Indiana University Northwest

School of Nursing
NURS B261Pathophysiology and Pharmacology for Nursing Practice
Case Study #1

Objectives
1. Discuss select pathophysiologic concepts across the lifespan and apply common
pharmacological interventions used in their treatment.
2. Identify therapeutic effectiveness, common and life-threatening side effects, critical
monitoring, and adverse reactions of various pharmacological agents.

Complete the following sections using information from Rosenjack-Birchum & Rosenthal (2019)
(specifically information in chapter 89 as well as chapter in ATI online study guide. You will
also need to use a laboratory and diagnostics manual and your drug guide to complete the lab and
diagnostics section.

History of Present illness:

S. G. is an 87 year-old female who lives independently in a retirement community. She is
widowed with 2 daughters who are active in her life. She has been experiencing an increasing
fatigue over the past 3 days and has had a fever for the last 24 hours. She reports a painful,
burning sensation when she urinates as well as increased frequency of urination. It has been over
90 degrees outside this week. She usually drinks 2-3 cups of water per day and a glass of tea. Her
daughter became concerned today when the patient became increasingly confused and
experienced mental status changes.

Past Medical History:

Patient has a history of hypertension and hyperlipidemia

Home Medication Chart:

ASA 81mg PO Daily
Simvastatin 20mg PO Daily
Metoprolol 25 mg PO BID
Lisinopril 10mg PO Daily
Furosemide 20mg PO Daily

Laboratory and Diagnostic Results (Indications):

CBC (complete blood count):

WBC 12,000 (5000-10,000)

Urinalysis:
Positive for Bacteria
Positive for WBCs

Urine Culture:
Positive E. coli
Current Assessment data:
VS
T: 101.6
P: 96
BP: 147/89
R: 22

Diagnosis: Urinary Tract Infection (UTI)

Current Medical Orders:

1. 0.9 Normal Saline 1000mL. Infuse at 83mL/hour

2. Sulfamethoxazole/Trimethoprim 600mg PO BID
3. Oxybutynin 5mg PO BID
4. 2gm Low Sodium Diet as tolerated
5. Ambulate patient at least TID
6. Continue home medications
7. Tylenol 325mg 1-2 tabs PRN Fever or Pain

What data from the history is relevant. Why is it clinically significant?

Relevant Data from patient present problem Clinical Significance (Cite sources)
Fever for the last 24 hours (T:101.6) Clinical manifestations include fever, chills,
severe flank pain, dysuria, urinary frequency,
urinary urgency, pyuria, and, usually,
bacteriuria.
Lehne, R. A. (2010). In Pharmacology for nursing care (10th ed., pp. 1077–1077). essay,
Saunders/Elsevier.

WBC 12,000 Patient has an high white blood cell count which could indicate inflammation and/or
infection.
Bladh, M. L. (2019). In Davis's Comprehensive Manual of Laboratory and Diagnostic
Tests with Nursing Implications (8th ed., pp. 370–371). essay, FA Davis Company.
Positive E. coli Among older women in nursing homes, between 30% and 50% have bacteriuria
Positive for Bacteria E.coli accounts for more than 80% of UTIs.
Lehne, R. A. (2010). In Pharmacology for nursing care (10th ed., pp. 1076–1076). essay,
Saunders/Elsevier. 

Altered Mental Status Ackley, B. J., Ladwig, G. B., Flynn, M. M. B., Martinez-Kratz, M. R., & Zanotti, M.
(2020). In Nursing diagnosis handbook: an evidence-based guide to planning care (12th
ed., pp. 118–118). essay, Elsevier.

Current pathophysiologic process (Cite your sources):

UTIs are caused by a bacterial infection of the upper or lower urinary tract. Infections may be
caused by one or multiple organisms. Bacterial organisms invade the tissues of the urinary tract
and cause inflammation. Without treatment, the infection can travel up the urinary tract from the
urethra to the bladder, and then the kidneys. Infections of the bladder and urethra are lower tract
infection, while infections of the kidneys are classified as upper tract infections. UTIs can either
be uncomplicated or complicated. Uncomplicated UTIs are more common in women of
childbearing age, while complicated UTI’s occur in both men and women who usually have
predisposing conditions such as an indwelling catheter. Those who have urinary tract infections
may experience pain, fever, chills, increased frequency in urination, and dysuria (Lehne, 1076).
Usual Clinical Presentation (what does a UTI usually look like)/ make comparison with current
patient presentation (Cite your sources):
Clinical presentations of uncomplicated UTIs include dysuria (painful urination), urinary
urgency, pelvic discomfort, pyuria, increased urinary frequency, and bacteriuria. Uncomplicated
UTIs that have infected the kidneys (acute uncomplicated pyelonephritis) include the previously
listed symptoms and additions of a fever, chills, and flank pain. Complicated UTIs manifest in
systemic illness, fever, bacteremia, and at times septic shock.
The patient has the following manifestations of fever, dysuria, pyuria, bacteriuria, and
increased frequency of urination. Compared to the above clinical manifestations, I would assume
the UTI has reached her kidneys and she is presenting symptoms for acute uncomplicated
pyelonephritis.

Tests (labs, radiography, etc.) commonly used to diagnose this problem/ make comparison with
how this patient was diagnosed (Cite your sources):

Medications commonly used to treat this problem/ make comparison with how this patient is
being treated (Cite your sources):

Complete the Following chart for all of the patient medications: (home medications and ordered
medications)

Medication Medication Class/Actions Side Effects/Nurse Why is this patient

Measures taking this drug?
Therapeutic Use.
Sulfamethoxazole/Trimethoprim Sulfonamides Infection
Oxybutynin Anticholinergics/antimuscarinic Frequent urination
s
Tylenol Anti-pyrectic/non Opiod Nausea, loss of Pain and fever relief
analgesic appetite, abdominal
pain, itching, rash,
headache, dark urine,
clay colored stool, and
jaundice
Simvastatin HMG-CoA Reductase inhibitor Headache, insomnia, High cholesterol
flushing muscle aches,
NV, abdominal pain
Metoprolol Beta Blockers Bradycardia, High blood pressure, heart
weakness, orthostatic failure, and chest pain
hypotension,
headaches, GI Upset
Lisinopril Ace inhibitor Dry mouth, cough, High blood pressure and
fatique, dizziness, heart failure
headache, hypotension
Furosemide Loop Diuretics Hyponatremia,  Fluid retention
hypokalemia, thirst,
 headache, hypotension
Case Study #1 Grading Rubric

Case Study Component Possible Points Student Points

Clinically relevant data is 10 points
presented, clinical
significance is correct and
sources are cited (in text and
in the reference list).
Pathophysiology is presented, 10 points
is correct, and sources are
cited (in text and in the
reference list).
Usual clinical presentation is 10 points
completed, sources are cited
(in text and in the reference
list), and comparisons are
made with current patient.
Tests commonly use to 5 points
diagnose this problem are
completed, sources are cited
(in text and in the reference
list) and comparisons are
made with current patient

Medications commonly used 5 points

to treat this problem are
completed, sources are cited
(in text and in the reference
list) and comparisons are
made with current patient. 10 points total
Medication chart is 10 points
completed, correct and
sources are cited (in reference
list, in text if multiple sources
are listed).
Total 50 POINTS