Acute Pyelonephritis

Nursing interventions vary depending on the severity of symptoms. These interventions include teaching the patient about the disease process with emphasis on

(1) continuing medications as prescribed, (2) having a follow-up urine culture, and (3) recognizing manifestations of recurrence or relapse (see Table 46-6). In addition to antibiotic therapy, encourage the patient to drink at least eight glasses of fluid every day, even after the infection has been treated. Rest will increase patient comfort. The patient who has frequent relapses or reinfections may be treated with long-term, low-dose antibiotics. Making certain the patient understands the rationale for therapy is important to increase adherence.

The overall goals are that the patient with pyelonephritis will have

(1) normal renal function, (2) normal body temperature, (3) no complications, (4) relief of pain, and (5) no recurrence of symptoms.

Pts w/ UTI: Teach patients to promptly report any of the following to their health care provider:

(1) persistence of bothersome LUTS beyond the antibiotic treatment course, (2) onset of flank pain, or (3) fever.

nursing diagnosis for pyelone-

-acute pain -impaired urinary elimination

objective data for a person w/ pyelone-

-fever -foul smelling urine -tender enlarged kidney -leukocytosis, positive findings for bacteria

When teaching a patient and caregiver measures to prevent a recurrence of a urinary tract infection (UTI), include the following.

1. Take all antibiotics as prescribed. Symptoms may improve after 1-2 days of therapy, but organisms may still be present. 2. Practice appropriate hygiene, including the following: •Carefully clean the perineal region by separating the labia when cleansing. •Wipe from front to back after urinating. •Cleanse with warm soapy water after each bowel movement. 3. Empty the bladder before and after sexual intercourse. 4. Urinate regularly, approximately every 3-4 hr during the day. 5. Maintain adequate fluid intake. 6. Avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area. 7. Report to the health care provider symptoms or signs of recurrent UTI (e.g., fever, cloudy urine, pain on urination, urgency, frequency). 8. Consider drinking unsweetened cranberry juice (8 oz three times a day) or taking cranberry extract tablets 300-400 mg/day for UTI prevention.

signs and symptoms of pyelonephritis typically improve within

24-48 hours after therapy starts

what to do for relapse

6 week course of antibiotic

hydronephrosis

A condition characterized by excess fluid in a kidney due to a backup of urine.

what may relieve discomfort associated with UTI?

Application of local heat to the suprapubic area or lower back may relieve the discomfort associated with a UTI- also a warm shower/bath will help

what fluids should be avoided with UTI?

Caffeine, alcohol, citrus juices, chocolate, and highly spiced foods or beverages should be avoided because they are potential bladder irritants.

why do fluids help with UTI?

Fluids will help flush out bacteria before they have a chance to colonize in the bladder.

acute pyelonephritis: what requires hospitalization?

Patients with severe infections or complicating factors such as nausea and vomiting with dehydration require hospitalization.

what is pyelonephritis? what is it cause by?

Pyelonephritis is an inflammation of the renal parenchyma (Fig. 46-2) and collecting system (including the renal pelvis). The most common cause is bacterial infection, but fungi, protozoa, or viruses can also infect the kidney.

why are ultrasound and CT scans used for diagnosing pyelonephritis?

Ultrasonography of the urinary system may be performed to identify anatomic abnormalities, hydronephrosis, renal abscesses, or an obstructing stone. CT urograms are 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.

expected pyelonephritis urinalysis results

Urinalysis results indicate pyuria, bacteriuria, and varying degrees of hematuria. WBC casts may be found in the urine, indicating involvement of the renal parenchyma. A complete blood count shows leukocytosis and a shift to the left with an increase in bands (immature neutrophils).

Urosepsis is what?

a systemic infection arising from a urologic source. Its prompt diagnosis and effective treatment are critical because it can lead to septic shock and death in 15% of cases unless promptly eradicated. Septic shock is the outcome of unresolved bacteremia involving a gram-negative organism.

Urosepsis is characterized by

bacteriuria and bacteremia

Recurring episodes of pyelonephritis, especially in the presence of obstructive abnormalities, can lead to

chronic pyelonephritis and poorly functioning kidneys

what indication in the pts urine might indicate UTI?

cloudy urine

Pyelonephritis usually begins with

colonization and infection of the lower urinary tract via the ascending urethral route. Bacteria normally found in the intestinal tract, such as E. coli or Proteus, Klebsiella, or Enterobacter species, frequently cause pyelonephritis.

Tell patients that fluids will increase frequency of urination at first but will also

dilute the urine, making the bladder less irritable.

Acute intervention for a patient with a UTI includes

ensuring adequate fluid intake if it is not contraindicated.

The clinical manifestations of acute pyelonephritis vary from

mild fatigue to the sudden onset of chills; fever; vomiting; malaise; flank pain; and the LUTS characteristic of cystitis, including dysuria, urgency, and frequency. Costovertebral tenderness to percussion (costovertebral angle [CVA] pain) is typically present on the affected side.

One of the most important risk factors for acute pyelonephritis is

pregnancy-induced physiologic changes in the urinary system.

pyuria

pus found in urine

For residents of long-term care facilities, urinary tract catheterization is a common cause of

pyelonephritis and urosepsis.

Acute pyelonephritis commonly starts in the

renal medulla and spreads to the adjacent cortex.

The effectiveness of therapy is evaluated based on

the presence or absence of bacterial growth on urine culture.

A preexisting factor of pyelonephritis

vesicoureteral reflux (retrograde, or backward, movement of urine from lower to upper urinary tract) or dysfunction of the lower urinary tract (e.g., obstruction from benign prostatic hyperplasia [BPH], a stricture, a urinary stone).

what do you do if you suspect bacteremia?

vital sign monitoring

Maintaining adequate fluid intake may be difficult because of the patient's perception that fluid intake will

worsen the discomfort and urinary frequency associated with a UTI.

how to diagnose pyelonephritis

• History and physical examination • Urinalysis • Urine for culture and sensitivity • Imaging studies: ultrasound (initially), CT scan, IVP, CT/IVP, VCUG, radionuclide imaging • CBC count with WBC differential • Blood culture (if bacteremia is suspected) • Percussion for flank (costovertebral angle [CVA]) pain

Severe Symptoms treatment

• Hospitalization • Parenteral antibiotics •Empirically selected broad-spectrum antibiotics •Switch to sensitivity-guided antibiotic therapy when results of urine and blood culture are available • Oral antibiotics when patient tolerates oral intake • Adequate fluid intake (parenteral initially; switch to oral fluids as nausea, vomiting, and dehydration subside) • NSAIDs or antipyretic drugs to reverse fever and relieve discomfort • Urinary analgesics (as above) • Follow-up urine culture and imaging studies

Mild Symptoms (Uncomplicated Infection) treatment

• Outpatient management or short hospitalization •Empirically selected broad-spectrum antibiotics • Adequate fluid intake • Nonsteroidal antiinflammatory drugs (NSAIDs) or antipyretic drugs • Follow-up urine culture and imaging studies