An Essential Test and the Toxicity or Efficiency of the Drugs - Case Study Example

Leroy Case Study

Primary Diagnosis: Pyelonephritis

Pyelonephritis is an inflammation of the kidney which mostly occurs as a result of a bacteria that find their way to the kidney. It is a life-threatening condition that causes hospitalization among various population groups who are at risk; especially when it is left untreated for a long time (Matsushita et al., 2017). For bacteria to penetrate up to the kidney, the patient becomes susceptible to kidney stones. The infection begins as a urinary tract infection whereby the causative bacteria migrate to the upper urinary tract structures due to failure to receive effective treatment. Just like UTIs, improper treatment could lead to recurrent attacks; hence such a patient is said to have developed chronic pyelonephritis. However, the chronic form of the disease rarely occurs; with only a few cases occurring in children and people who have urinary obstructions (Chick et al., 2017).

Bacteria that cause pyelonephritis reach the kidney especially when there is a reflux of urine from the bladder during micturition; a condition referred to as vesicoureteral reflux. Bacterial infection could affect both or one of the kidneys hence intense examination is needed to ascertain the severity (Dharmarajan et al., 2017). During the inflammation, the pelvis, calyces, and the medulla are affected. Patients are also at risk of developing kidney stones because the bacteria break down urea to form ammonia, which makes urine alkaline (Raphael, Carroll, Murray, Greene & Beddhu, 2017). If left untreated, the inflammation could become severe and cause localized abscesses in the medulla as well as the cortex. Although healing may be successful, scarring occurs, and the affected tubule also atrophies.

Some of the main symptoms associated with this condition include fever, burning sensation during micturition, cloudy urine, and pain which is felt in the abdomen, back, groin, or side. Leroy has presented with the fever and costovertebral angle (CVA) tenderness on his right side; which are indicative of pyelonephritis. Confusion and impaired judgment are also symptoms associated with older adults with pyelonephritis. CVA tenderness is very significant when diagnosing for an infected kidney. This area is located on the back at a point in between the 12th rib and the vertebral column. Both kidneys are positioned below the CVA along the lumbar vertebra. Since the kidneys are located on both sides of the spine and below the CVA, pain or tenderness will be felt when the CVA is tapped in case the client has a kidney infection. Other tests that can be done to ascertain pyelonephritis include urine tests which screen for bacteria types, urine concentration, blood, and pus in the urine. Additionally, imaging techniques such as X-rays or ultrasounds are useful in checking for cysts, malignancies, or any other substance causing obstructions in the urinary tract. Radioactive imaging is effective in checking for scarring effect of pyelonephritis.

Treatment of pyelonephritis involves the use of antibiotics which target the specific causative bacteria. Therefore, it is necessary that urine samples are taken to identify the specific bacteria after which sensitivity tests will suggest the best antibiotic alternative. However, if identification cannot be done, then broad-spectrum antibiotics can be used to clear the bacteria. For instance, levofloxacin is a quinolone that is active against both Gram positive and Gram negative bacteria through the inhibition of type II topoisomerase enzymes. This mechanism blocks bacterial division because both separation and supercoiling of replicated DNA do not occur. The antibiotics should be taken for the entire prescription period which could be 10-14 days even when symptoms diminish to minimize risks of resistance (Raphael et al., 2017).

Other Diagnoses

Urolithiasis

It is a condition in which some urine components solidify and get deposited in the kidney or the entire urinary tract. This effect results from the role of the kidney in filtering blood to remove metabolic wastes which are excreted in urine. In some people, an anomaly occurs whereby some mineral components in the urine crystallize and form kidney stones (Chick, Reddy, Yam, Kobrin & Trerotola, 2017). These crystals are those of calcium, uric acid, and oxalate. If they are small, they may be passed with urine while the large-sized ones get stuck in the kidney. These stones in the kidney are the cause of inflammation or irritation which cause the manifestation of symptoms; some of which have been presented by Leroy. For instance, just like Leroy, patients with kidney stones suffer from CVA tenderness. Other symptoms exhibited by patients with kidney stones include frequent urination, burning sensation during urination, and production of urine with a red or brown color. A sonogram of the kidney, ureter, and bladder can be done to ascertain this infection. Urine culture and urinalysis are also useful tests in checking for hematuria and acidity while a complete blood count which reveals elevated levels of WBCs could be indicative of infection. Intravenous pyelography can also be used to visualize the size and position of the position of the stone as well as its effect on urine flow (Chick et al., 2017). If the stones are large and highly obstructive, it is necessary to consider an invasive surgical technique in the management plan.

Trauma

This diagnosis is based on the emotional disturbances that Leroy demonstrates, and they could be due to the events that have occurred in his life. For instance, he no longer lives with his children, yet they could be a source of comfort after losing his wife. Trauma is an emotional response and may be based on flashbacks which bring about unpredictable reactions (Dayton et al., 2016). Leroy could be experiencing a sense of denial since his children live out of state and he is under the care of a CNA who is not always with him to help him manage his emotions.

Discussion Part Two

The primary diagnosis at this point is influenza pneumonia which is a very contagious viral infection. Infection from one person to the other occurs easily through the air especially when an infected person coughs or sneezes (Nikolaidis et al., 2016). The pathology is observed through an inflammation caused in the lungs because pus and other fluids fill up the air sacs hence preventing the free flow of oxygen to reach the bloodstream (Halstead et al., 2016). Lack of enough oxygen circulation in the body leads to other detrimental effects which could also cause death. The population groups that are at risk of developing pneumonia as a result of influenza include children, pregnant women, and the elderly whereby Leroy is included. He also presents with classic symptoms of influenza infection such as fever and tachypnea. Rapid breathing occurs in a bid to mitigate effects of inadequate oxygen that is available for body cells (Nikolaidis et al., 2016). Tests that can be used to identify the virus include viral cultures as well as specific viral antigen detection. Management strategies involve rest and administration of oxygen, antipyretics, and analgesics with close observation of the patient in a ventilated room. Amantadine hydrochloride and rimantadine hydrochloride are effective prescriptions against influenza pneumonia since they aid in the prevention of air sac obstruction (Ishiguro et al., 2016).

Discussion Part Three

GFR is an essential test that reveals the state of renal function in filtering blood hence it can be used to determine the stage of a patient’s kidney disease. It is calculated from the results of the amount of creatinine in blood, and can also be estimated from one’s age, body size or gender. A low GFR value signifies that the kidneys are not working efficiently hence planning for treatment needs to commence. Although this value declines with age, the normal range for a healthy adult should be above 90. However, for Leroy’s case, it is very low since it is roughly 40mL/min. The loss of renal function for his case is due to the kidney infection. However, it can also be caused by other factors such as hypertension and diabetes mellitus (Wanner et al., 2016). Since kidney disease affects the blood pressure (Bansal et al., 2016), Leroy needs also to be put on ACE inhibitors such as captopril in addition to the kidney disease drugs. These drugs are highly beneficial since they not only lower blood pressure but also minimize the amount of protein present in urine (Bansal et al., 2016). Toxicity levels will be evaluated by their elimination rates which are determined by frequent blood level measurements. Their efficiency will be based on their ability to lower blood pressure as well as reducing creatinine levels in urine. Therefore, these tests are essential in determining the toxicity or efficiency of the drugs.