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NR 508 Week 5 TD, NR 508 ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 5 TD, NR 508 ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 5 TD, Quiz and Summary, NR 508 Week 5 TD, Quiz and Summary
PART 1:
Leroy is a 70 year-old-man, whose wife passed away 5 years ago, and
whose 2 children live out-of–state. His neighbor caretaker (Ms. Webb, a
middle-aged retired CNA, whom his children hired to provide home
care to him 3x/week) brings him to your clinic. He presents with quite
severe confusion, incidentally to very minor changes in his environment,
which provokes some violence (a symptom which startles Ms. Webb),
increasingly impaired judgment, and increasing repetitiousness and
inconsistencies in his usual beh\avior. Upon initial work-up and physical
exam, you notice an increased respiratory rate, a slight fever (100°F),
and costovertebral angle tenderness on his right side.
Please provide a list of differential diagnoses, as well as an indication of
your primary diagnosis. Pyelonephritis, renal stones, renal abcess,
bacterial prostatitis,
What additional tests would you order to confirm a diagnosis? Once
this has been completed, please indicate and describe your chosen
pharmacological treatment with inclusion of dose and mechanism of
action of your chosen prescription. Trimethoprim-
sulfamethoxazole (Bactrim), Levofloxacin (Levaquin), Take into
consideration pt’s CrCl
Pyelonephritis. Urinary tract infections encompass both the upper and lower
portions of the urinary tract. Cysitits, also known as a bladder infection, is
considered a lower urinary tract issue while pyelonephritis, also known as a
kidney infection, is considered an upper urinary tract issue (Hooton, 2016).
Acute pyelonephritis (APN) is responsible for approximately 14 percent of
all UTIs (Enikeev, Glybochko, Alyaev, Enikeev, & Rapoport, 2017). If
APN is left untreated it can cause patients to become septic as well as cause
destruction of the parenchyma and kidney abscess (Piccoli et al., 2011).
APN can be classified as complicated or non-complicated. Complicated
involves underlying, predisposing factors such as diabetes, HIV, obstruction,
, stones, neoplasms, reflux nephropathy, or a collagen disease (Piccoli et al.,
2011). Uncomplicated is when the patient does not have any underlying
factors as previously mentioned (Piccoli et al., 2011). However, according to
Hooton (2016), APN is typically considered complicated in most men who
are over 50 years of age because most usually have some urologic
abnormality. The clinical definition of pyelonephritis is based on
presentation and includes costovertebral angle tenderness, fever, and a
positive urine culture (Piccoli et al., 2011). Some patients, although rare,
may present with signs of sepsis, shocks, acute renal failure, or multiple
organ dysfunction, also known as MODs (Hooton, 2016). The patients urine
culture will typically reveal Escherichia coli however, Staphylococcus
saprophyticus may be present as well as some forms of Enterobacteriaceae,
which include Klebsiella pneumonia and Proteus mirabilis (Hooton, 2016).
Diagnosing APN is based on the clinical assessment and lab work. A
urinalysis (UA) is a valuable diagnostic tool because it will reveal pyuria
(Hooton, 2016). Almost all male patients who have pyelonephritis will have
a UA that is positive for pyuria; if the UA is negative for pyuria, other
diagnoses should also be considered, especially some sort of obstruction
(Hooton, 2016). Patients who are very ill and/or have symptoms of urosepsis
should be evaluated using radiographic imaging (Hooton, 2016). Cat Scan
(CT) or ultrasound are typically used however, CT (without contrast) has
become the standard study because of it’s ability to also show obstructions,
gas-forming infections, calculi, abscesses, and hemorrhage (Hooton, 2016).
Antibiotics should be initiated immediately, preferably with results of the
urine culture. If the urine culture is not available, start the patient on a broad-
spectrum antibiotic until culture results and susceptibility are known.
Leroy is suffering from pyelonephritis, most likely complicated based on his
age however, his medical history was not given so I cannot say definitively.
Leroy also seems to be septic, After assessing Leroy, I would order a UA,
urine culture, CBC, and CMP. The CBC is to evaluate WBCs and the CMP
is to evaluate for renal and hepatic function. Considering Leroy is
experiencing altered mental status (AMS) with some combativeness and
lives alone, I would send him to the hospital for further evaluation and
workup. In the hospital they will most likely order a CT of his abdomen and
pelvis and begin IV antibiotic therapy with ceftriaxone (Rocephin) or
levofloxacin (Levaquin).
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