Case study home visit acute pyelonephritis
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Case study & Home visit Acute Pyelonephritis. นศพ.ธนาธิป ตันติธนเศรษฐ์ 53020 68 RAMD/B นศพ.ไอริณ จารุวัฒนพานิช 53 02 176 RAMD/B. Patient Profile. หญิงไทยอายุ 22 ปี อาชีพ พนักงานโรงปูน จบการศึกษาชั้นมัธยมศึกษาตอนปลาย

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Case study & Home visit Acute Pyelonephritis

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Case study home visit acute pyelonephritis

Case study & Home visit Acute Pyelonephritis

. 5302068 RAMD/B

. 5302176 RAMD/B


Patient profile

Patient Profile

  • 22

  • . . . .

  • ()

  • 25 2556

  • : .

  • :

    • -

    • -


Case study home visit acute pyelonephritis

:

:


Case study home visit acute pyelonephritis


Case study home visit acute pyelonephritis

Chief complaint ::

  • 1

    Present illness ::

  • 1 week PTA :

  • 3 day PTA :

    • 1 day PTA :


Case study home visit acute pyelonephritis

Past History ::

7

,

Personal History ::

LMP 18 .. 56(7 days PTA)


Case study home visit acute pyelonephritis

Family History

Socioeconomic History

. .

2

15,000/

41

14 1

(.)


Physical examination

Physical Examination

Vital SignT 39.7cBP 97/59 mmHg

HR 118/min RR 20/min

BW 60kg ,Ht 166 cm BMI 21.77 kg/m

General Appearance good conscious, not pale , no jaundice

Skin Normal skin color, no rash, no petechiae

HEENT pharynx&tonsil are not injected, cervical LN not palpable

Heart no cyanosis, normal s1 , s2 ,no murmur

Lungs normal breath sound , no adventitious sound

Abdominal no distention , soft, moderate tenderness at suprapubic area, no rebound tenderness, no guarding, liver and spleen not palpable, left costovertebral angle tenderness

Extremities no pain, no swelling, no deformities

Nervous system grossly intact


Lab 25 8 56 cbc

Lab (25.8.56) CBC


Lab 25 8 56 ua

Lab (25.8.56) UA


Case study home visit acute pyelonephritis

  • Provisional diagnosis

    • Acute pyelonephritis

  • Management

    • Vital sign

    • CBC, UA

    • Ibuprofen 400mg 1tab pcstid

    • Ceftriaxone 2 gm i.v. drip in NSS 100ml in 30 mins OD

  • Definite diagnosis

    • Acute pyelonephritis


Case study home visit acute pyelonephritis

  • Home medication

    • Ibuprofen 1*3 oral pc #20

    • Paracetamol(500) 2*prn 4-6.#20

    • Ceftriaxone(1)i.v.2 gm od#10

    • 0.9%NSS 100ml # 10


Follow up ua 29 8 56

Follow up : UA (29/8/56)


Participatory observation

PARTICIPATORY OBSERVATION


Clinical knowledge

Clinical Knowledge


Epidemiology

Epidemiology

Acute infection of renal pelvis or parenchyma.

Incidence and prevalence

15-17 cases per 10,000 females and 3-4 cases per 10,000 males.

At least 250,000 cases are diagnosed annually in the United States.

Demographics

Age

more commonly in sexually active women

more commonly in men over 50 years of age

Gender

more commonly in woman

Genetics

Vesicoureteric reflux is familial, with 10% of first-degree relatives affected

Polycystic renal disease (which is often complicated by pyelonephritis) has an autosomal dominant inheritance


Pathogenesis

PATHOGENESIS

http://www.medscape.com/viewarticle/771300

Fecal flora colonize atthe vaginal opening

ascension via the urethra > bladder > ureter > kidney.

seeding of the kidneys from bacteremia

seeding of the kidneys from bacteria in the lymphatics.


Etiology

Etiology

  • Adapted from Hooton TM. The current management strategies for community-acquired urinary tract infection.Infect Dis Clin North Am. Jun 2003;17(2):303-32.[Medline]. Bacterial Etiology of Urinary Tract Infections


Sign symptoms

Sign & Symptoms

  • Classical presentation is

  • Fever

  • Flank pain

  • Nausea/vomiting

  • CVA tenderness

  • +/- Cystitis symptoms

  • Sepsis/shock

http://www.medscape.org/viewarticle/412933_2


Complicated uti

Complicated UTI

  • involve any of the following:

  • Acute renal failure

  • Chronic renal damage leading to hypertension and renal failure

  • Sepsis syndromes

  • Renal papillary necrosis

  • Xanthogranulomatous pyelonephritis

  • Risk factor of Complicated UTI

  • Male

  • Elderly

  • Hospital-acquired

  • Pregnancy

  • Diabetes

  • Immunosuppression

  • Urinary tract abnormality

  • Childhood UTI

  • Recent antimicrobial use

  • Symptoms > 7 days

http://www.medscape.org/viewarticle/412933_2


Emergency management

Emergency Management

Antipyretics

Antiemetics

Iv fluids

Initial dose of ATB

Observation up to 12 hr.

http://www.medscape.org/viewarticle/412933_2


Admission indication

Admission Indication

Absolute indications

Severe illness

Persistent vomiting

Progression of uncomplicated UTI

Suspected sepsis

Uncertain diagnosis

Urinary tract obstruction

Relative indications

Age > 60 years

Persistent vomiting

Progression of uncomplicated UTI

Suspected sepsis

Uncertain diagnosis


Diagnosis

Diagnosis

  • OPD suggested by the history and physical examination and supported by urinalysis results, which should include microscopic analysis. Other laboratory studies are used to identify complicating conditions and to assist in determining whether the patient should be admitted.

  • Imaging studies may be required to make the diagnosis in infants and children

  • Imaging studies are rarely indicated for the diagnosis in adult except:

  • atypical or confusing presentation

  • patient deteriorates or does not respond to therapy,

  • important considerations are nephrolithiasis, obstructive uropathy, and perinephric abscess.


Laboratory diagnosis of urinary tract infection

Laboratory Diagnosis of Urinary Tract Infection

  • urine culture showing at least 10,000 CFU/ mm3and symptoms compatible with the diagnosis.

  • 1,000 - 9,999 CFU/mm3 are of concern in men and pregnant women


Antimicrobial agents used in the treatment of acute pyelonephritis

Antimicrobial Agents Used in the Treatment of Acute Pyelonephritis


Management atb used in the treatment of acute pyelonephritis

Management ATB Used in the Treatment of Acute Pyelonephritis

7-14 days immunocompetent host and no U/D

14-21 days in immunosuppressive course of a fluoroquinolone or TMP-SMX

Urine cultures are recommended in all patient 1-2 wk. after full course of ATB.

Fever generally resolves within 72 hours of starting antibiotic therapy

Short-term antibiotic therapy (3 days), have 50% relapse


Pyelonephritis prevention

PyelonephritisPrevention

  • Drink plenty of fluids:

    • Drink 6 to 8 glasses of water per day.

  • Do not postpone urination when you feel theurge to urinate.

  • Empty your bladder completely when you urinate.

  • Try to urinate every 2 to 4 hours.

  • Practice safe sex:

    • Use condoms.

  • Urinate as soon as possible following sexual intercourse.

  • Wash the genital area each time you shower or bathe.

  • Wear cotton underwear.

  • Women should always wipe from the front to the back.

  • Women should avoid prolonged sitting in wet clothes.

  • Women should not use vaginal deodorants or perfumes.

  • Circumcisiondecreases the risk ofurinary tract infectionsin males


Case study home visit acute pyelonephritis


Case study home visit acute pyelonephritis

  • Acute pyelonephritis


Home visit

HOME VISIT

IFFE

Ideas

Feeling

Functions

.drip (25/8/56-29/8/56)

Expectations


Case study home visit acute pyelonephritis

6

. . 30

.-5 .


Case study home visit acute pyelonephritis

    • vital sign

    • UA, CBC

      ER

      drip 5 UA

      drip ceftriaxone 2 gm i.v. drip in NSS 100ml in 30 mins OD


Case study home visit acute pyelonephritis

,drip

  • drip ceftriaxone 11 4 ER drip ER ()

  • Follow up UA 5drip(29/8/56)


Case study home visit acute pyelonephritis


Case study home visit acute pyelonephritis


Case study home visit acute pyelonephritis

.

  • (Individual):

  • (Environment):

    (Health service system):

    • Health resources

    • Health financing

    • Planning & management


Case study home visit acute pyelonephritis

  • (Individual):

  • (Environment):

  • (Health service system):


Case study home visit acute pyelonephritis


Gap analysis

Gap Analysis


Case study home visit acute pyelonephritis


Case study home visit acute pyelonephritis

..


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