Pathophysiology Concept Map for Nursing Students

Patient Profile
23 year-old female
present herself to the
family health clinic with
while voiding
Assessment
Diagnostic testing
Differentia Diagnoses
Treatment
Follow-up
Vital Signs: BP 138/88, HR 118, T 38.9C, RR 20, 02sat 98% on RA
Pain assessment: Onest of pain started this mprning; localized as falnk pain with
7/10 intensity, pain while voiding, denies headache
Skine assessment: Patient flushed and hot to tuch; no abnormalities or discoloration to skine
Respiratory assessment: tachycardic, S1 S2 sounds present, peripheral pulses equal and 4+
Abdominal assessment: Abdoment soft with slight lower tenderness, no gurding.
Noted costoverterbral angle tenderness to mleft flank area. Question nausea or vomiting
Neurovaslscular Assessment: Alert and oriented but feels less energetic and fatigued
Urinary Assessment: Query dysuris, polyuria and other issues with frequency, nocturia or urgency
Reproductive Assessment: Query porential pregnancy
Physical Assessmet
CBC with differentials
E/U/c, and C&S
Urinalysis
(including Urine Dipstick)
Assesses the cells, electrolytes, and chemical constituents (urea and creatinine to mesure kidneyt funcation) that circulate in the blood and identifies the presence os
microorganisms
Normal CBC finding for females inculde RBCs 4.0 - 5.2 x 10^12/L;
WBCs 4- 10 x 10^9/L;Hgb 123-157g/L;Hct 0.370 - 0.460; plt 130 - 400x
100^9/L; and absence of microorganisms
Normal E/U/C finding for females include Na 1356 -, k 3.5-5.0 Ca 2.18-2.58,
p 0.8-1.5, Mg 075-0.95; Bun 2.5-8.0 mmol/L; and Creatinine 50-90 mmol/L
Findings commonly associted with a UTL include increased WBCs and persence of E. Coli
Patient History
Frequent UTIs strarting at the age of 18
Patient explains that the pain is the worst she has ever experienced
Has been taking Advil every 8 hours; most recent dose taken yesterday
No known druge allergies
Findings commonly associted with UtIs include; unpleasant smell, pH>8.0, increased WBCs, presence of casts (moulds of renal tubules and may contain protein, WBCs,RBCs, or bacteria) and a bacteria count>105/mL
Normal findings in a urinalysis include amber yellow, aromatic urine; protein <0.15g/day; absence of glucose, ketones, Bilirubin, and casts; specific gravity of 1.005-1.030; pH 4.6-8.0; RBCs 0-4 and Wbc 0-5 per high-power field.
Includes description of appearance; amell; specific gravity; PH; presence of glucose, nitrates, ketones and protein; examination of urine sediments for red and white blood cells, crystals and casts
Examiniton of the urine for either routine or microsocopic studies to provide baseline information or about possible abnormalities
Urine Cultures
REnal, Bladder, and Pelvice
Ultrasound/CT Scan
Additional evalution in urinalysis that identifies presence of organisms in the bladder; frequently to determine causative organisms in suspected UTIs
Normal finding for this diagnostic tool include the absence of organisms in the urine
Finding commonly associted with UTIs include the presence of E. coil, enterococci, Klebasiella species, Proteus species, and streptococci
Provides visualization of kidneys, bladder and repoductive organs to dect cyst, tumours, masser, abscesses, and/or obstruction
Utilized when obstruction in the urinary system is suspected, hematuria after tretment of urinary tract infection, or unxplainable pelvic or flank pain
Renal Calculi
UTI
Ovarian Torsion
Suspected Diagnosis:
Pyelonephritis
Risk Factors
Kidney stones (polycrystalline aggregates) causing urinary tract obstruction
S/S:
Renal Colic pain: actue, excrucitating flank and upper abdominal quadrent pain of effected side. Pain radiating to lower abdominal quadrant, balder area, perineum. Skin may be cool and clammy. Nausea and vomiting may be common
Reasons to suspect: Actue lower abdominal tenderness. Unilateral sodtavertebral angle tenderness
Reasons to rule out : Skin is hot and flush, no nauses or vomiting
Bascteria infection in any part of the urinary system (kidneys, ureters, bladder and urethra).
S/S: urinary frequency, lower abdominal or back discomfrot, burning or pain on urination (dysuria), cloudy/foul smelling urine. In adults, fever and other signs of infection are absent
Resons to supsect: pain on urination, lower abdominal tenderness, Hx of previous UTIs,3+ Leuks, positive nitrates
Reasons to rule out : Febrile, Tachycardic, Hypertensive, low energy and fatigue, hot and flush skine, left-sided costoverebral angle tenderness
Rotation of ovary at its pedicle, occluding the ovsrisn srtery and/or vein.
S/S: Sudden onset of sharp, unilateral lower abdominal pain. Nasusea and vomiting/S:
Resons to supspect: Lower abdominal pain, Nause and vomiting
Reasons to rulr out: Fever, Dysurea, CVAT
Infection of the kidney parenchymal and renal pelvis
Acute S/S: abrupt onset of shanking, moderate to high fever, consant ache in the loin area of the back, lower urinary tract symptoms (dysuria, urgency, frequency) significant malasis, nausea and vomiting, unilateral costovertebral angle
tenderness, and pyuria
Chronic S/S: same as acture or may have insidious onset.Often history of recurrent episodes of UTI or actue pyelonephritis. Polyuria and nocturia and mild protrinuria. Hypertension not a symptom but a cause.
Reasons to suspect: febrile, dysuria, malaise, unilateral costovertebral angle tenderness, pyuria
Reasons to suspect Chronic: History of several UtIs, Hypertension
Pathophysiology: E. Coli (common pathogen causing UTi) experess febrea projection that help them adhere to surfaces.Thes projections help them adhere and climb the urethra. E.Coli ascend urethra and the bladder. In the bladder, the bacteria colonize and cause infection and cause infectiion. Therefore,Pyelonephritis commonly occure secondry to lower UTI.
Obstructive abnormalities: Anatomic abnormality, Kidney stones, BPH
Vesicoureteral reflux: Ureter enters the bladder at apporoximate right angle, forcing urine back into bladder during micturation. This is a common cause of chornic UTI/pyelonephritis in young patients
Functional abnormalities: neurogenic bladder, detrusor muscle instabillity, sonstipation
High blood pressure
Risk factors present in the patient: potentially refiex (due to chronic UTIs at a young age) and HTN
Nursing management
Medical Management
Outpatient management or short-term
hospitalization for IV antibiotics
Trear fever as directed to redyce systemic inflammation
SBBAR communication
Collect urine culture and sensitivity, and urinalysis as this will
indicate the bacteria causing the infection
Collsborate with medical team for treatment instructions
Monitor input and output, as this can indicate the concentration
of urine and renal and renal tubular funcation
Ongoing monitoring of VS and neuro status
Provide comfrote and ressurance
Adivse patient she may need to go to hospital, as pyelonephritis may
involve multiple pathogens that can be resistant to common antibiotic
treatment
Adequate fluid intake
NSAID or antipyretics
Urine analgesics (phenazopyridine [Pyridum])
Follow -up urine culture and imaging studies
Broad spectrum antibiotics (ampicillin or
vancomycine combined eith aminoglycoside
such as tobramycine)
Switch to sewnsitivite guided therapy when C/S
results are available, for 14-21 days
Trimethoptim-sulphamethoxazole (ex. Septra)
Fluoroquinolones (Ciprofloxacin, norfloxacine)
Helath Teaching
Continuous
prophylaxis
Urology
Referral
Swtiching to a non-invasive method of
contraception
Urinationg after intercourse
Adequate hydration
Wiping front to back
Voiding promptly after feeling the urge
Avoid tight-fitting underwear
Avoid douching
Low-does antibiotic use
Post-coite antibiotic use
Estrogen therspy via cream
Short trem use of methenamine salts
Renal ultrasound
Intravenous pyelography
CT scan
MRI
Cytomography
Noncolicky pain: Mild-severe, Dull, deep ache in the flank or back, exaggerated when drinking large amounts of water
Pathophysiology Concept Map
By: Zico Marsongko, Margaret Stoesser
Julia Coffin, Erika Bautista, Trisha Melnik
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