Understanding Patient Health through Case Study Analysis

Introduction

The analysis of case study of patients is important to develop range of perspectives regarding the disease which the patient is suffering from opposed to single view of the individual or patient during the initial health survey. The case study provides opportunity for the nurses to gain greater understanding regarding any health problems through hands in approach and reduces development of potential error in care while supporting patients in practice with similar health complications. Thus, the current case study of Eliza is analysed, and the pathophysiology of the disease is explained. Thereafter, the ABCDE approach is used to assess the health needs of the patient and priorities in nursing care to be focussed are discussed. Further, the impact of the diagnosed health condition of Eliza in the family is discussed with the role of the nurse to be followed.

Pathophysiology of Acute Pyelonephritis

In the case study of Eliza, it is informed by the registered paediatric through review of Eliza’s health records and condition that she is suffering from acute pyelonephritis. Acute pyelonephritis is referred to as the infection of the kidney and renal pelvis which usually ascent due to the infection by the bacterial pathogen in the upper parts of the uterus from the bladder and extending to the kidneys (Morello et al., 2016). The common symptoms of acute pyelonephritis in children above the age of 2 years include presence of fever, changes in appetite, lower back or stomach pain, urgency to urinate, increased frequency and pain during urination (Morello et al., 2016). In case of Eliza, it is seen that all the symptoms that is high body temperature indicating fever, urgency and frequency to urinate, stomach pain and reduced appetite is present which confirms through physical assessment that she is suffering from acute pyelonephritis.

In acute pyelonephritis, the patient experiences high fever and stomach pain because the infectious pathogens (bacteria) on entering the kidneys through ascending from the urinary tract leads to destroy cells or tissues in the kidney. It leads to the release of toxic gas in the kidneys which causes the advent of fever, abdominal pain, nausea and vomiting (Mizutani et al., 2017). Acute pyelonephritis develops when the bacteria travels and enters the kidney causing infection within the organ (Mizutani et al., 2017). Thus, it can be confirmed that bacteria reaching the kidney through the urinary tract of Eliza has led to the expression of the disease and its related symptoms.

One of the key causes of acute pyelonephritis is the presence of gram-negative bacteria mostly Escherichia coli. The presence of other gram-negative bacteria like Klebsiella, Proteus and Enterobacter are responsible for causing acute pyelonephritis in children (Kwon et al., 2020). In most cases, the bacteria causing acute pyelonephritis comes from the fecal flora. The bacteria are able to reach the kidney in two ways that are hematogenous spreading and ascending infection continued from the urinary tract (Jansåker et al., 2018). The study by Pakkyara et al. (2019) argued that haematogenous spreading of bacteria in acute pyelonephritis is less common and occur in patients with ureteral obstructions or immunocompromised debilitated patients. The case study of Eliza informs no prior ureteral obstructions or immunocompromising is faced by the individual indicating the infection causing the disease may have been spread through ascending infection which occurs in most individuals. In the ascending infection process, the bacteria initially get attached to the ureteral mucosal epithelium of the patient which later travels to the bladder through the urethra (Kajbafzadeh et al., 2020).

A urinalysis for Eliza was performed which indicates that she has presence of high level of nitrates in urine. The increased level of nitrites indicates presence of E. coli or K. pneumonia bacteria to be present in the body (Hyun et al., 2019). Since E. coli is mainly responsible for UTI or pyelonephritis, then it can be determined the specific bacteria is present in Eliza’s urinary tract which has her suffer from the disease and face increased nitrate level in the urine. This is because E. coli contains presence of nitrate reductase which leads to cause increased amount of nitrites to be present in the urine out of increased conversion of nitrate into nitrites (Umesha et al., 2018).

Nursing Assessment

The effective health assessment of patient is important as it is the first step to identify the problem of the patient and their key medical needs to be managed to support their enhanced well-being (Smith and Bowden, 2017). The ABCDE assessment approach mentioned by the UK Resuscitation Council is to be used for examining the health condition and needs of Eliza who is suffering from acute pyelonephritis. The ABCDE assessment is to be used because it is one of the strong clinical tools that allows holistic analysis of health of the patient to determine the deterioration in their health and prioritise intervention accordingly to ensure their enhanced life and well-being (Smith and Bowden, 2017). The ABCDE assessment stands for airway, breathing, circulation, disability and exposure assessment (resus.org.uk, 2021). The airway assessment is made to determine presence of any airway obstruction which creates medical emergency to be resolved to ensure enhanced health of the patient (resus.org.uk, 2021). In acute pyelonephritis, airway obstruction is unrelated symptom, but to ensure her airways are working properly and are not hindered by any additional health issue, the assessment is being made. The airway assessment of Elisa indicates that there is no obstruction and she is seen to be able to make full sentences while speaking.

The breathing assessment is executed to determine any hindered breathing condition, level of oxygen saturation, respiration rate and SpO2 level in the blood (resus.org.uk, 2021). The presence of acute pyelonephritis can lead to raise various complications such as renal vein thrombosis, sepsis, papillary necrosis or acute renal failure. The development of such complications may lead to create rapid breathing along with additional symptoms such as rash, confusion, chills and others (Belyayeva and Jeong, 2018). In case of Eliza, she is found to be suffering from acute pyelonephritis and therefore, the breathing assessment is made to determine if the disease has extensively progressed to cause acute complications that leads to hindered breathing. However, no complication in breathing efficiency was detected in Eliza during assessment indicating her acute pyelonephritis is still under control and has not relapse to cause adverse health complications.

The circulation assessment is made to determine the efficiency of the heart and blood flow within the body (resus.org.uk, 2021). In acute pyelonephritis, the worsening of the condition leads to dangerous situation known as sepsis in which the heart rate is highly increased. This is because the presence of sepsis creates a systematic infectious response within the body that leads the body to work harder by increasing the level of heart beat to ensure more blood is pumped within the body to cope with the problem (Tambo et al., 2020). In contrast, the study by Khoo et al. (2020) mentions that presence of any infection in the body may raise the heart rate. This is because presence of infection in the body leads it to feel stressed from pain which leads to raise the heart beat to enhance blood flow to vital organs to ensure their effective functioning under the stress. Thus, the circulation assessment for Eliza is been made where it is reported that her heart beat is 145 beats/min. The normal heart rate of a 3 years old child is 80-100 beats/min (Gąsior et al., 2018). This indicates that Eliza has elevated heartbeat, but the hindered respiratory rate and acute kidney injury that is required for indication of progression to sepsis are lacking in Eliza. It leads to confirm that she has not developed sepsis and the elevated heartbeat is impact of presence of infection in the body due to acute pyelonephritis.

In circulation assessment for Eliza, the blood pressure level is also examined. This is because the presence of acute pyelonephritis may cause kidney damage and stimulate blood poisoning through increased presence of pathogen in the blood which leads to low blood pressure and dizziness (Nickavar and Sadeghi-Bojd, 2020). The normal blood pressure of individuals is between 100/60 to 120/90 mmHg (NHS, 2018). In case of Eliza, it is seen that her blood pressure is 100/60 indicating she has ideal blood pressure. The central capillary refill time is examined in respect to circulation assessment in Eliza. This is because the test helps in assessing the ability of flow of blood to the peripheral tissues and level of dehydration in patients (Hon et al., 2021). The normal central capillary refill time is 2 seconds or less in healthy children (Hon et al., 2021). In case of Eliza, her central capillary refill time is found to be 2 seconds indicating she has normal blood flow efficiency and lack of dehydration. The disability assessment includes examining the consciousness level of the patient along with other vitals such as blood glucose level, urine concentration, hypercapnia and others (resus.org.uk, 2021).

In case of Eliza who is suffering from acute pyelonephritis, the disability assessment included examination of her urine concentration, culture of her urine and bassline blood concentration. The NICE guidelines mention for diagnosis of acute pyelonephritis urine collection and testing is to be made along with urine culture to determine the bacteria causing the urinary tract infection (UTI). Moreover, it is to be performed to determine the level of infection present in the body and detect the nature of pathogen that has affected the patients (NICE, 2018). The urine sampling of Eliza indicates she has high level of nitrates and it indicates presence of infection in the body. The baseline blood samples are obtained, but the case study does not reveal any abnormality been detected in the sampling which helps to avoid presence of blood poisoning due to acute pyelonephritis in case of Eliza. Moreover, she is seen to be in discomfort but expresses effective consciousness while being reviewed.

The exposure assessment is made to examine presence of any external symptoms of the disease on the body. It is to be made by complying with the patient’s demands so that their dignity and privacy is not lost (resus.org.uk, 2021). The exposure assessment of Eliza indicates that she has high fever of 38.5℃ indicating the presence of infection in the body and confirming acute pyelonephritis as it shows other symptoms related to the disease in the before assessment criteria. Eliza shows no presence of rash or cuts on the body confirming no additional external infection is present in the patients that may lead to expression of the hindered health symptoms.

Nursing priorities for Eliza

The initial nursing priority for Eliza is management of her acute pyelonephritis as prolonged suffering from the condition would lead to kidney damage and fatal conditions. The case study informs that Eliza has high fever which is to be controlled. According to NICE, parenteral antibiotics are to be provided to children with fever to lower their body temperature to normal. In addition, the cephalosporin is to be administered until the results for culture arrive for Eliza (NICE, 2018). This is because it would help to control the spreading of infection in the body. The study by Cattrall et al. (2019) mentions that in treatment of acute pyelonephritis in children, the first line of oral antibiotics is to vary according to pattern of local antibiotic resistance. However, the use of trimethoprim only or combination of amoxicillin, cephalexin and sulphamethoxazole are standards first-line medication for the management of the condition considering that E. coli is the causative organism of the disease. This is because trimethoprim sulfamethoxazole bonds with the dihydropteroate synthetase to catalyse the reaction and promotes dihydrofolate reductase of bacteria along with prevents formation of Tetrahydrofolic acid. It leads to prevent the growth and differentiation of bacteria to prevent the increased expression of the infection in the body (Eremenko et al., 2020). The current result of urine for Eliza is not available and so the mentioned medication could not be used. In this case, the NICE mentions use of 125mg cefalexin 2-3 times a day for 7-10 days for the patients suffering from acute pyelonephritis. This is cephalexin is bactericidal agent which acts to inhibit the synthesis of cell wall of the bacteria. It leads the bacteria to be attacked and destroyed in the body and limit the infection rate (NICE, 2018).

The case study mentions that Eliza has already vomited and under discomfort. In this condition, if she is unable to take oral antibiotics, then the nurses are to use intravenous antibiotic administration process. The intravenous antibiotics provided to patients suffering from acute pyelonephritis include 750 mg of cefuroxime 3-4 times a day or 1-2 g of ceftriaxone 1 times a day (NICE, 2018). The bacteria in acute pyelonephritis acts to trigger inflammation of the kidney tissues that causes increased production of urine to be released which would later led to dehydration (Jiang et al., 2021). In case of Elia, she is found to be suffering from acute pyelonephritis and has showed frequent and uncontrolled urination with currently no effect of dehydration. However, to ensure Eliza remain stable and does not get dehydrated under any condition, she is to be ensured to take in more fluids and drink increased amount of water with assistance from the nurses or her mother. This is because increased fluid intake stabilises the inner fluid content of the body along with support enhanced removal of infections from the body (Hudson and Mortimore, 2020). A reassessment of acute pyelonephritis condition is to be made for Eliza by executing urine test and culture after 48 hours of administration of the medication. This is to determine if the medications are effective in lowering the infection rate and if there is need of any change in medication required fir the patient to more effectively control the acute pyelonephritis state (NICE, 2018).

Impact of acute illness on patients and family along with role to be played by nurses

The occurrence of acute illness impacts the patients to face mood disorder like depression and anxiety out of pain and suffering from the condition (Watson et al., 2018). In case of Eliza, acute pyelonephritis is leading her to experience pain and suffering which may make her feel depressed and anxious regarding her ability to lead life. In this condition, the role of the nurse is to provide her emotional support and boost her emotional health by providing positive comments regarding her and ability to cope with the complication. This is because positive motivation of the patients regarding their efficiency to overcome the condition improve their mood and lower negative thinking regarding their health (Chiotos et al., 2020).

The acute illness impacts the patient to become physical weak (Wang and Bellomo, 2017). In case of Eliza, it is seen that she is already showing less appetite and increased suffering which would impact her to become physical weak. In this condition, the role of the nurse caring for Eliza is to provide diet chart and consultation from dietician to be followed by Eliza’s mother so that she is able to determine the way food is to be provided to Eliza to support her to regain her physical strength with ease. As argued by Zakayo et al. (2020), acute illness impacts the patient withdraw from their friends as they lack mental and physical strength to socialise. Eliza is seen to be suffering immense pain and discomfort due to acute pyelonephritis which would impact her to avoid meeting her friends and stay at home to be cured. In this condition, the role of the nurse is to mention Eliza’s mother who is her sole carer regarding the way to support her to socialise during the illness so that she remains happy and connected with others. This is because patients with acute illness if experience isolation are seen to show lesser response to treatment and lack of complication towards care out of uncontrolled mood (Watson et al., 2018).

The presence of serious illness of a person creates hindered impact not only on the patient as well as their family because it causes change in the lifestyle of the family members and additional different healthcare experience while caring for the patients by the members of the family (Roeder and Pisani, 2018). In case of Eliza, it is seen that she is clingy towards her mother who is recently separated and facing hardship in managing Eliza with other two children on her own without the help of Eliza’s dad. The acute illness of children impacts the parents to feel worried for their child and experience stress and anxiety regarding the way to care for the child to improve their well-being and good health (Zakayo et al., 2020). Thus, the presence of acute pyelonephritis in Eliza is going to similarly impact her mother to make her feel worried and stressed regarding the way to ensure well-being of her daughter. The role of the nurse in this condition is to inform the patient’s parents regarding the way to promote self-management of the disease at home and educate them about the need and way each medications or treatment are to be followed. This is because it would make the parents and family members of the child with acute illness develop confidence regarding the duties they are to perform and in which way so that enhanced well-being of the sick individual can be easy achieved (Beesley et al., 2018).

Eliza’s mother is seen to be single and her brother as well as sister are too small to take their own care or act in to support caring for Eliza. In this condition, the acute illness of Eliza would impact the family members mainly the five-year-old brother and mother feel burden of care for the patient. However, the role of the nurse in this condition is to arrange social support for Eliza’s mother to provide her assistance and advice regarding the way to manage the household and equally care for all children including extensive care required by Eliza. This is because social support carer or professionals are individuals with effective expertise and knowledge regarding the way to support caring for the family by a single mother without facing hindrance (White et al., 2018). As argued by Park et al. (2018), acute illness of patients in family is seen to create change in relationship. this is because family members are more focussed on caring for the sick individual and ignore the social environment in the family. In case of Eliza, her requirement of care for acute pyelonephritis may make her mother more inclined to care for her and her 1-year old sister which would led her to ignore her son as she is older than others and is fit. This may make Eliza’s bother to feel left out from the family. In this condition, the role of the nurses is to effectively interact with Eliza’s brother to inform him regarding Eliza’s serious condition and need for their mother is to focus more on her so that no hindered relationship is built between the mother and son.

Conclusion

The above discussion mentions that Eliza is suffering from acute pyelonephritis which mainly occurs due to ascending of infectious pathogens mainly bacteria from the urinary tract which enter the body through faecal flora. the ABCDE assessment of Eliza indicates she has stable breathing and airway. However, her heart beat is raised, and she is expressing increased urine output with the incidence of presence of increased nitrate in urine. According to NICE, cefalexin is to be primarily provided as the urine culture has not yet been done to support management of infection along with increased fluid intake is to be promoted to be taken by the patients. The arrangement of social support along with education regarding care management for the acute disease is to be provided to Eliza as well as her mother and brother to avoid negative impact of the acute disease on them.

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