SEPSIS, RESOLVED,

SECONDARY TO ACUTE
PYELONEPHRITIS DM TYPE 1,
POORLY CONTROLLED NON-
ALCOHOLIC FATTY LIVER
DISEASE
 members
AQUILLO, NATHALIE B. PACIS, MA LUISA XEENA F,

BORJA, DESIREE LYN T. SALVADOR, ERIKA JHANE O.

CRISTOBAL, MICA DIANE C. SINFUEGO, LEI JUSTINE A.

DANCEL, SHEYDEN D. TOLENTINO, ROEL T.

GALANO, SHAINAH REIGN T. TOMAS, SHERYLLE JOYCE Z.

MAQUIRAYA, BRITTANY LEI

a. overview of the background of the case
• A 24- year-old female patient identified as PRF, presented to
Laoag City General Hospital on October 16, 2023, with a chief
complaint of fever and lower back pain. Dr. Helen Catcatan,
the admitting physician, conducted an initial evaluation and
preliminary diagnosed PRF with acute pyelonephritis based
on their symptoms.

• Further diagnostic tests confirmed the diagnosis of sepsis

resolved, secondary to acute pyelonephritis.

• The patient voluntarily consented to participate in a case

study to contribute to the advancement of nursing knowledge
and skills.
B. PERTINENT OF INFORMATION
Name: Princess Reynita G. Fernandez
Age: 24 y/o
Address: Brgy #30-B Sta Maria Laoag City, Ilocos Norte
Date of Birth: September 24, 1999
Birthplace: Laoag City
Nationality: Filipino
Status: Single
Religion: Roman Catholic
Occupation: Student
Admitting Diagnosis: To consider acute pyelonephritis
Final Diagnosis: Sepsis, resolved, secondary to pyelonephritis,
DM Type 1, Poorly Controlled, Non-Alcoholic Fatty Liver Disease
Admitting Physician: Dr. Helen Catcatan
C. READINGS
I. DIABETES MELLITUS TYPE 1
• Type 1 Diabetes Mellitus is an autoimmune condition that destroys
insulin-producing cells, leading to an inability to regulate blood
sugar. Individuals with Type 1 Diabetes require lifelong insulin
replacement and careful management to prevent complications.
GLOBAL
• In 2017, there were an estimated 234, 710 new cases of type 1
diabetes worldwide.
• Nearly half of these new cases occured in people under the age of
15.
• Diabetes was the direct cause of 1.5 million deaths in 2019.
C. READINGS
NATIONAL
• As of 2019, 3.99 million out of 63.26 million Filipino adults has
diabetes.
• Diabetes was the fourth leading cause of death in the Philippines in
2020.

LOCAL
• As of November 17, 2022, there were 8, 539 cases of diabetes
mellitus in the province of La Union.
C. READINGS
RISK FACTORS CLINICAL MANIFESTATIONS
• Family History • Polydipsia
• Age • Polyuria
• Polphagia
• Weight Loss
CAUSES • Fatigue
• Genetics
• Autoimmune Factors
• Environmental Triggers
• Early Diet and Environmental
Exposures
C. READINGS
COMPLICATIONS:
• Diabetic ketoacidosis
• Hypoglycemia
• Artherosclerosis
• Diabetic microangiopathy
• Diabetic nephropathy
• Diabetic neuropathy
• Diabetic retinopathy
• Infections
PHARMACOLOGICAL MANAGEMENT
- The primary treatment for Type 1
Diabetes Mellitus (T1DM) is insulin
therapy.
• Rapid-acting insulin
• Short-acting insulin
• Intermediate-acting insulin
• Long-acting insulin
• Insulin pumps
• Hypoglycemic agents
• Aspirin
C. READINGS

MEDICAL MANAGEMENT SURGICAL MANAGEMENT

• Nutritional management • Pancreas Transplantation
• Exercise • Islet Cell Transplantation
• Regular monitoring • Amputation
• Education and Support
• Glycosylated Hemoglobin
• Serum Electrolytes Levels
 C. READINGS
NURSING MANAGEMENT
1. Provide information on insulin administration, blood glucose monitoring, carbohydrate
counting, meal planning, recognizing and managing hypoglycemia/hyperglycemia, and
foot care.
 To understand the condition, its management, and how to make informed decisions
regarding insulin administration, diet, exercise, and monitoring.
2. Educate on the importance of adhering to prescribed insulin regimens, proper storage
of insulin, and the significance of timing and dosage accuracy.
 Ensures consistent insulin therapy, which is crucial for maintaining stable blood sugar
levels and preventing complications.
3. Collaborate with dietitians to develop personalized meal plans, educate on
carbohydrate counting, healthy food choices, portion control, and the effects of different
foods on blood sugar levels.
 A balanced diet plays a significant role in glycemic control and overall health for
individuals with T1DM.
C. READINGS
NURSING MANAGEMENT
4. Teach individuals how to use glucometers or continuous glucose monitoring
systems,
interpret results, and take appropriate action based on blood glucose readings.
 Regular monitoring helps in understanding patterns, adjusting in insulin
doses, and preventing extreme fluctuations in blood sugar levels.

5. Assist in creating an exercise plan, educate on the effects of physical

activity on blood
sugar levels, and teach strategies to prevent exercise-induced hypoglycemia.
 Regular physical activity assists in improving insulin sensitivity and overall
health but requires adjustments in insulin dosage and carbohydrate intake.
C. READINGS
II. ACUTE PYELONEPHRITIS

• Acute pyelonephritis is a type of urinary tract infection that

affects the kidneys.
• It is characterized by enlarged kidneys, abscesses, and
accumulation of white blood cells around and in the renal
tubules.
• Symptoms can include fever, chills, nausea, flank pain,
headache, muscle pain, and general prostration.
• Most cases are uncomplicated and can be cured with antibiotics.
• Complicated infections can be caused by underlying medical
conditions, anatomic abnormalities, obstruction, or multidrug-
resistant bacteria.
 C. READINGS
INCIDENCE AND PREVELANCE
GLOBAL
• Approximately 12–13 women per 10,000 population receive outpatient
treatment for acute pyelonephritis each year, while 3–4 cases require
hospitalization.
• In men, the incidence is lower, with 2–3 cases per 10,000 treated as
outpatients and 1– cases/10,000 requiring admission.
• Young women are most susceptible to acute pyelonephritis, followed by
infants and older adults.
• These variations in incidence are attributed to anatomical and hormonal
differences among different age groups and genders.
 C. READINGS
CLASSIFICATIONS
1. Severity-based classification 4. Clinical classification based on
• Mild complications
• Moderate • Renal Abscess
• Severe • Perinephric Abscess
2. Anatomic classification • Septic Shock
• Unilateral Pyelonephritis
• Lateral Pyelonephritis

3. Etiology-based classification
• Community-acquired
• Hospital-acquired or nosocomial
 C. READINGS
RISK FACTORS CAUSES
• Sex  Acute pyelonephritis is primarily
• Urinary Tract Abnormalities caused by a bacterial infection, most
• Urinary Catheters commonly by the bacterium
• Compromised Immune Escherichia coli (E. coli). The
System infection typically starts in the lower
• Pregnancy urinary tract, such as the bladder or
urethra, and ascends to the kidneys,
leading to inflammation and infection
in one or both kidneys.
 C. READINGS
CLINICAL MANIFESTATIONS COMPLICATIONS
1. Flank Pain • Sepsis and Septic Shock
2. Fever and Chills • Renal Abscess
3. Urinary Symptoms • Chronic Pyelonephritis
• Urinary urgency • Perinephric Abscess
• Frequency • Sepsis in Pregnancy
• Burning or pain during urination • Renal Papillary Necrosis
4. General Symptoms • Urosepsis
• Fatigue and weakness
• Nausea and vomiting
• Mental confusion or delirium
5. Other Signs
• Tenderness in the flank area
• Abdominal pain
• Cloudy or foul-smelling urine
 C. READINGS
PHARMACOLOGICAL MANAGEMENT MEDICAL MANAGEMENT
• Pain Management
1. Antibiotics: Antibiotics are the mainstay
• Fluid Intake
of treatment for acute pyelonephritis. The
• Rest
choice of antibiotic depends on factors
such as the severity of symptoms, local
resistance patterns, and any known
allergies
• Fluoroquinolones
• Third generation cephalosporins
• Trimethoprim-sulfamethoxazole (TMP-
SMX)
 C. READINGS
SURGICAL MANAGEMENT
-Surgery is generally not the initial
treatment for acute pyelonephritis.
• Abscess Drainage
• Corrective Surgery for Anatomical
Abnormalities
• Recurrent Infections
• Complications
NURSING MANAGEMENT
1. Instruct to have an adequate
fluid intake
2. V/S monitoring
3.Ensure that the administration
of antibiotics is done
4. Promote rest and balanced
activity.
5. Patient education of condition
and treatments
6. Urinary assessment
C. READINGS
III. SEPSIS

• Sepsis is caused by a dysregulated immune response to an

infection.

• It can lead to widespread inflammation, organ failure, and death.

• Symptoms include fever, rapid heart rate, rapid breathing, low blood
pressure, and altered mental status.

• Early diagnosis and treatment are crucial for survival.

 C. READINGS
INCIDENCE AND PREVELANCE
GLOBAL
• Sepsis is a major global health concern, accounting for nearly 20%
of all deaths worldwide in 2017.
• Children under 5 years of age are particularly vulnerable to sepsis,
with almost half of all global sepsis cases occurring in this age
group.
• Sepsis disproportionately affects low- and middle-income countries,
with approximately 85% of cases and deaths occurring in these
regions.
 C. READINGS
INCIDENCE AND PREVELANCE
NATIONAL
• Sepsis is a prevalent health concern in the Philippines, with a
reported incidence of 25% and an all-cause mortality rate of 34% in
the population studied.
• A lack of data on sepsis mortality and burden exists in the
Philippines, making it challenging to accurately assess the extent of
the problem.
• Despite early diagnosis challenges, efforts should focus on
modifiable factors associated with sepsis to improve outcomes.
• Sepsis incidence in medical patients at UP-PGH ranges from 10%
to 30%, with mortality rates varying from 10% to as high as 56%.
• Neonatal sepsis accounted for 0.06% of deaths among children
under 5 in the Philippines in 2017.