Pyelonephritis Case History Taking and Initial Care

 

History Taking and Initial Care 👀 Pyelonephritis – Check for fever and urination pain and monitor body temperature rise 👀 FEMORAL FRACTURE – Check accident progress and pain area, check blood pressure and pain score 👀 Pulmonic embolism – Check for shortness of breath and oxygen saturation 👀 Pneumonia – Cough, phlegm color change, body temperature, respiratory rate check 👀 Congestion heart failure (CHF) – Check swelling and shortness of breath, monitor weight change 👀 Myocardial infarction (MI) – Check the location and duration of chest pain, check blood pressure and heart rate 👀 Stroke – Check the time and speech impairment of symptoms, observe blood pressure 👀 Diabetic ketoacidosis (DKA) – Check thirst and frequency of urination, check respiratory rate (Kussmaul breathing) 👀 Sepsis – Check fever, history of infection, monitor changes in body temperature and heart rate

 

 

 

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Comprehensive Simulation Scenario for Nurse Training: Pyelonephritis Case History Taking and Initial Care

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Scenario Title: Thorough Patient Interview and Assessment for Suspected Pyelonephritis

Setting: Emergency Department / Outpatient Triage Room

Characters:

• Nurse (RN) – Assessment and education provider
• Ms. Sujin Kim (Patient) – Adult female, presenting with suspected pyelonephritis symptoms

 

 

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Phase 1: Patient Identification and Introduction

Nurse: Good morning, Ms. Kim. I’m the nurse who will be assisting you today. Could you please confirm your full name and date of birth?

 

Patient: Good morning. My name is Sujin Kim, and my date of birth is July 12, 1980.

 

Nurse: Thank you, Ms. Kim. I appreciate you coming in today. Before we begin, please know that everything we discuss

will be kept confidential. We’ll go through your current symptoms and relevant history to better understand what you’re experiencing and determine the appropriate next steps in your care.

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Phase 2: History of Present Illness (HPI)

Nurse: When did you first notice the symptoms you’re currently experiencing?

 

Patient: The fever and right-side pain started about three days ago. Then, I began to feel a burning sensation when urinating two days ago.

 

Nurse: How would you describe the pain during urination? Would you say it’s more of a burning or stinging feeling?

 

Patient: Definitely burning.

 

Nurse: On a scale from 0 to 10—where 0 means no pain and 10 means the worst pain imaginable—how would you rate your side pain and the burning sensation during urination?

 

Patient: The side pain is an 8, and the burning is about a 6.

 

Nurse: Have you noticed any changes in your urine, such as color, odor, or frequency?

 

Patient: Yes. My urine has become darker and has a stronger smell than usual.

 

Nurse: Do any actions or conditions make the pain worse or better?

 

Patient: The pain seems to worsen when I move around or drink less water. It gets a bit better when I lie down and rest.

 

Nurse: Where exactly do you feel the side pain, and is it continuous or does it come and go?

 

Patient: It’s on the lower right side of my back, and it’s mostly constant, though sometimes it becomes sharper.

 

 

 

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Phase 3: Past Medical History (PMH)

Nurse: Have you experienced any infections, surgeries, or hospital visits recently?

 

Patient: No surgeries or hospital stays recently, but I had a urinary tract infection about six months ago.

 

Nurse: Are you currently taking any prescription medications, over-the-counter drugs, or dietary supplements?

 

Patient: No, I’m not taking anything regularly.

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Phase 4: Family History (FH)

Nurse: Does anyone in your immediate family have a history of kidney conditions or urinary tract problems?

 

Patient: My mother had kidney stones last year. No one else in the family has had similar problems.

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Phase 5: Social History (SH)

Nurse: Do you smoke or drink alcohol? If yes, how often?

 

Patient: I don’t smoke. I drink socially—maybe once or twice a month.

 

Nurse: What is your occupation? Does your job require long periods of sitting or heavy physical activity?

 

Patient: I work at an office, so I sit for most of the day.

 

Nurse: Thank you for providing this information. It helps us evaluate your condition more thoroughly.

 

 

 

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Phase 6: Vital Signs Assessment

Nurse: I’ll now check your vital signs, starting with your temperature using a tympanic thermometer. I’ll gently insert the probe into your ear. Please hold still.

(The nurse gently pulls the ear upward and back and inserts the thermometer.)

 

Nurse: Your temperature is 38.6°C, which confirms that you have a fever.

 

Nurse: Next, I’ll measure your blood pressure. Please relax your arm on this cushion at heart level.

(The nurse wraps the cuff around the upper arm, inflates the cuff, and records the result.)

 

Nurse: Your blood pressure is 100/65 mmHg. That’s slightly on the lower side but not unusual during fever.

 

Nurse: Now I’ll check your pulse. Please remain relaxed while I take the measurement at your wrist.

(Nurse counts for 60 seconds.)

 

Nurse: Your pulse is 105 beats per minute, which is slightly elevated—this can occur with infection or fever.

 

Nurse: Lastly, I’ll measure your respiratory rate. Just breathe normally while I observe silently.

(Nurse counts chest rises for one minute.)

 

Nurse: Your respiratory rate is 22 breaths per minute, which is mildly elevated.

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Phase 7: Patient Education and Immediate Care Plan

Nurse: Based on your symptoms—fever, side pain, burning urination, and the changes in urine color and odor—as well as your elevated vital signs, we suspect an upper urinary tract infection, possibly pyelonephritis.

To confirm this, we’ll proceed with the following:

1. Blood Tests – These will check your white blood cell count, C-reactive protein (CRP), and kidney function markers like creatinine and BUN.
2. Urine Tests – A urinalysis and urine culture will help us detect the specific bacteria and determine antibiotic sensitivity.
3. Imaging – Depending on results, we may order an ultrasound or CT scan to check for kidney inflammation or obstructions such as stones.

We’ll also begin supportive care immediately:

• IV Fluids – To help maintain hydration and support your blood pressure.
• Antibiotics – Empirical intravenous antibiotics will be started right away while we wait for culture results.
• Pain and Fever Management – Acetaminophen or similar medications may be given to help control symptoms.

Nurse: While we manage your care, please avoid strenuous activity. Rest is essential. If your symptoms worsen—such as increased pain, nausea, vomiting, confusion, or difficulty urinating—notify us immediately.

 

Patient: Thank you for explaining everything so clearly. I feel more at ease now.

 

Nurse: You’re very welcome, Ms. Kim. We’ll begin the tests shortly and keep you updated on the results and treatment plan. If you have any questions or feel worse at any point, don’t hesitate to let me or any of the staff know.

 

 

 

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Learning Objectives for Nurse Trainees

• Conduct comprehensive, structured case history using MECE principles
• Identify hallmark symptoms of pyelonephritis and differentiate it from lower UTI
• Perform accurate vital sign assessments and interpret infection-related changes
• Provide empathetic, easy-to-understand patient education and reassurance
• Initiate appropriate tests and immediate supportive care for suspected pyelonephritis

End of Scenario

 

 

 

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Pyelonephritis Case History Taking and Initial Care