Sign and symptoms/Clinical presentation of disease process

The main clinical indications include a body temperature exceeding 38.9°C, blood in the urine, a burning feeling when peeing, an increased desire to urinate, and abdominal cramping (Suki & Massry, 2012). Additional symptoms include right-sided non-radiating flank pain, a loss of appetite accompanied nausea, and vomiting.

The respiratory and pulse rates were both within the normal range. The fact that the kidney infection has no effect on the functioning of the cardiovascular and pulmonary systems justifies the outcome. The blood pressure was below the standard range of 120/80-140/90, as pyelonephritis shocks the osmoregulation process, resulting in decline. The septic shock is a classic sign of the infection, where pyelonephritis causes delirium, shivering, as well as significantly low blood pressure (Schrier, 2010).

Testing

The physical exam is one of the most important testing approaches in pyelonephritis, with blood pressure, body temperature, and abdominal examination being critical indicative elements. For instance, in positive diagnosis, the systolic output should be below 90mm/Hg. Temperature measure is also vital, as pyelonephritis is symptomized with a temperature above 39.4°C. Abdominal examination also determines the clinical position, where costovertebral angle tenderness in reported in the event the patient is suffering from pyelonephritis (Caughey, Lyell, & Tran, 2005). A pelvic exam is also vital, where the suspicion is based on adnexa and unilateral discomfort over the cervix and uterus.

Laboratory tests are also necessary in the investigation, where culturing and urinalysis are the most important tests. The latter tests presence of nitrites while bacterial culture seeks to confirm the presence of uropathogens that infects the parenchyma and renal pelvis such community-acquired E.coli, including atypical causes such as Pseudomonas and Enterococcus (Ronald, 2002).

Imaging studies

Radiology has a limited role in diagnosing pyelonephritis among adults. Nevertheless, CT scan finds tremendous applicability in pediatric tests, as the minors are unable to narrate the experiences. The relevance of imaging is critical considering the classic triads of nausea and vomiting, fever, and costovertebral angle pain is the most significant element in case-conceptualization. CT scan investigates signs of hematogenous and tubulointerstitial changes, especially edematous development in the parenchyma and renal pelvis (Craig, Wagner, & Travis, 2008).

Differential Diagnosis

Differential diagnoses include endometritis, acute cystitis, cervicitis, urethritis, ovarian cyst, appendicitis, ectopic pregnancy, and pancreatitis. The choice is based on shared clinical symptoms, where the diseases are manifested by fever, nausea, and vomiting. Lab results also show clumps of white blood cells in some ailments, an issue that is confirmed by a common source of non-radiating pain.

Final Diagnosis

The final diagnosis is pyelonephritis, a conclusion that was evidenced by the classic triad of worsening right flank pain, fever, nausea and vomiting (Craig, Wagner, & Travis, 2008). While the symptoms are shared by other ailments, risk factors such as sexual behavior and familial predisposition helping in confirming the diagnosis.

Management

Pharmacologic

Pharmacological intervention entails giving the patients broad-spectrum combination of ampicillin and an aminoglycoside. In the event the clinician suspects E Coli, the empiric therapy should involve oral drugs such as ciprofloxacin or co-amoxiclav (Colgan, Williams & Johnson, 2011). The antibiotics regimen has proved an effective first-line treatment in a number of community-acquired uropathogens, including atypical causes such as Pseudomonas and Enterococcus (Ronald, 2002). In the event pyelonephritis is a recurrent infection, the management should also include treating risk factors that are increasing the vulnerability. For instance, hypertension should be managed by an angiotensin-converting enzyme (ACE) inhibitor drug prescription such as Delapril and Quinapril (Finkel, Clark, & Cubeddu, 2009). Urinary tract infection should be treated by integrating routine course antibiotics into the regimen.

Non-pharmacologic

Non-medical approaches help in reducing the risk of bacteria infecting the urinary tract as well as reoccurrence. For instance, the drug therapy should be complemented by patient education, where the patient should be advised on drinking plenty of fluids and avoiding irritants such as spray among other gynecological products that can irritate the urethra.

Education

The patient should also be educated on prevention tips, such as urinating after sex to flush out pathogens as well as wiping from front to back to prevent the spread of fecal bacteria to the urinary tract in women (Crutchlow, Dudac, MacAvoy & Madara, 2002). Lifestyle modification is also another non-pharmacological intervention, where advising patients to reduce the number of sexual partners or using protection helps in offsetting the risk of recurrence.

II. Disease Background

Anatomy -The uropathogens infects the parenchyma and renal pelvis in the kidney as well as the urethra.

Etiology- While pyelonephritis is a blood-borne condition as well as an inflammatory disorder caused by bladder outflow obstruction, it is also a communicable disease spread through hygienic and sexual behaviors.

Pathophysiology -

Consequences: adult and Geriatric: Pyelonephritis results in a myriad of renal complications among adults and elderly patients.

Epidemiology - While the specific statistics has not been documented, pyelonephritis significantly contributes to the burden of diseases where urinary tract infections account for over 7 million cases, and 1 million emergency department visits every year (Craig, Wagner, & Travis, 2008).

Prognosis - Untreated cases of pyelonephritis advance to other urogenital conditions, including renal failure.

Patient Education - The attitudinal causal factors make education a critical cog in the main course treatment

III. Treatment Evaluation

Approach Considerations

Guidelines and literature referenced - role of risk factors such as familial links and blood pressure

Complications - Antibacterial resistance calls for multidrug therapy

Health promotion and risk reduction - Role of public health intervention such as hygienic and sexual practices

Medicolegal Concerns - Refusing to reveal the condition to sexual partners

Future Research needed -

Consultation: Engaging the patient on allergenicity and known adverse effects of using antibiotics

Long term monitoring - Screening of other diseases, including hypertension

Ethical and cultural consideration - Cultural dimension especially when the ailment is arising from irresponsible sexual behavior.

Cost - Treating community-acquired uropathogens with antibiotics is a low-cost intervention

IV. Critical Reflection of interaction and investigation.

While prompt treatment is essential, there is a need for understanding predisposing factors, including the risk of spreading uropathogens to sexual partners. The vulnerability of reoccurrence also makes case conceptualization critical, where the management process is an entirety comprising pharmacological and non-pharmacological interventions, as well as follow-up of the patient.

V. Test questions based on objectives and presentation

Learning Objectives

Understanding clinical presentation

Understanding the predisposing factors

Matching Questions

How would you rate the degree of discomforts coming from the suprapubic area on a scale of 1 to 10?

Do you know any member of your family who ever suffered from a kidney ailment?

How regularly do you smoke and take alcoholic drinks?

Have you ever been diagnosed with a UTI?

Have you been screened for type-2 diabetes and cancers of the urogenital track?

References

Colgan, R., Williams, M., & Johnson, J. R. (2011). Diagnosis and treatment of acute pyelonephritis in women. American family physician, 84(5).

Craig, W. D., Wagner, B. J., & Travis, M. D. (2008). Pyelonephritis: radiologic-pathologic review. Radiographics, 28(1), 255-276.

Crutchlow, E. M., Dudac, P. J., MacAvoy, S., & Madara, B. R. (2002). Pathophysiology. Jones & Bartlett Learning.

Finkel, R., Clark, M. A., & Cubeddu, L. X. (Eds.). (2009). Pharmacology. Lippincott Williams & Wilkins.

Ronald, A. (2002). The etiology of urinary tract infection: traditional and emerging pathogens. The American journal of medicine, 113(1), 14-19.

Schrier, R. W. (Ed.). (2010). Renal and electrolyte disorders. Lippincott Williams & Wilkins.

Suki, W. N., & Massry, S. G. (Eds.). (2012). Therapy of renal diseases and related disorders. Springer Science & Business Media.