Acute Pyelonephritis

Recurring episodes of pyelonephritis or UTIs lead to what?

Scarred, poorly functioning kidneys and CHRONIC pyelonephritis.

Hematogenous infection can cause pyelonephritis but is uncommon and is a consequence of...

Septicemia, bacteremia and infective endocarditis

What are examples of nursing diagnosis for pyelonephritis (or other UTIs)?

-Acute pain -Impaired urinary elimination *Monitor I/O, daily weights, etc.

What does acute pyelonephritis mean?

Acute- Develops relatively quickly Pyelo- Pelvis Neph- Kidney Itis- Inflammation *Renal pelvis

A UTI is what?

Any infection of the urinary tract.

Urosepsis is characterized by what?

Bacteriuria and bacteremia (bacteria in blood). *Close observation and VS; prompt care

Nursing Management: Nursing Implementations: What is included in ambulatory and home care for pyelonephritis?

Continue drugs as prescribed (Educate!) Follow-up urine culture Recognize manifestations of recurrence or relapse (Educate!) Encourage adequate fluids (at least eight glasses of fluid every day, even after the infection has been treated) Rest to increase comfort Long-term, low-dose antibiotics to prevent relapses or reinfections (Prophylactic) *Nursing interventions vary depending on the severity of symptoms. *Explain rationale to increase compliance.

What drug therapy is used for pyelonephritis?

Drug therapy: Antibiotics (SAME AS UTI QUIZLET) NSAIDs or antipyretic drugs: (TYLENOL) Fever Discomfort Urinary analgesics (I.E PYRIDIUM) Adequate fluid intake / IVF Prophylaxis may be used for recurrent infection *In severe, vanco (hard on kidneys; peak and troph, immunoglycoside), zosyn *Cephalosporin

What dysfunctions of the LOWER urinary tract can cause pyelonephritis?

Dysfunction of lower urinary tract: Obstruction from BPH (Benign Prostatic Hyperplasia)- MEN Stricture (restriction; stone, BPH, constipation, obstruction) Urinary stone (urinary calculi)

What does CHRONIC pyelonephritis often progress to?

End-stage renal disease (ESRD) even if the underlying infection is successfully treated.

A blood culture is indicated when?

Fever

Nursing Management: OBJECTIVE data for nursing assessment on pyelonephritis includes what?

Fever Hematuria, foul-smelling urine, tender, enlarged kidney Leukocytosis; positive findings for bacteria, WBCs, RBCs; pyuria; ultrasound, CT scan, and IVP abnormalities

What are nursing assessments for nursing management of pyelonephritis?

Health history: -Previous UTIs, calculi, stasis, retention, pregnancy, STDs, bladder cancer -Antibiotics, anticholinergics, antispasmodics -Urologic instrumentation -Urinary hygiene -Nausea, vomiting, anorexia, chills, nocturia, frequency, urgency -Suprapubic or lower back pain, bladder spasms, dysuria, burning sensation on urination *Medications

Nursing Management: Nursing Implementations: Health promotion/Prevention for pyelonephritis includes what?

Health promotion: -Early treatment for cystitis to prevent ascending infections Patients with structural abnormalities are at high risk Stress the need for regular medical care

What are diagnostic studies for pyelonephritis?

History Physical examination *Palpation for CVA pain (Tenderness is usually present on the same side) Laboratory tests Urinalysis (Indicate pyuria, bacteriuria, and varying degrees of hematuria) Urine for culture and sensitivity CBC with differential (leukocytosis) *Blood culture (if bacteremia is suspected) US and CT Urography *Ultrasonography of the urinary system may be performed to identify anatomic abnormalities, hydronephrosis, renal abscesses, or the presence of an obstructing stone. *CT urography is also used to assess for signs of infection in the kidney and complications of pyelonephritis, such as impaired renal function, scarring, chronic pyelonephritis, or abscesses

E. Coli, Proteus, and Enterobacter can cause pyelonephritis and are commonly found where?

In bowel flora.

UTIs usually start where?

In the LOWER urinary tract *UTI starts lower and goes up to kidneys= Pyelonephritis

What is pyelonephritis and what is it commonly caused by?

Inflammation of renal parenchyma and collecting system; KIDNEY INFECTION Most commonly caused by bacteria *Fungi, protozoa, or viruses can also infect kidneys (mostly in people with immunosuppression such as DM and HIV)

What are systemic/differentiating symptoms of acute pyelonephritis from a LOWER urinary tract infection?

Leukocytosis (increased WBC in blood) Flank pain at costovertebral angle Fever N/V Chills

What are signs and symptoms/diagnosis of urosepsis?

Low BP Tachycardia Tachypnea SOB Decreased urine output Fever etc. Lactic acid WBC count low in shock phase (starts high but then loses all)

What are clinical manifestations for pyelonephritis?

Mild fatigue *Fever with chills Vomiting, Malaise (If severe enough) *Flank pain Cystitis - dysuria, urgency, frequency (because of the UPPER urinary tract infection, it is not getting appropriate/normal output to the bladder) *Costovertebral tenderness on affected side Bacteriuria and pyuria (PUS) *Fever, chills, and flank pain are differentiating factors for pyelonephritis; THE KIDNEYS!

Pyelonephritis commonly starts where in the kidneys?

Renal medulla and spreads to adjacent cortex

Nursing Management: Planning includes what?

Patient will have: -Relief of pain -Normal body temperature -No complications -Normal renal function -No recurrence of symptoms

Failure of the Vesicoureteral orifice can be caused by what?

Primary congenital defect or bladder outlet obstruction. *Pressure and distorts valve *Urinary stasis

What is used to confirm the diagnosis of CHRONIC pyelonephritis?

Radiologic imaging and a biopsy rather than clinical features. *Imaging studies reveal a small, fibrotic kdney.

What is CHRONIC pyelonephritis usually the cause of?

Recurring infections involving the UPPER urinary tract.

Complications if acute pyelonephritis include:

Renal abscesses Recurrent infections Chronic pyelonephritis Papillary necrosis- worse diagnosis

What is urosepsis and what can it lead to?

Systemic infection from urologic source Can lead to septic shock and death Prompt diagnosis/treatment critical *When UTI is left untrated

What happens in CHRONIC pyelonephritis?

The kidneys become small, atrophic, and shrunken and lose function due to fibrosis (scarring).

Nursing Management: Evaluation includes what?

Use of nonanalgesic relief measures Appropriate use of analgesics Pass urine without urgency Urine free of blood Adequate intake of fluids

Pyelonephritis usually begins where and is commonly caused by what?

Usually begins with colonization and infection of lower tract via ascending urethral route Frequent causes: Escherichia coli *Other causes: Proteus, Klebsiella, Enterobacter

What is the one-way valve called that allows urine to go into the bladder from the ureters and not back out?

Vesicoureteral orifice

What preexisting factor is usually common in pyelonephritis?

Vesicoureteral reflux- COMMON IN PEDS Backward movement of urine from lower to upper urinary tract

For residents of long-term care facilities, urinary tract ________ is a common cause of pyelonephritis and urosepsis.

catheterization

Neutrophils infiltrate and die off and then are ______ out.

peed *WBCs in urine

One of the MOST important risk factors for pyelonephritis is what and why?

pregnancy Induced physiologic changes in the urinary system.

Acute pyelonephritis if often ________.

unilateral