Miss Adele Onbuku is a 27-year-old who has presented to the emergency department with acute pain on micturition and has been diagnosed with acute pyelonephritis.  Discuss the subsequent treatment and care for this lady according to the marking guide.

Marking guide Case Study: 

Table of contents

Introduction including definition of the condition

1.Discuss the aetiology and incident of the condition

2.Identify the pathophysiology of this condition and explain the clinical manifestations

3.Describe the investigations and laboratory tests that would be carried out to evaluate the condition

4.Discuss the nursing care for the client based on the ADL’S (In table form) develop a care plan based on your : Assessment,

5.Discuss the pharmacological treatment of the condition and potential side effects of the medications

                                                                SAMPLE SOLUTION

Acute pyelonephritis is a condition that results from the invasion of the parenchyma of the kidney, the part of the organ responsible for the filtration of blood and extraction of urine before expulsion via the pelvis (Bonsib, 2013). It is a common problem among young adult women and may be mild or acute. Acute pyelonephritis may indicate abnormalities in the structure or function of the urinary tract, urinal track infections (UTIs) and side effects of recent use of antibiotics.

ETIOLOGY INCIDENCE

According to Wright (2013), in normal adults with no other complications (excluding children and the elderly), the most common cause of acute pyelonephritis is gram-negative bacteria such as Escherichia coli that is responsible for up to 60 – 80% of the cases. Proteus mirabilis, Klebsiella, Enterobacter and Pseudomonas species are other gram-negative bacteria responsible for fewer cases of the acute pyelonephritis. Gram-positive bacteria like Staphylococcus saprophyticus, Enterococcus faecalis and S aureus cause few cases of acute pyelonephritis. This type acute pyelonephritis is usually uncomplicated.

Wright (2013) adds that elderly people, individuals with diabetes and people with immunosuppression exhibit more common cases of complicated acute pyelonephritis than healthy adults do. In this special demography, the causative agents for acute pyelonephritis are many and varied. The majority of the pathogens in this delicate group are associated with other existing diseases in the patients and they have in many cases become resistant to antibiotics. Notably, in elder patients, E coli is a minor causative agent of acute pyelonephritis and gram-negative pathogens like P mirabilis, Pseudomonas, Serratia and Klebsiella become the major cause as a result of increased use of catheters that act as infection portals (BMJ, 2017). Klebsiella, Enterobacter, Clostridium and Candida are the major causative agents in people with diabetes. HIV, cancer and kidney transplantation lead to immunosuppression that subjects the patients to other silent pathogens such as Candida.