Whilst the suggested duplicate will get you part of the way there, you actually need to unpivot then pivot, like this.
(Oh and please don't post images. DDL is appreciated and saves us typing and/or guessing.)
CREATE TABLE #Test( Action char, [Key] INT, Old varchar(5), OldValue varchar(5), New varchar(5), NewValue varchar(5));
INSERT INTO #Test VALUES
('U', 123, 'Col1','Dog','Col1','Dog'),
('U', 123, 'Col2','Cat','Col2','Mouse'),
('U', 123, 'Col3','Honey','Col3','Bee'),
('I', 123, NULL,NULL,'Col45','Sun');
SELECT PVT.Action
,PVT.[Key]
,PVT.OldCol1
,PVT.OldCol2
,PVT.OldCol3
,PVT.NewCol1
,PVT.NewCol2
,PVT.NewCol3
,PVT.NewCol45 FROM (
SELECT [Action]
,[Key]
,Label
,Value
FROM #Test
CROSS APPLY (VALUES ('Old'+Old, OldValue), ('New'+New, NewValue)) c(label, value)
)src
PIVOT
(
MAX(VALUE) FOR Label IN (OldCol1, NewCol1, OldCol2, NewCol2, OldCol3, NewCol3, NewCol45)
)PVT
ORDER BY PVT.Action Desc
Action Key OldCol1 OldCol2 OldCol3 NewCol1 NewCol2 NewCol3 NewCol45
------ ----------- ------- ------- ------- ------- ------- ------- --------
U 123 Dog Cat Honey Dog Mouse Bee NULL
I 123 NULL NULL NULL NULL NULL NULL Sun
(2 row(s) affected)