiting,headache ,rashes (Hecker et al.,2014).

Moreover, it can be concluded that pyelonephritis is a curable disease and with proper medication, it can be cured easily.However, negligence in treatment is not desirable because it can cause severe kidney problem in the future.Proper nursing care is also required for Adele to recover.

References

McGann, P., Snesrud, E., Maybank, R., Corey, B., Ong, A. C., Clifford, R., ... & Schaecher, K. E. (2016). Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: first report of mcr-1 in the United States. Antimicrobial agents and chemotherapy, 60(7), 4420-4421.

Gupta, K., & Trautner, B. W. (2013). Diagnosis and management of recurrent urinary tract infections in non-pregnant women. Bmj, 346, f3140.

Tarchouna, M., Ferjani, A., Ben-Selma, W., & Boukadida, J. (2013). Distribution of uropathogenic virulence genes in Escherichia coli isolated from patients with urinary tract infection. International Journal of Infectious Diseases, 17(6), e450-e453.

Walsh, C., & Collyns, T. (2017). The pathophysiology of urinary tract infections. Surgery (Oxford), 35(6), 293-298.

Spoorenberg, V., Prins, J. M., Opmeer, B. C., de Reijke, T. M., Hulscher, M. E. J. L., & Geerlings, S. E. (2014). The additional value of blood cultures in patients with complicated urinary tract infections. Clinical Microbiology and Infection, 20(8), O476-O479.

Hooton, T. M., Calderwood, S. B., & Bloom, A. (2016). Acute complicated cystitis and pyelonephritis. Up-to-Date March.

Shaikh, N., Borrell, J. L., Evron, J., & Leeflang, M. M. (2015). Procalcitonin, C?reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database of Systematic Reviews, (1).

Lajiness, M., & Quallich, S. (Eds.). (2016). The nurse practitioner in urology. Springer International Publishing.

Hecker, M. T., Fox, C. J., Son, A. H., Cydulka, R. K., Siff, J. E., Emerman, C. L., ... & Donskey, C. J. (2014). Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting. PLoS One, 9(2), e87899.