Agalin, Yasierah K. St.N Fano, Ma. Tricia Joy Consol B. St.

N
Belasci, Cheene S. St.N Kasuyo, Fardejah Maisa St.N
Berja, Giselle B. St.N Medel, James Paolo B. St.N
 Acute pyelonephritis is a common bacterial infection of the renal
pelvis and kidney most often seen in young adult women. History and
physical examination are the most useful tools for diagnosis. Most
patients have fever, although it may be absent early in the illness.
 Goiter is a swelling of the neck or larynx resulting from enlargement of
the thyroid gland (thyromegaly), associated with a thyroid gland that is not
functioning properly. The degree of swelling, and the severity of symptoms
produced by the goiter depend on the individual. Some cases involve a small
amount of swelling, and others can involve considerable swelling that
actually constricts the trachea and causes breathing problems.
Worldwide, the most common cause for goiter is deficiency, The prevalence
of goiter in areas of severe iodine deficiency can be as high as 80%.
Populations at particular risk tend to be remote and live in mountainous areas
in South-East Asia, Latin America and Central Africa. Iodization programs are
of proven value in reducing goiter size and in preventing goiter development
and cretinism in children. Autonomy can develop in nodular goiters leading
occasionally to thyrotoxicosis and iodization programs can also induce
thyrotoxicosis, especially in those aged >40 years with nodular goiters
This study will be a significant endeavor in understanding this
condition, it will help the students and clinical instructors in gaining
more knowledge that will help them deal with future similar cases. By
being able to encounter this case and study it, students will become
more competent and expectedly will be more confident with them.
Furthermore this research will provide recommendations on how to
plan and proper nursing interventions for the said case.
 We had found this case to be interesting and challenging on our part
as student nurses since its our first time to encounter it. And we were
able to relate to it since its one of the most common diseases that
affect the thyroid gland In the Philippines, Based on the studies of
urinary iodine levels conducted by the Department of Health, most
goiter cases are found in the mountainous provinces and other
remote areas of the country. The Food and Nutrition Research Institute
performed a nutritional survey in 1998 to assess the extent of iodine
deficiency among 10,616 school children aged six to 12 years. It was
discovered that the country as a whole had mild iodine deficiency.
 At the end of our two-week exposure in the Davao Medical School Foundation
Hospital, medical- surgical ward, we will be able to acquire knowledge and
reliable information about goiter in order for us students to become
knowledgeable; be able to demonstrate competent nursing care that will address
our patients condition; and to demonstrate right attitude and provide quality
nursing care.
This case study is made to achieve the following reasons:
Establish rapport with our patient as well as her significant others to gain trust and
cooperation.
Collect significant information regarding our patients conditions as well as the
family history, past and present health history.
Evaluate clients data according to the nursing and developmental theory
Describe the structures and normal function of the body organs involved.
Trace the Pathophysiology of the disease process and its enduring symptomatology.
Review and interpret medical order and results of possible laboratory examination
that the client has undergone.
Identify the different signs and symptoms, as well as the presentation of its etiology
and contributing factors in the development of this condition.
Make effective nursing care plans that address the present and possible needs.
Enumerate clients medications which include both therapeutic and the adverse
effects.
Present discharge plan for clients condition.
Name: Pie Occupation: none
Sex: Female Birthdate: May 15, 1980
Age: 37 Mother: Apple pie
Status: Single Father: Pineapple pie
Address: Gardenia St. La vista Chief complaint: Abdominal pain
Monte PH2, Matina Pangi, Davao
City
Nationality: Filipino
Religion: Roman Catholic
History of present illness

12 hours PTA, the patient noted onset of diffuse abdominal pain (8/10),
crampy in character, radiating to her right flank, no other signs and
symptoms noted, no medications taken.
6 hours PTA, the patient had 1 episode of vomiting, 1-2 table spoons of
watery vomitus, no gastric contents noted, no other signs and
symptoms noted, persistence of symptoms prompted consultation at
this institution where urinalysis was done and afterwards, patient was
admitted.
Past Medical history: Gastrointestinal: (-) constipation
(+) UTI ( Jan 2013) unrecalled antibiotics, Renal and urinary: (+) dysuria
no urinalysis after antibiotic regimen
Gynecological: (-) discharges
(-) Hypertension, DM and Asthma
Musculoskeletal: (-) joint pain, (-) range
of motion limitations , no deformities, no
swelling/erythema notes
Personal social history:
Endocrine and metabolic: (-) thyroid
(-) drug allergy enlargement
(+) food ( shrimp allergy) Neurological: Awake, alert coherent,
oriented to name, place and time, intact
memory and cranial nerves.
Review of systems:
General: (-) weight loss, (-) weakness IMPRESSION:
Skin: (-) pruritus, (-) jaundice, no lesions Acute pyelonephritis,
notes, no discoloration, good skin turgor uncomplicated
EENT: (-) tinnitus, (-) epitaxis
Respiratory: (-) shortness of breath ,
normal lung sounds, equal chest expansion
Cardiovascular: (-) chest pain , no
murmers notes
Erik Erickson
PSYCHSOCIAL DEVELOPMENTAL THEORY:
Psychosocial Stage: Generativity vs Stagnation: 35-65
years old

This is the longest period of a human's life. It is the stage

in which people are usually working and contributing to
society in some way and perhaps raising their children. If
a person does not find proper ways to be productive
during this period, they will probably develop feelings of
stagnation.
Sigmund Freud
PSYCHOSEXUAL DEVELOPMENTAL THEORY:
Psychosexual Theory: Genital (12 years of age and older)
During this stage, sexual impulses reemerge. If other stages
have been successfully met, adolescents engage in
appropriate sexual behavior, which may lead to marriage
and childbirth.
John Piagets Cognitive theory

COGNITIVE DEVELOPMENTAL THEORY:

Cognitive developmental stage: Formal operational stage (11
years or older).
The use of abstract thinking and deductive reasoning. General
concepts are related to specific situations, and alternatives are
considered. The world is evaluated by testing beliefs in an
attempt to establish values and meaning in life.
 VIRGINIA HENDERSON
Henderson wrote her definition of nursing before the development of theoretical
nursing. She defined nursing as the unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health
or its recovery that he would perform unaided if he had the necessary strength, will
or knowledge. And to do this in such a way as to help him gain independence as
rapidly as possible. The nurses goal is to make the patient complete, whole, or
independent. In turn, the nurse collaborates with the physicians therapeutic plan.
Nurses temporarily assist an individual who lacks the necessary strength, will, and
knowledge to satisfy one or more of the 14 basic needs
 The principal function of the urinary system is
to maintain the volume and composition of
body fluids within normal limits. One aspect of
this function is to rid the body of waste
products that accumulate as a result of cellular
metabolism. Other aspects of its function
includes regulating the concentrations of
various electrolytes in the body fluids
maintaining normal pH of the blood.
URINARY SYSTEM ANATOMY

Kidneys- are a pair of bean-shaped organs found along the

posterior wall of the abdominal cavity. The left kidney is
located slightly higher than the right kidney because the
right side of the liver is much larger than the left side. The
kidneys filter metabolic wastes, excess ions, and chemicals
from the blood to form urine.
Ureters- are a pair of tubes that carry urine from the
kidneys to the urinary bladder.
 Urinary Bladder- is a sac-like hollow organ used for the storage of
urine. Urine entering the urinary bladder from the ureters slowly fills
the hollow space of the bladder and stretches its elastic walls. The walls
of the bladder allow it to stretch to hold anywhere from 600 to 800
milliliters of urine.
Urethra- is the tube through which urine passes from the bladder to the
exterior of the body.
The flow of urine through the urethra Urinary system cross-secrion is
controlled by the internal and external urethral sphincter muscles. The
internal urethral sphincter is made of smooth muscle and opens
involuntarily when the bladder reaches a certain set level of distention.
The opening of the internal sphincter results in the sensation of needing
to urinate. The external urethral sphincter is made of skeletal muscle
and may be opened to allow urine to pass through the urethra or may be
held closed to delay urination.
URINARY SYSTEM PHYSIOLOGY

Maintenance of Homeostasis
The kidneys maintain the homeostasis of several important
internal conditions by controlling the excretion of
substances out of the body.
The kidney can control the excretion of potassium, sodium,
calcium, magnesium, phosphate, and chloride ions into
urine. In cases where these ions reach a higher than normal
concentration, the kidneys can increase their excretion out
of the body to return them to a normal level. Conversely,
the kidneys can conserve these ions when they are present
in lower than normal levels by allowing the ions to be
reabsorbed into the blood during filtration.
 The kidneys monitor and regulate the levels of hydrogen ions
(H+) and bicarbonate ions in the blood to control blood pH. H+
ions are produced as a natural byproduct of the metabolism of
dietary proteins and accumulate in the blood over time. The
kidneys excrete excess H+ ions into urine for elimination from
the body. The kidneys also conserve bicarbonate ions, which act
as important pH buffers in the blood.
Blood Pressure. The kidneys monitor the bodys blood pressure
to help maintain homeostasis. When blood pressure is elevated,
the kidneys can help to reduce blood pressure by reducing the
volume of blood in the body. The kidneys are able to reduce
blood volume by reducing the reabsorption of water into the
blood and producing watery, dilute urine. When blood pressure
becomes too low, the kidneys can produce the enzyme renin to
constrict blood vessels and produce concentrated urine, which
allows more water to remain in the blood.
Filtration
Inside each kidney are around a million tiny structures called
nephrons. The nephron is the functional unit of the kidney that
filters blood to produce urine. Arterioles in the kidneys deliver
blood to a bundle of capillaries surrounded by a capsule called a
glomerulus. As blood flows through the glomerulus, much of the
bloods plasma is pushed out of the capillaries and into the
capsule, leaving the blood cells and a small amount of plasma to
continue flowing through the capillaries.
 The liquid filtrate in the capsule flows through a series of tubules lined with
filtering cells and surrounded by capillaries. The cells surrounding the
tubules selectively absorb water and substances from the filtrate in the tubule
and return it to the blood in the capillaries. At the same time, waste products
present in the blood are secreted into the filtrate. By the end of this process,
the filtrate in the tubule has become urine containing only water, waste
products, and excess ions. The blood exiting the capillaries has reabsorbed
all of the nutrients along with most of the water and ions that the body needs
to function.
Production of Hormones
The kidneys produce and interact with several hormones that are involved
in the control of systems outside of the urinary system.
Calcitriol.- is the active form of vitamin D in the human body. It is
produced by the kidneys from precursor molecules produced by UV
radiation striking the skin. Calcitriol works together with parathyroid
hormone (PTH) to raise the level of calcium ions in the bloodstream.
When the level of calcium ions in the blood drops below a threshold level,
the parathyroid glands release PTH, which in turn stimulates the kidneys
to release calcitriol. Calcitriol promotes the small intestine to absorb
calcium from food and deposit it into the bloodstream. It also stimulates
the osteoclasts of the skeletal system to break down bone matrix to
release calcium ions into the blood.
 Erythropoietin.- is a hormone that is produced by the kidneys to stimulate
the production of red blood cells. The kidneys monitor the condition of the
blood that passes through their capillaries, including the oxygen-carrying
capacity of the blood. When the blood becomes hypoxic, meaning that it is
carrying deficient levels of oxygen, cells lining the capillaries begin
producing EPO and release it into the bloodstream. EPO travels through the
blood to the red bone marrow, where it stimulates hematopoietic cells to
increase their rate of red blood cell production. Red blood cells contain
hemoglobin, which greatly increases the bloods oxygen-carrying capacity
and effectively ends the hypoxic conditions.

Renin - is not a hormone itself, but an enzyme that the kidneys produce to
start the renin-angiotensin system (RAS). The RAS increases blood volume
and blood pressure in response to low blood pressure, blood loss, or
dehydration. Renin is released into the blood where it catalyzes
angiotensinogen from the liver into angiotensin I. Angiotensin I is further
catalyzed by another enzyme into Angiotensin II.Angiotensin II stimulates
several processes that increase blood pressure
 Urinary system - also known as the renal system produces, stores and
eliminates urine, the fluid waste excreted by the kidneys
Cellular metabolism - the set of chemical reactions that occur in living
organisms in order to maintain life. Cellular metabolism involves complex
sequences of controlled biochemical reactions, better known as metabolic
pathways.
Fluid balance - an aspect of the homeostasis of living organisms in which the
amount of water in the organism needs to be controlled, via osmoregulation
and behavior, such that the concentrations of electrolytes (salts in solution) in
the various body fluids are kept within healthy ranges.
Erythropoietin - a hormone secreted by the kidneys that increases the rate
of production of red blood cells in response to falling levels of oxygen in the
tissues.
 Renin (enzyme) - also known as an angiotensinogenase, is an
enzyme that participates in the body's renin-angiotensin aldosterone
system also known as the renin-angiotensin-aldosterone axisthat
mediates extracellular volume, and arterial vasoconstriction.
Renal Pelvis - the large bony structure near the base of the spine to
which the hind limbs or legs are attached in humans and many other
vertebrates.
E. coli - Escherichia coli, commonly known as E. coli, often cause the
infection. a Gram-negative, facultatively anaerobic, rod-shaped
bacterium of the genus Escherichia that is commonly found in the
lower intestine of warm-blooded organisms.
Bacteria causing ascending acute pyelonephritis overlap with those
which cause UTIs
Common organism: Escherichia coli
with minor contributions from:
Proteus mirabilis
Klebsiella pneumoniae
Enterobacter
Serratia
Pseudomonas aeruginosa.

Pregnancy is the major risk factor for acute pyelonephritis in

women due to the physiological alterations that occur in the
urinary tract.
In nonpregnant women, men and children, the most common risk
factors for acute pyelonephritis are diabetes mellitus, anatomical
abnormalities of the urinary tract and obstruction causes.
 IF PRESENT RATIONALE
Hyperthermia or commonly known as fever is present when the body
FEVER temperature is higher than 37C which can be measured orally, but
37.7C if measured per rectum. It occurs when the body is invaded by
some bacteria, viruses, or parasites.
Sometimes the occurrence of fever may also be due to non- infectious
factors like injury, heat stroke or dehydration. Some underlying
conditions can also cause hyperthermia, like thyrotoxicosis, heart
attack and other forms of cancer.
Chills is a feeling of coldness occurring during a high fever, but
CHILLS sometimes is also a common symptom which occurs alone in specific
people.
It occurs during fever due to the release of cytokines and
prostaglandins as part of the inflammatory response, which increases
the set point for body temperature in the hypothalamus. The increased
set point causes the body temperature to rise (pyrexia), but also makes
the patient feel cold or chills until the new set point is reached.
Shivering also occurs along with chills because the patient's body
produces heat during muscle contraction in a physiological attempt to
increase body temperature to the new set point. When it does not
accompany a high fever it is normally a light chill.
 IF PRESENT RATIONALE
Dysuria is a very common symptom that is associated with significant
DYSURIA morbidity and is sometimes associated with serious medical disorders.
Diagnosing the etiology of dysuria is an important training problem for
third year medical students because accurate diagnosis requires
prudent selection and interpretation of common diagnostic studies.
Also, learning the proper use of antibiotic therapy for dysuria is
important because of its impact on health care cost, on selection
pressure for antimicrobial resistance in the microbial pool of the
community, and on patient morbidity.
NAUSEA Nausea is the sensation (feeling) issued a strong food or want to vomit.
Usually accompanied by autonomic signs such as hypersalivation,
diaphoresis, tachycardia, pallor, and tachypnea, nausea closely related
to anorexia. Nausea caused by distention or irritation in any part of the
gastrointestinal tract, but can also be stimulated by higher brain
centers.
Nausea is a common symptom of digestive disorders, but may also
occur in fluid and electrolyte imbalance, infection, metabolic
disorders, endocrine, and cardiac maze.
 IF PRESENT RATIONALE
VOMITING The term "vomiting" describes the forceful expulsion of the contents of
the stomach via the mouth or sometimes the nose, also known of as
emesis. The causes of vomiting are as wide ranging as those for nausea
and include anything from food poisoning or gastritis to head injuries
and brain cancer. Nausea is the discomfort that is felt before vomiting
but not all nausea actually results in vomiting..
 COMPLETE BLOOD COUNT
RESULT RANGE INTERPRETATION
Hemoglobin 129 g/L 120 160 g/L Haemoglobin is a hemoprotein that functions
(hgb) primarily to carry oxygen and carbon dioxide
throughout the body

Normal hemoglobin level indicates that the The

body have adequate haemoglobin to bind to
oxygen molecules.

Hematocrit 0.38% 0.37 - 0.45 Hematocrit represents the percentage of RBCs in

(hct) the plasma

Normal hematocrit level indicates a normal

concentration of RBC in the blood
Red blood cells 4.28 4.0 - 5.0 Red blood cells are cells that contain hemoglobin
(RBC) 10^2/L and its function is to transport oxygen that is bound
to the hemoglobin to bodily tissues and carry
carbon dioxide to the lungs.
Normal RBC count indicates adequate number of
oxygen-transporting cells in the body
 RESULT RANGE INTERPRETATION
White blood 6.6 10^9/L 4.8 - 10.8 White blood cells are function as the protective
cells (WBC) movable army in the body that defends the body
against foreign antigens

Normal WBC count indicates the body has a normal

immunity and is able to fight infections, it also
indicates that there is no infection present

Mean 89.9 82 - 98 Mean corpuscular volume (MCV) is the average

corpuscular volume of red cells in a specimen.
volume (MCV) Normal MCV indicates

Mean 33.6 g/L 33 - 36 The mean corpuscular hemoglobin concentration

corpuscular (MCHC) is a measure of the concentration of
hemoglobin hemoglobin in a given volume of packed red blood
concentration cells.
(MCHC) Normal MCHC indicates..
 RESULT RANGE INTERPRETATION
Mean 26-34 Mean corpuscular hemoglobin (MCH) is..
corpuscular Normal MCH indiactes
hemoglobin
(MCH)

.
DIFFERENTIAL COUNT: The blood differential test measures the percentage
of each type of white blood cell (WBC) in the blood. It also reveals if there
are any abnormal or immature cells

RESULT RANGE INTERPRETATION

Neutrophil 62 % 40 - 70 Neutrophils are the
Normal neutrophil count indicates

lymphocyte 30 % 19 - 48 Mean corpuscular volume (MCV) is the average

volume of red cells in a specimen.
Normal MCV indicates

Monocyte 5% 3-9 The mean corpuscular hemoglobin concentration

(MCHC) is a measure of the concentration of
hemoglobin in a given volume of packed red blood
cells.
Normal MCHC indicates..
 RESULT RANGE INTERPRETATION
Eosinophil 0.03 % 0.00-0.04 Eosinophilia is seen in allergic disorders and
invasive parasitoses.
Eosinopenia is seen in the early phase of acute
insults, such as shock, major pyogenic infections,
trauma, surgery, etc.

Basophil 0.00 % 0.00-0.010.00- Basophilia, if absolute (see above) and of marked

0.01 degree is a great clue to the presence of
myeloproliferative disease as opposed to leukemoid
reaction.
Basopenia is not generally a clinical problem.
Platelet Count 252 150 - 450 Thrombocytopenia often occurs as a result of a
10^9/L separate disorder, such as leukemia or an immune
system problem.
High platelet levels do not necessarily signal any
clinical problems, and are picked up on a routine full
blood count. However, it is important that a full
medical history be elicited to ensure that the
increased platelet count is not due to a secondary
process
 URINALYSIS: Chemical Analysis
RESULT RANGE INTERPRETATION
pH 6.0 5.5 to 7 Urine pH indicates whether the unine is acidic or alkaline,
Acidic urine occurs in metabolic acidosis (diabeticketosis),
diarrhea, starvation, urinary tract infections caused by
E. coli, and respiratory acidosis (carbon dioxide retention).
Alkaline urine (pH 7.0) occurs in urinary tract infections
caused
by urea-splitting bacteria, renal tubular acidosis, chronic
renal
failure, and respiratory alkalosis (due to hyperventilation)

Specific Gravity 1.020 1.005- . Urinary specific gravity (SG) is a measure of the
1.030 concentration of solutes in the urine
Low specific gravity may occur in patients with diabetes
insipidus (decreased or absent ADH), glomerulonephritis
with pyelonephritis, severe renal damage.
High specific gravity can occur in diabetes mellitus,
increased secretion of ADH, nephrosis, congestive heart
failure
 RESULT RANGE INTERPRETATION
Glucose Negative The glucose urine test measures the amount of sugar
(glucose) in a urine sample. The presence of glucose
in the urine is called glycosuria or glucosuria.
Glycosuria occurs in patients with elevated serum
glucose levels (e.g. diabetes mellitus see chapter on
hyperglycemia) or in the presence of a reduced
renal threshold and reduced glucose reabsorption in
renal tubular disease and pregnancy
Protein Negative Proteinuria means do Increased renal tubular
secretion, increased glomerular filtration
(glomerular disease), nephrotic syndrome,
pyelonephritis, glomerulonephritis, malignant
hypertension.
platelet count is not due to a secondary process
 Urine Flowcytometry
RESULT RANGE INTERPRETATION
WBC 2758 /uL 0 17 /uL When the WBC count in urine is high, it means that there is
inflammation in the urinary tract or kidneys. The most
common cause for WBCs in urine (leukocyturia) is a
bacterial urinary tract infection (UTI), such as a bladder or
kidney infection

RBC 62 /uL 0 11 /uL . This test is used to detect hemoglobin in the urine
(hemoglobinuria). Hemoglobin is an oxygen-transporting
protein found inside red blood cells (RBCs). Its presence in
the urine indicates blood in the urine (known as hematuria).
The small number of RBCs normally present in urine usually
result in a "negative" test. However, when the number of
RBCs increases, they are detected as a "positive" test result.
Epithelial Cells 2 /uL 0 17/uL Epithelial cells in urine may be a cause for concern if the
numbers are higher than normal. The sloughing of epithelia
is quite a normal process of the body sheddingdead cells
and creating new ones. If epithelial cells are high in your
urine it could signal a problem with your kidneys or an
infection in your urinary system.
 RESULT RANGE INTERPRETATION
Cast 0 /uL 0 -1 Urinary casts are formed only in the distal convoluted
tubule (DCT) or the collecting duct (distal nephron). The
proximal convoluted tubule (PCT) and loop of Henle are not
locations for cast formation. Hyaline casts are composed
primarily of a mucoprotein (Tamm-Horsfall protein)
secreted by tubule cells.

Bacteria 19999 /uL 0 - 278 Urine is normally sterile, which means that it contains no
bacteria. A small number of bacteria may be found in the
urine of many healthy people. This is usually considered to
be harmless. However, a certain level of bacteria can mean
that the bladder, urethra, or kidneys are infected.
 SERUM ELECTROLYES
RESULT RANGE INTERPRETATION
Creatinine 167.0 umol/L 53-106 Creatinine is a waste product that comes from the normal wear and
tear on muscles of the body. Everyone has creatinine in their
bloodstream. Creatinine clearance requires a timed urine sample. All
the urine you have passed within a specific time period usually 24-
hours is saved (collected) in a container and tested. The result
shows how much creatinine has passed through your kidneys into
your urine. It helps show how well your kidneys are removing the
waste products from your blood.
Sodium 139.1umol/L 0 - 278 Sodium helps to keep the right balance of fluids in the body.
Hyponatremia is an electrolyte imbalance and is indicated by
a low level of sodium in the blood. In hypernatremia, the level
of sodium in blood is too high. Hypernatremia involves dehydration,
which can have many causes, including not drinking enough fluids,
diarrhea, kidney dysfunction, and diuretics.
Potassium 4.19 mmol/L 3.50- Potassium is one of the most important electrolytes in the human
5.30 body, with others including chloride, calcium, phosphorus,
magnesium and sodium. As an electrolyte, potassium is vital to the
healthy functioning of all of your body's cells, tissues and organs. It
also helps to control the amount of water in your body and maintain a
healthy blood pH level. As
 RESULT RANGE INTERPRETATION
you lose electrolytes in your sweat, you should always obtain a source
of these important minerals during or after a bout of intense physical
activity. A moderate potassium deficiency can increase your blood
pressure, lead to salt sensitivity, increase your risk of cardiovascular
disease and reduce the health of your bones. In addition to heart
arrhythmias, excessively low potassium levels -- a condition called
hypokalemia -- can cause glucose intolerance, weakness, fatigue,
muscle cramps and stomach problems.

Calcium 1.22 1.13-1.32 Calcium is required for vascular contraction and vasodilation, muscle
mmol/l function, nerve transmission, intracellular signaling and hormonal
secretion, though less than 1% of total body calcium is needed to
support these critical metabolic functions. Inadequate intakes of
dietary calcium from food and supplements produce no obvious
symptoms in the short term. Circulating blood levels of calcium are
tightly regulated. Hypocalcemia results primarily from medical
problems or treatments, including renal failure, surgical removal of
the stomach, and use of certain medications (such as diuretics).
Symptoms of hypocalcemia include numbness and tingling in the
fingers, muscle cramps, convulsions, lethargy, poor appetite, and
abnormal heart rhythms. If left untreated, calcium deficiency leads to
death.
 ULTRASOUND REPORT
The liver is normal in size and tissue attenuation. The intrahepatic ducts are not
dilated. The widest diameter of the common bile duct is normal in caliber. No
focal lesions noted.
The gallbladder is normal in size and configuration. No wall thickening,
abnormal intraluminal echoes and calculi demonstrated.
The pancreas is normal in size and parenchymal echo pattern. No focal
lesions noted here.
No enlarged lymph nodes or mass appreciated in the vicinity of the
abdominal aorta.
The spleen is normal in size and configuration. No focal lesions noted.
Splenic hilum is unremarkable.
Both kidneys exhibit hypoechoic parenchyma relative to the liver and
spleen. There is mild dilatation in the right pelvocalyceal system and
visualized proximal ureter. The left pelvocalyceal system and ureter are not
dilated. No focal lesions and calculi appreciated.
The urinary bladder is adequately filled sowing regular contour and
smooth walls. No abnormal echoes or calculi noted intraluminally.
Compression technique performed in the lower abdomen with
particular attention in the right side shows no non-compressible bowel
loops, mass lesion or abnormal fluid collection. The appendix is not
visualized.

IMPRESSION:
1. Mild Ureterohydronephrosis, Right. CT Stonogram suggested
2. Sonographically normal liver, Urinary Bladder and right lower quadrant area
 1. AMPICILLIN
Pregnancy Category B
Drug classes
Antibiotic
Penicillin

Therapeutic actions
Bactericidal action against sensitive organisms; inhibits synthesis of
bacterial cell wall, causing cell death.
Indications
Treatment of infections caused by susceptible strains of Shigella, Salmonella,
Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria
gonorrhoeae, enterococci, gram-positive organisms (penicillin Gsensitive
staphylococci, streptococci, pneumococci)
Meningitis caused by Neisseria meningitidis
Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients
 Dosage & route
Maximum recommended dosage, 814 g/day (reserve 14 g for serious infections, such
as meningitis, septicemia); may be given IV, IM, or PO. Use parenteral routes for
severe infections; switch to oral route as soon as possible.
For adults
Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g
ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of
starting procedure. Six hours later, give 1 g ampicillin IM or IV or 1
g amoxicillin PO.
Prevention of bacterial endocarditis for dental, oral, or upper respiratory
procedures: 2 g ampicillin IM or IV within 30 minutes of procedure.
STDs in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO
with 1 g probenecid.
Prophylaxis in cesarean section: Single IV or IM dose of 25100 mg/kg immediately
after cord is clamped.
Adverse effects
CNS: Lethargy, hallucinations, seizures
CV: CHF
GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue,
nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,
pseudomembranous colitis, nonspecific hepatitis
GU: Nephritis
Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia,
prolonged bleeding time
Hypersensitivity: Rash, fever, wheezing, anaphylaxis
Local: Pain, phlebitis, thrombosis at injection site (parenteral)
Other: Superinfectionsoral and rectal moniliasis, vaginitis
Contraindications and cautions
Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
Use cautiously with renal disorders.
 Nursing considerations
Assessment
History: Allergies to penicillins, cephalosporins, or other
allergens; renal disorders; lactation
Physical: Culture infected area; skin color, lesion; R,
adventitious sounds; bowel sounds; CBC, LFTs, renal
function tests, serum electrolytes, Hct, urinalysis
Interventions
Culture infected area before treatment; reculture area if
response is not as expected.
Check IV site carefully for signs of thrombosis or drug reaction.
Do not give IM injections in the same site; atrophy can occur.
Monitor injection sites.
Administer oral drug on an empty stomach, 1 hr before or 2 hr
after meals with a full glass of water; do not give with fruit juice
or soft drinks.
Teaching points
Take this drug around-the-clock.
Take the full course of therapy; do not stop taking the drug if you
feel better.
Take the oral drug on an empty stomach, 1 hour before or 2 hours
after meals; do not take with fruit juice or soft drinks; the oral
solution is stable for 7 days at room temperature or 14 days
refrigerated.
This antibiotic is specific to your problem and should not be used
to self-treat other infections.
You may experience these side effects: Nausea, vomiting, GI upset
(eat frequent small meals), diarrhea.
Report pain or discomfort at sites, unusual bleeding or
bruising, mouth sores, rash, hives, fever, itching, severe diarrhea,
difficulty breathing
DOLCET
Classification: Analgesic, Opiates
Action: Centrally acting analgesic not chemically related to opioids
but binds to mu-opioid receptors and inhibits reuptake of
norepinephrine and serotonin.
Indication: Moderate to severe pain.
Adverse Reactions: Vasodilation; dizziness vertigo, headache,
somnolence, stimulation, anxiety, confusion, coordination
disturbances, euphoria, nervousness, Visual disturbances, dry
mouth. Nausea, diarrhea, constipation, vomiting, abdominal pain,
flatulence. Urinary retention.
Nursing Considerations
Assessment
Assess patients pain before therapy and regularly thereafter to
monitor drug effectiveness (give before pain become extreme)
Assess for hypersensitivity reactions
Monitor for possible drug induced adverse reactions
Monitor for CNS changes
Monitor input-output ratio and check for decreasing output
which may indicate retention
Assess changes in bowel pattern. Increase diet bulk and oral
fluids and to prevent constipation
Assess patients and familys knowledge on drug therapy
OMEPRAZOLE
Generic Name: Omeprazole
Brand Name :Losec,Prilosec
Classifications: gastrointestinal agent; proton pump inhibitor
Pregnancy Category: C
Availability: 10 mg, 20 mg, 40 mg capsules c
Actions
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses
gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the
acid (proton H+) pump] in the parietal cells.
Therapeutic effects
Suppresses gastric acid secretion relieving gastrointestinal distress and
promoting ulcer healing.
Uses
Duodenal and gastric ulcer. Gastroesophageal reflux disease including
severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of
pathologic hypersecretory conditions such as Zollinger-Ellison syndrome,
multiple endocrine adenomas, and systemic mastocytosis. In combination
with clarithromycin to treat duodenal ulcers associated with Helicobacter
pylori.
Contraindications
Long-term use for gastroesophageal reflux disease, duodenal ulcers;
lactation.
Administration
Oral
Give before food, preferably breakfast; capsules must be swallowed whole
(do not open, chew, or crush).
Note: Antacids may be administered with omeprazole.
Adverse effects
CNS:Headache, dizziness, fatigue.
GI:Diarrhea, abdominal pain, nausea, mild transient
increases in liver function tests.
Urogenital:Hematuria, proteinuria.
Skin:Rash.
Patient & Family Education
Report any changes in urinary elimination such as pain
or discomfort associated with urination, or blood in
urine.
Report severe diarrhea; drug may need to be
discontinued.
Do not breast feed while taking this drug.
DOMPERIDONE
Trade Name(s)
Motilium [Canada]
Ther. Class.
gastric stimulant
Pharm. Class.
butyrophenones
dopamine antagonists
Indications
Management of symptoms associated with GI motility disorders
including subacute/chronic gastritis and diabetic gastroparesis.
Treatment of nausea/vomiting associated with dopamine agonist
antiparkinson therapy.
Action
Acts as a peripheral dopamine receptor blocker.
Increases GI motility, peristalsis and lower esophageal sphincter pressure.
Facilitates gastric emptying and decreases small bowel transit time.
Also increases prolactin levels.
Contraindication/Precautions
Contraindicated in:
Known hypersensitivity/intolerance;
Concurrent use of ketoconazole;
Prolactinoma;
Conditions where GI stimulation is dangerous including GI
hemorrhage/mechanical obstruction/perforation;
Lactation: Breast feeding is not recommended unless potential benefits
outweigh potential risks.
Use Cautiously in:
History of breast cancer;
Hepatic impairment;
Severe renal impairment (dose adjustment may be necessary during chronic
therapy);
OB: Use only if expected benefit outweighs potential hazard;
Pedi: Safe and effective use in children has not been established.
Adverse Reactions/Side Effects
CNS: headache, insomnia
GI: dry mouth
GU: amenorrhea, impotence
Derm: hot flushes, rash
Endo: galactorrhea, gynecomastia, hyperprolactinemia
Route/Dosage
PO: (Adults) Upper GI motility disorders 10 mg 3 to 4 times daily;
may be increased to 20 mg 3 to 4 times daily; nausea/vomiting due to
dopamine agonist antiparkinson agents 20 mg 3 to 4 times daily,
higher doses may be required during dose titration.
Patient/Family Teaching

Instruct patient to take as directed. Advise patient to avoid grapefruit juice during therapy.

Advise patient to notify health care professional if galactorrhea (excessive or spontaneous flow of breast
milk), gynecomastia (excessive development of male mammary gland), menstrual irregularities (spotting
or delayed periods), palpitations, irregular heart beat (arrhythmia), dizziness, or fainting occur.

Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast
feeding.

Assess for nausea, vomiting, abdominal distention, and bowel sounds before and after administration.

Monitor BP (sitting, standing, lying down) and pulse before and periodically during therapy. May cause
prolonged QT interval, tachycardia, and orthostatic hypotension, especially in patients older than 60 yrs
or taking >30 m g/day.

Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual

dysfunction).
SODIUM BICARBONATE
Generic Name: Sodium Bicarbonate
Brand Name: Sodium Bicarbonate
Classifications: gastrointestinal agent; antacid; fluid and electrolyte
balance agent
Pregnancy Category: C
Actions
Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid
to form sodium chloride, carbon dioxide, and water. After absorption of
sodium bicarbonate, plasma alkali reserve is increased and excess
sodium and bicarbonate ions are excreted in urine, thus rendering
urine less acid. Not suitable for treatment of peptic ulcer because it is
short-acting, high in sodium, and may cause, gastric, distention,
systemic, alkalosis, and possibly acid-rebound.
 Uses
Systemic alkalinizer to correct metabolic acidosis (as occurs in
diabetes mellitus, shock, cardiac arrest, or vascular collapse), to
minimize uric acid crystallization associated with uricosuric agents, to
increase the solubility of sulfonamides, and to enhance renal excretion
of barbiturate and salicylate over-dosage. Commonly used as home
remedy for relief of occasional heartburn, indigestion, or sour stomach.
Used topically as paste, bath, or soak to relieve itching and minor skin
irritations such as sunburn, insect bites, prickly heat, poison ivy, sumac,
or oak. Sterile solutions are used to buffer acidic parenteral solutions to
prevent acidosis. Also as a buffering agent in many commercial
products (e.g., mouthwashes, douches, enemas, ophthalmic solutions).
Contraindications
Prolonged therapy with sodium bicarbonate; patients losing chloride
(as from vomiting, GI suction, diuresis); heart disease, hypertension;
renal insufficiency; peptic ulcer; pregnancy (category C).
 Adverse effects

GI: Belching, gastric distention, flatulence.

Metabolic: Metabolic alkalosis; electrolyte imbalance:
sodium overload (pulmonary edema), hypocalcemia
(tetany), hypokalemia, milk-alkali syndrome, dehydration.
other: Rapid IV in neonates (Hypernatremia, reduction in
CSF pressure, intracranial hemorrhage).
Skin: Severe tissue damage following extravasation of IV
solution.
Urogenital: Renal calculi or crystals, impaired kidney
function.
Patient & Family Education
Do not use sodium bicarbonate as antacid. A non-absorbable
OTC alternative for repeated use is safer.
Do not take antacids longer than 2 wk except under advice and
supervision of a physician. Self-medication with routine doses of
sodium bicarbonate or soda mints may cause sodium retention
and alkalosis, especially when kidney function is impaired.
Be aware that commonly used OTC antacid products contain
sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon.
Do not breast feed while taking this drug without consulting
physician.
Observe for signs of alkalosis (over treatment)
Observe for and report S&S of improvement or reversal of
metabolic acidosis.
Assessment Diagnosis Planning Intervention Evaluation
Subjective: Acute Pain r/t acute At the end of 8 INDEPENDENT Goal met as
inflammation of hour shift, patient 1. Established evidenced by
katong na admit ko renal tissues will: rapport. decreased pain
kay sakit kaayo secondary to acute Rationale: To get scale from 8/10 to
akong kilid as pyelonephritis - report patients cooperation. 2/10
verbalized by the decreased pain
patient scale from 8/10 to 2. Monitored VS.
2/10 Rationale: To have
Objective: baseline data.
- (-) facial
- (+) Facial grimace, grimace and 3.Assessed for
guarding behavior guarding referred pain, as
behavior appropriate
- Pain scale of 8/10 Rationale: To help
determine possibility
of underlying
condition or organ
dysfunction requiring
treatment.
Assessment Diagnosis Planning Intervention Evaluation

4. Accepted clients
description of pain.
Rationale: Pain is a
subjective
experience and
cannot be felt by
others.

5. Observed non-
verbal cues and
pain behaviors and
other objective
defining, as noted.
Rationale:
Observations may
not be congruent
with verbal reports
or may be only
indicator present
when client is unable
to verbalize.
Assessment Diagnosis Planning Intervention Evaluation

6.Provided comfort
measures
Rationale: To
promote non
pharmacological
pain management.

7. Instructed in and
encourage case of
relaxation
techniques.
Rationale: To
distract attention and
reduce tension.
Assessment Diagnosis Planni Intervention Evaluation
ng

8. encourage verbalization of
feeling about pain
Rationale: to evaluate coping
abilities and identify ideas of
additional concern

9. Encouraged adequate rest

period.
Rationale: To prevent fatigue that
can impair ability to manage pain.

DEPENDENT
10. Administered pain reliever as
necessary.
Rationale: To maintain
acceptable level of pain.
General prognosis
Acute pyelonephritis is a potentially organ- and/or life-threatening
infection that often leads to renal scarring. Acute pyelonephritis
results from bacterial invasion of the renal parenchyma. Bacteria
usually reach the kidney by ascending from the lower urinary tract.
Bacteria may also reach the kidney via the bloodstream. Timely
diagnosis and management of acute pyelonephritis has a significant
impact on patient outcomes.
And it is usually responds well to antibiotic therapy, with most
patients becoming asymptomatic in due course. Time to resolution of
symptoms depends largely on the initial severity of disease. For
patients who present with severe acute symptoms, it is important to
ensure that their course of antibiotics is completed in its entirety.
Providing adequate and prompt treatment assures that most patients
become asymptomatic and that pyelonephritis does not recur.
As nurses, our vital role is to provide health care and deliver services
in the hospital to improve the health status of each individual. This
nursing care study is important for us because it in enables to give the
proper health teaching to our chosen client.
We recommended this case to the following persons and institution
for the further improvement of the study.

TO THE FAMILY:
This study for the family of our patient to follow the treatment
prescribed such as to take the medications as on time and right
dosage and other recommended measures by the physicians,
encourage having adequate rest to hasten the recovery of the patient.
Through the adherence of fulfillment of the suitable medical
management, for the fast recovery of the patient.
TO THE STUDENT:
We recommended this study for the students as a reference for the
future cases, in order to have some based line data to refer.

TO THE COLLEGE OF NURSING

We recommended this study to our department for giving us a precise
details and an access of further study of this case. We advocate also for
giving us an abundance time to research in order to prevent
typographical and grammatical errors.

TO THE DAVAO MEDICAL SCHOOL FOUNDATION HOSPITAL

We recommended this study to Davao medical school foundation for
them to able to evaluate and appreciate the said case and share this as a
reference and information having those patients who has certain
condition.