Acute Pyelonephritis and Diabetes Mellitus: A Case Study

Running head: CASE STUDY NMIH308
CASE STUDY NMIH308
Name of the Student
Name of the University
Author Note

CASE STUDY NMIH3081
Part 1
"Levett-Jones (2017) introduced the clinical reasoning cycle as having eight stages:
look, collect, process, diagnose, plan, act, evaluate and reflect. This report will analyse the
key issues that contributed to the critical incident of the case study using the initial four
stages of Levett-Jones’ (2017) clinical reasoning cycle."
Patient situation
In the case study the patient whose name is Mrs. Jones had been admitted to local
emergency department with flank pain, high pyrexia and dysuria. Mrs. Jones had a known
history of type I Diabetes Mellitus. She had also been suffering from acute pyelonephritis.
Mrs. Jones was given intravenous antibiotic in order to manage acute pyelonephritis. Polyuria
had also been seen in Mrs. Jones. During her stay at emergency department it was reported
that her fluid output was 1.7l. Her core body temperature was 38.3 degree Celsius. The
patient had low blood pressure of around 105/60 (Hypotension). Her heart rate was around
108 (tachycardia). The patient had a normal oxygen saturation level of around 97%. Her
respiratory rate was 21 (normal). However, high blood sugar level was observed which is 9.4
mmol/L.
Cues/Information
According to the case study RN Cameron was an experienced nurse who had been
working on a 16-bed medical ward along with a newly graduated nurse RN Grace. Later
again Mrs. Jones was observed by RN Cameron and it was observed that her core body
temperature was 38.8 degree Celsius. The patient’s (Mrs. Jones) respiratory rate increased
rapidly. Respiratory rate was around 29. Tachypnoea was observed. Her blood pressure was
also reduced to 89/40 (severe hypotension). Oxygen saturation level also decreased to 95%.
Mrs. Jones was also remained polyuric throughout the night. RN Cameron stated that his all

CASE STUDY NMIH3082
three patients were restless overnight (Mrs.Jones and other two male patients). Next day
morning, the morning RN observed that Mrs. Jones was pale and difficult to rouse. At that
time her core body temperature was 39.4 degree Celsius, her heart rate increased to 156 bpm
(severe tachycardia). Mrs. Jones was also suffering from severe hypotension (BP 65/36). Her
blood sugar level was around 33.4 mmol/L (Hyperglycaemia). Most notably her oxygen
saturation level dropped to 90%.
Process information
Considering all the information it can be clearly stated that the patient (Mrs. Jones)
was suffering from severe acute pyelonephritis. This is basically an ascending urinary tract
infection (observed in ascending urinary tract) caused by bacteria. It produces severe
inflammation in the kidney of the affected patient. Considering the fact that the patient had a
known history of type 1 Diabetes Mellitus, she was given Lantus and Novarapid immediately
after admission. In spite of giving these two medications to control the blood glucose level
her blood glucose level was 33.4 mmol/L.
Identification of problems/issues
As the patient was suffering from acute pyelonephritis the development of
hyperglycemia in patient is quite obvious. Elevated core body temperature, tachycardia and
tachypnea were the common symptoms in the patient suffering from acute pyelonephritis.
One of the common symptoms of acute pyelonephritis is dysuria and in severe cases it
worsened to hematuria. In the case study, it was observed that the blood pressure gradually
reduced to 89/40 from 105/60. This clearly indicated that huge amount of blood loss (may be
through urine- hematuria) occurred in the patient. As a consequence, hypovolenic shock was
developed. The hypovolemic shock in turn produced a pathological change in the body that in
turn affected the normal tissue function. As a result sepsis developed in the patient. So, acute