Pyelonephritis (Final Case)

8/2/2019 Pyelonephritis (Final Case)

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PYELONEPHRITISGROUP 1


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I. INTRODUCTION

The diagnosis of a urinary tract infection (UTI) istypically confirmed on the basis of a certain numberof microorganisms in the urinary system, althoughmanifestation may begin with many fewer

organisms. The infectious process usually affectsthe bladder, but the uretrhra, ureters, and kidneymay be involved.


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Urinary tract infection (UTI) is one of the mostcommon infection treated by primary careproviders, untreated, it has the potential for seriousconsequence, such as pyelonephritis and

bacteremia. On rare occasions, complication of UTIcan lead death. Cystisis is the most common typesof UTI.


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DEFINITION:

CYSTITIS

Inflammation of the urinary bladder

s/sx:

Pressure in lower pelvis Painful urination (dysuria)

Frequent urination(polyuria)

Abnormal urine color(cloudy)

Foul odor of urine


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-URETHRITIS

inflammation of the urethra.

s/sx:

Dysuria

Painful urination

-URETERITIS

Inflammation of the ureter.

s/sx:

Renal colic

Fever

Blood in the urine


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PYELONEPHRITIS

Inflammation of renalpelvis.

s/sx:

Acutely ill with chills andfever

High fever and chills

Leukocytosis

Bacteriuria

Dysuria

Flank pain

CVA tenderness

Nausea

Foul smelling urine


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CAUSES:

Pyelonephritis is caused by Escherichia coli this isa type of bacteria that normally in the largeintestine. However, any physical obstruction to theflow of urine, such as structural abnormality,

bladder tumor, strictures, kidney stone or anenlarged prostrate or backflow (reflux) of urine fromthe bladder into the ureters may causepyelonephritis


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PREVALENCE RATE:

EPIDEMIOLOGY:

-Pyelonephritis is very common, with 12-13 casesannually per 10,000 populations in women and 3-4cases per 10,000 in men. Young women are mostlikely to be affected, traditionally affecting sexualactivity in that age group. Infants and the elderly arealso at increase risk, reflecting anatomical changesand hormonal status.


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6 years of age;

Boys: 1.8% Girls: 6.6%

5-7% Female febrile infant (8 weeks of age)

1% School-age children 1-3% Girl between 1-5 years of age

0.003% School age boys


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DIAGNOSIS:

The presence of nitrite and leukocyte (white bloodcell) on a urine dipstick test in patients with typicalsymptoms are sufficient for the diagnosis ofpyelonephritis, and are an indication for empirical

treatment. Formal diagnosis is with culture of theurine blood cultures may be needed if the source ofthe infection is initially doubtful.


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II.NURSING HISTORY

PATIENTS PROFILE

Name: Ms. Yuri

Age:21

Sex: Female

Address: P2 Dubinan west Santiago city Nationality: Filipino

Civil status: Single

Religion: Roman Catholic

Occupation: Office secretary

Date admitted: 3/4/2011 Time admitted: 8:10am

Admitting diagnosis: UTI, Pyelonephritis

Chief complaint: Right lower quadrant and radiatingflank pain since Saturday February 26, 2011.


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B. HISTORY OF PRESENT ILLNESS

The day PTA, the patient complained of back painand couldnt stand alone because she felt dizzy andradiating flank pain in night lower quadrant of theabdomen and general also complaining for body

malaise and painful urination.


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PAST MEDICAL HISTORY

The patient has been hospitalized when shewas in 4th yr. high school due to bronchitis

FAMILY HISTORYThe patient verbalized that her father had also

suffered urinary tract infection.


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E. GORDONS FUNCTIONAL PATTERN

HEALTH PERCEPTION

BEFORE CONFINEMENT:

-The patient stated that she consider herself healthybecause she cannot feel something unusual.

DURING CONFINEMENT:-She stated that shes already unhealthy because she can

feel pain

NUTRITION

BEFORE CONFINEMENT:

-The patient seldom drink water and sometimes not at all.Shes also fun in eating sweets and salty foods.

DURING CONFINEMENT:

-On her first day of confinement the ROD ordered DAT.


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ELIMINATION PATTERN

PRIOR CONFINEMENT

-The patient usually voids for 1-2 times a day. The color ofher urine was dark yellow. However, 1 day PTA shecomplained of pain upon urination in the pain scale 7

that causes her to void in small quantities. DURING CONFINEMENT

-She voids 2-4 times a day in normal quantities and slightpain upon urination

ACTIVITY

BEFORE CONFINEMENT:-The patient can go to work and stayed at the office from

7-5 pm can do activity daily living.

DURING CONFINEMENT:

-The patient appears weak to go the bathroom.


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SLEEP/REST PATTERN:

BEFORE CONFINEMENT:

-Her usual sleeping pattern was 6-8 hours daily.

DURING CONFINEMENT:-She is able to sleep 8-10 hours and an hour of snaps

in the afternoon

COGNITIVE PERCEPTUAL PATTERN

-The patient can read and write and her sensesfunctions well. The decision for the benefit of thepatient always comes from her. However, at timesshe asks for assistance her family.


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SEXUAL PATTERN:

-The client is single

COPING STRESS TOLERANCE

-She asks for assistance from her mother in terms of

making decision to avoid stress. She managed herproblem through praying.

VALUES AND BELIEF PATTERNS

BEFORE CONFINEMENT:

-She said she attends Sunday masses regularly but herrecent confinement hinders her practice.

DURING CONFINEMENT:

-During hospitalization, she prays to GOD to bless her andher family with good health.


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III.PHYSICAL EXAMINATION

March 4, 2011

General appearance:

The patient looks weak and irritable, complainingpain at the right lower quadrant and radiating flank

pain, (+) guarding and facial grimace and palelooking with excessive sweating.

Vital Sign:

BP: 100/70 mmHg

Temperature: 38.3 RR: 25 cpm

PR: 89 bpm

Parts Technique Abnormal Analysis


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Hair

Head

Face

Eyes

Ears

Mouth

Neck

Lungs

Abdomen

Extremities

Upper: Nail

Skin

Lower: Nail

Skin

Inspection

Inspection

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Palpation

Percussion

AuscultationInspection

Palpation

Percussion

Auscultation

Inspection

Inspection

Palpation

Inspection

Palpation

Inspection

Palpation

Inspection

Palpation

Weak looking and facial

grimace

pale, and with eye bags

Dry mouth, pale, cracked and

dry lips.

Shivers

Pale

Dry

Pale

Pale

As body response to pain

Due to inadequate sleep

As body response to fever and

fluid loss of the body

Due to fever

Response of the body to

Inflammation

Due to fever


inflammation

Due to fever


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MARCH 5, 2011

General appearance: the patient looks pale andweak.

Vital sign: BP: 100/80mmHg

Temperature: 37.5

RR: 19 cpm

PR: 87 bpm



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q y

Hair

Head

Face

Eyes

Ears

Mouth

Neck

Lungs

Abdomen

ExtremitiesUpper: Nail

Skin

Lower: Nail

Skin

Inspection

Inspection

Palpation

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Palpation

Percussion

Auscultation

Inspection

Palpation

Percussion

Auscultation

InspectionInspection

Palpation

Inspection

Palpation

Inspection

Palpation

Inspection

Palpation

Weak looking

Pale and with eye bags

Cracked and dry lips

Pale

Dry

Pale

Dry

Due to uncomfortable feeling

Due to inflammation andinadequate sleep

Due to fever and fluid loss of

the body

Response of the body toinflammation


inflammation


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IV.LABORATORY RESULTS

URANALYSIS NORMAL VALUES RESULTS ANALYSIS

COLOR Amber Dark yellow Urine becomes over

concentrated with waste that

makes urine dark yellow

TRANSPARENCY Clear Turbid The presence of bacteria,

increase WBC and RBC that

cause her urine turns to turbid

SPECIFIC GRAVITY 1.010 - 1.025 1.015

PH 4.5 8.0 Alkaline

PROTEIN 6 8 g/d (+) 2 Due to infection, medications,

and physical stress

SUGAR 65 99 mg/dl (-)

A. MARCH 4, 2011


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URANALYSIS NORMAL VALUES RESULTS ANALYSIS

WBC 5000 10000/mm3 TNTC Due to her body response to

invasion, they provide

components of coagulation,

transportation and complement

production during acute

infection.

RBC 4.2 5.4 mil/mm3 12 15

AMORPHUS URATES Moderate

EPITHELIAL CELLS Moderate

BACTERIA Many Due to infection


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HEMATOLOGIC REPORT

Complete Blood Count Normal Values Results

Hemoglobin 110 160 g/d 139

Hemotocrit 34-47 41.5

White Cell Count 5-10x10 9 23.6

Segmenters 50-65% 93

Lymphocytes 25-35% 4.2

Eosinophils 1-3%

2.8

Monocytes 3-7%

Platelet count 150-450 X 10 9 24

A. MARCH 4, 2011


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V.REVIEW SYSTEM

-ANATOMY OF URINARY SYSTEM

The urinary system consist of two kidneys, twoureters, the urinary bladder, and the urethra. A largevolume of blood flows through the kidneys, which

removes substances from the blood to form urine.The urine contains excess water and ion metabolicwastes such as urine and toxic substancesconsumed with food. The urine produce by the

kidneys flows through the ureters to the urinarybladder, where it is stored until it is eliminatedthrough the urethra.


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FUNCTIONS OF THE URINARY SYSTEM

KIDNEYS:

The major functions of the urinary system areperformed by the kidneys, and the kidneys play thefollowing essential roles in controlling the

composition and volume of body fluids.

1. Excretion. The kidneys are the major excretoryorgans of the body. They remove waste products,many of with are toxic from the blood.


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The kidneys control blood volume by regulating thevolume of urine produced.

3. The kidneys help regulate the concentration ofmajor ions in the body fluid.

4. The kidneys help regulate the pH of the fluids.

5. The kidneys regulate the concentration of redblood cell in the blood.

6. The kidneys participate with the skin, and liver,invitamin D synthyesis.


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URINARY BLADDER is a hollow muscularcontainer that lies in the pelvic cavity just posteriorto the pubic symphisis. It functions to store urine,and its size depends on the quality of urine present.

URETHRA is a tube that exist the urinary bladderinfection and anteriorly the triangle-shape portion ofthe urinary bladder located between the opening ofthe ureters and the opening of the urethra is called

the trigone. The urethra carries urine from theurinary bladder to the outside of the body.


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KIDNEY are been shape organs, each about thesize of a tightly clenched fist. They lie in theposterior abdominal wall, behind the peritoneum,with one kidney on either side of the vertebral

column.


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OUTER KIDNEY

Hilium (opening)-where the renal artery and nervesenter and where the renal vein and ureter exit thekidney.

Renal artery-branch off the abdominal aorta and

abdominal aorta and enter the kidneys. They giverise to several branches.

Renal vein-are veins that drain the kidney. Theycorrect the kidney to the inferior vena cava.


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Renal pelvis-is the funnel-like dilated proximal partof the ureter in the kidney. In humans, the renalpelvis is the point of convergence of two or threemajor calyces.

URETER-are muscular tubes that proper urine fromthe kidneys to the urinary bladder.


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INNER KIDNEY

Cortex-is the outer part of the substance or thekidney, composed mainly of glomeruli andconvulated tubules.

Renal pyramid -the conical masses composing the

medullary substance of the kidney.

Major calyces -in the kidney, surrounds the apex ofthe malphighian pyramids. Urine formed in thekidney passes through a papilla at the apex into a

minor calyx then into the major calyx beforepassing through the renal pelvis into the ureter. Afusion of minor calyx.


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Renal artery-brach off the abdominal aorta andenter the kidneys.

Minor calyces -the cup-shape dilation of theintrarenal ureter, into which a single papilla of a

multiple-lobe kidney protrudes.

Nephron -is the basic structure and functional unitof the kidney. Its chief function is to regulate theconcentration of water and soluble substance like

sodium salts by filtering the blood, reabsorbed whatis needed and excreting the rest of urine.


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NORMAL KIDNEYS AND PARTS


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PYELONEPHRITIS


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URINE FLOW Urine is produced by the processes of filtration, reabsorption

and secretion.

FILTRATION

The renal filtrate passes from the glomerulus into Bowmans

capsule and contains no blood cells and few blood proteinsthen filtration pressure is responsible for filtrate formation.

REABSORPTION

About 99% of the filtrate volume is reabsorbed, 1% becomesurine. Proteins, amino acids, glucose, fructose, sodium,potassium, calcium are among the substances reabsorbed.

About 65%of the filtrate volume is reabsorbed in the proximaltubule and collecting ducts.

SECRETIONS

Hydrogen ions same by-products of metabolism, and somedrugs are actively secreted into the nephron.


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B. PATHOPHYSIOLOGY

PYELONEPHRITIS

Precipitatingfactor:

Immunocompromise patientLifestyleMisconceptionwith regard toproper hygiene

care

Etiology:

Attachment ofEschericha colibacteria in the

urethra

Predisposing

factor:AgeGenderHealthproblem


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B. PATHOPHYSIOLOGY

Proliferation of bacteria in the urethra

Urethritis

Urethrovesical reflux


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B. PATHOPHYSIOLOGY

Introduction of bacteria to the Ureter

Inflammation of the Ureter

Ureteritis


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B. PATHOPHYSIOLOGY

Infection ascends to the kidneys

Pyelonephritis

Activation of theimmune response

GeneralBody

Malaise

Nauseaandvomiting

Dysuria

Colic


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B. PATHOPHYSIOLOGY

Release ofpyrogens from

bacteria

Release ofprostaglandins E2

Elevation of thebody thermostat bythe hypothalamus

Flankpain


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B. PATHOPHYSIOLOGY

Vasoconstriction

Shivers

Fever


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VII. NURSING CARE PLAN

March 4, 2011


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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE:

Giniginaw ako

as verbalized by

the patient.

OBJECTIVE:

-Warm to touch

flush face teary

eyes shivering

-TEMP: 38.3c

-chills

Alteration in

thermoregulator:

hyperthermia r/t

bodys response

against invading

pyrogens 2 to

UTI.

After 30 minutes

of continuous

nursing

intervention the

patient will be

able to stabilized

body

temperature in

normal

range.from 38.3-

37.5 c

Monitor v/s

Wrap in warm

blankets extra

clothing and

check clothing.

Provide warm

liquids if the

client can

swallow

Close the

window and

doors and turns

the light on.

Turn off electric

fan and aircon if

necessary

Provide extra

pillow beside thepatient

Administer

paracetamol as

prescribed by the

ROD

-For base line

data

-To provide warm

and comfort.

-To elevate the

body

temperature

After 30 minutes

of continuous

nursing

intervention the

patient was able

to stabilized body

temperature

from 38.3 to 37.2

c

-GOAL MET-

March 4, 2011


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SUBJECTIVE:

Masakit tang

tagiliran ko

hanggang likod ko.

As verbalized by thepatient.

OBJECTIVE:

Facial grimace

guarding irritable

body weakness pale

-Pain scale:8/10

Acute pain r/t an

inflammatory

process in the

kidney.

After 30 minutes or

1 hour of giving

appropriate

intervention, the

patient will be ableto alleviate pain.

Monitor v/s and

record

Perform a

comprehensive

assessment of painseverity(0-10 scale)

Encourage

verbalization of

feelings about pain

Provide quit

environment

comfort measures

like back rubEncourage

adequate rest period

Keep comfortable.

-For baseline data

-For baseline data

-Help determine

possibility of

underlying condition-To prevent fatigue

-To provide non

pharmacologic pain

management

-To prevent fatigue

-For quick recovery

After 30 minutes or

1 hour of giving

appropriate

intervention, the

patient was able toelevate pain.

-GOAL MET-

March 4, 2011


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SUBJECTIVE:

Nagsusuka akoas

verbalized by the

patient.

OBJECTIVE:-Pale

-weak looking

-dry skin and lips

-restlessness

(+)vomit for 3 times

Risk for deficient

fluid volume r/t

nausea and

vomiting secondary

to dehydration.

After 30 minutes to

1 hour the patient

will be able to

maintain fluid

balance.

Monitor v/s

Monitor I and O

balance, being

aware of altered

intake outputEncourage the

client to increase

fluid intake at least

6-8 glasses a day.

Review

appropriate use of

medication

Give hard candies

-For baseline data

-To ensure accurate

picture of fluid

status

-To maintain fluidand electrolytes

balance

- To have potential

for causing of

exacerbating

Dehydration.

-To lessen the

stimulation of saliva

that enduses

vomiting

After 30 minutes to

1 hour the patient

was able to

maintain fluid

balance.-GOAL MET-

March 4, 2011


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ASESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

OBJECTIVE:

-Small frequent

urination with pain-PAIN SCALE:7/10

-WBC:

TNTC

-DYSURIA

-Urine analysis:

-COLOR: Dark

yellow

TRANSPARENCY:Tur

bid

-S.G.:1.015

-PH: Alkaline

-PROTINE: +2

SUGAR: -

RBC:12-15

Impaired urinary

elimination r/t

inflammation of

bladder mucosa

Within 8 hours of

nursing intervention

the patient

verbalizeunderstanding of

condition and

techniques to

prevent urinary

tract infection (UTI)

Monitor v/s

Encourage fluid

intake at least 8-10

glasses a dayDiscuss possible

dietary restriction

base on individual

symptoms.

Discuss proper

genitalia cleansing

and using of

feminine wash

Monitor and

assess urine output

-For baseline data

-To help maintain

renal function,

prevent infectionand urinary stones

-To help elevate the

present condition

-To let the patient

understand the said

topics

-For base line data,

for any particular

changes

Within 8 hours of


the patient

verbalizedunderstanding of

condition and

techniques to

prevent urinary

tract infection (UTI).

-GOAL MET-

March 5, 2011


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ASESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE:

Nanghihina ako as

verbalized by the

patientOBJECTIVE:

-Decrease range of

motion

-weak looking

-pale

-irritable

-slowed movement

Impaired physical

mobility r/t

decrease muscle

strength secondaryto fatigue

After 2-3 hours of


the patient will able

to increase strengthand function of

compensatory body

parts.

Establish rapport

Assess nutritional

status and clients

report of energywith monitor v/s

Provide comfort

measures such as

therapeutic touch

Encourage the

patient to eat

nutritious food

which is rich in

vitamin c such as

orange fruits,

malunggay.

Identify energy

conserving

techniques for ADLs

Schedule activitieswith adequate rest

periods during the

day.

Provide safety

measures

-To gain trust and

cooperation

-For baseline data

-To provide comfort-To promote well

being and maximize

energy production

-To limits fatigue,

Maximize

participation.

-To relive fatigue

-To prevent falling

After 2-3 hours of


the patient was able

to increase strengthand function of

compensatory body

parts.

-GOAL MET-


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VIII. DRUG STUDY

DRUG(CLASSIFICATON)

INDICATION ACTION ADVERSE EFFECT CONTRAINDICATION NSG. CONSIDERATION


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CEFUROXIME

Brand name : Ceftin

(Anti-infectives)

750mg IV

For Urinary tract

infection

Second-generation

cephalosporin that

inhibits cell-wall

synthesis promoting

osmotic instability;usually bactericidal.

CV: Phlebitis

GI: nausea, vomiting,

diarrhea

Other:

hypersensitivityreaction

Contraindicated in

patients

hypersensitive to

drug and other

Cephalosporins. Usecautiously in the

patients

hypersensitivity to

penicillin because of

possibility of cross-

sensitivity with other

beta-lactam

antibiotics.

Before giving

ask patient if

she has

allergies to

penicillins orcephalosporin.

Obtain

sensitivity test

before giving

the first dose.

If large doses

are given,

therapy is

prolonged or

patient is at

risk, monitor

patient for sign

and symptoms

of infection.

Look-alike-sound alike:

Dont confuse

drug with other

Cephalosporins

that alike

DRUG(CLASSIFICATON)

INDICATION ACTION ADVERSE EFFECT CONTRAINDICATION

NSG. CONSIDERATION


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GENTAMICIN

(Anti-infectives)

80mg IV

Serious

infections

caused by

sensitive strains

of

pseudomonas

aeruginosa,

Escherichia coli,

Proteus,

Klebsiella or

Staphylococcus

Inhibits protein

synthesis by

binding directly

to the 30s

ribosomal

subunits;

bactericidal.

CNS: fever,

headache,,

lethargy,confusion,

dizziness

CV:Hypotension

Respiratory: Apnea

GI: vomiting, nausea

Skin: rash

Contraindicated in

patients

hypersensitivity to

drug or other

aminoglycosides.

Use cautiously in

neonates, infants,

elder patients with

impaired renal

function or

neuromuscular

disorders.

Obtain sensitivity tests before

giving first dose.

Evaluate patients hearing

before and during therapy.

Notify and during therapy.

Notify prescriber if patients

complain tinnitus, vertigo,

hearing loss.

Weight patient and review

renal function studies before

therapy begins.

Obtain blood peak gentamicin

level 30 minutes after IV

infusion finishes.

Monitor renal function

Watch for s/sx of

superinfection

Therapy usually continues for

7-10days. If no response occurs

in 3-5days, stop therapy and

obtain new specimen forculture and sensitivity.

DRUG

(CLASSIFICATON)

INDICATION ACTION ADVERSE EFFECT CONTRAINDICATI

ON

NSG.

CONSIDERATION


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(CLASSIFICATON) ON CONSIDERATION

METOCLOPRAMID

E

(antiemetics)

1amp IV

To prevent or

reduce nausea

and vomiting

Stimulates

motility of

upper GI tract,

in cases lower

esophageal

sphincter tone,

and blocks

dopamine

receptors at

the

chemoreceptortrigger zone.

CNS: fatigue,

anxiety

CV: Hypotension

GI: nausea, bowel

disorders,

diarrhea

GU: urinary

frequency,

incontinence

Skin: rash

Contraindicated

in patients

hypersensitivity

to drug.

Contraindicated

in patients for

whom

stimulation of GI

motility might be

dangerous (those

withhemorrhage,

obstruction or

perforation)

Monitor bowel

sounds.

Safety and

effectiveness of

drug havent

been established

for therapy

lasting longer

than 12 weeks.

Alert: use 25mg

diphenhydramine IV counteract

extrapyramidal

adverse effects

from high doses.

DRUG(CLASSIFICATON)

INDICATION ACTION ADVERSE EFFECT CONTRAINDICATION

NSG. CONSIDERATION


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KETOROLAC

Brand name: Toradol

(non steroidal anti-

inflammatory drugs)

1amp IV

Short-term

management of

moderately

severe, acute

pain for single

dose treatment.

May inhibit

prostaglandin

synthesis, to

produce anti-

inflammatory,

analgesic and anti-pyretics.

CNS: dizziness,

headache

GI: vomitin,

flatulence

Skin: rash

Other: pain atinjection site.

Contraindicated in

patients

hypersensitivity to

drug and in those

with advanced renal

impairment andthose at risk for

renal impairment

depletion or at risk

of bleeding.

Contraindicated as

prophylactic

analgesic before

major surgery or

intraoperatively

when hemostatic is

critical; and in

patients currently

receiving aspirin, an

NSAID or pronecid.

Alert. The maximum

combined duration

of parenteral and

oral therapy is 5

days.

Dont give drugsepidurally or

intrathecally because

of alcohol content.

NSAIDs may mask

the s/sx of infection

because of their

antipyretic and

inflammatory

actions.

Serious GI toxicity,

including peptic

ulcers and bleeding,

can occur in patient

taking NSAIDs,

despite lack ofsymptoms.

Look-alike-sound

alike: dont confuse

Toradol with Tegretol

or Foradil

DRUG(CLASSIFICATON)

INDICATION ACTION ADVERSE EFFECT CONTRAINDICATION NSG.CONSIDERATION


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Calcium Carbonate

Brand name:

Contylan

(antacid and

antiflatulent)

Used for acute

hypocalcemiaa,

electrolyte

depletion,

cardiac arrest,

hyperkalemiaand

hypermagnesia.

Used in chronic

hypocalcemia,

calcium

deficiency, and

as an antacid.

Used treatment

of

hyperphosphat

emia

Calcium is essential

for function, integrity

of nervous, muscular

and skeletal systems.

It plays an important

role in normal cardiacand renal function,

respiration blood

coagulation, cell

membrane and

capillary

permeability. It

assists in regulating

the release and

storage of

neurotransmitters

and hormones.

Calcium neutralizes

or reduces gastric

acid production.

CNS: headache

CV: Hypotension

GI: nausea, vomiting

GU: difficult or

painful urination

Skin: flushing,warmth, rash,

redness, sweating

Other: burning

sensation at injection

site

No contraindicated

had notify.

Assess bp, ECG

reading, renal

function.

Give syrup

diluted in juice

or water. Chew chewable

tablet well

before

swallowing.

Monitor for sign

of

hypercalcemia.

DRUG INDICATION ACTION ADVERSE EFFECT CONTRAINDICATIO NSG. CONSIDERATION


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N

PARACETAMOL

Classification:

-Therapeutics:

Antipyretics, non

opioid analgesics

Mild pain and

fever

Inhibits to synthesis

of prostaglandins

that serve as

medicines of pairs

and fever primarily

in the CNS has no

significant anti-

inflammatory

properties or G.I

toxicity

GI: hepatic failure,

hepatoxicity

GV: Renal failure(high

doses/chronic use)

HEMAT: neutropehia.

Fancy topenia,

Leukopenia

DERM: rash, urticaria

Previous

hypersensitivity

products

containing alcohol,

aspartame,

sacharin, sugar or

tartrazine should

be avoided in

patients who have

hypersensitivity or

intolerance to

these compound.

Assess overall

health status and

alcohol usage

before

administering

paracetamol

patients who are

malnourished or

chronically abuse

alcohol are at

higher risks of

developing

hepatotoxicity With chronic use

of usual doses of

drugs.

Assess amount

frequently and

type of drugs taken

in patients self

medicating,

especially with

over the counter

drugs prolonged

use of paracetamol

increase the risk of

adverse renal

effects.

Assess fever: Note


59/59

END OF CASE

PRESENTATIONTHANK YOU!

GROUP 1 (GROUP BULILIT & BAGTIT!)

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Pyelonephritis (Final Case)