Upgrade to remove ads
Only $2.99/month

Acute pyelonephritis

Terms in this set (21)

Overview
Bacterial infection of the renal parenchyma
Affecting one or both kidneys
Wide-ranging presentation, from mild to septic shock
Good prognosis, rarely with extensive permanent damage
Also called acute infective tubulointerstitial nephritis
Overview-Pathophysiology
Infection spreads from the bladder to the ureters to the kidneys, commonly through vesicoureteral reflux.
Vesicoureteral reflux may result from congenital weakness at the junction of the ureter and bladder.
Bacteria refluxed to intrarenal tissues may create colonies of infection within 24 to 48 hours.
Bacteria attach to the epithelium leading to an inflammatory response; chemokines are released and attach to neutrophil activating chemokine receptors, which alter the epithelial barrier and allow polymorphonuclear leukocytes to cross into the urine.
Bacteria invade the renal parenchyma.
Female anatomy allows for higher incidence of infection.
Overview-Causes
Bacterial infection of the kidneys
Escherichia colli the most common colonizing organism
Other gram-negative causative organisms, including Proteus, Klebsiella, Serratia, Clostridium, Pseudomonas, and Enterobacter
Other causative organisms, such as Enterococcus, Staphylococcus, and Candida
Overview-Risk Factors
Female anatomy allows for higher incidence of infection.
Renal procedures that involve instrumentation, such as cystoscopy
Hematogenic infection, such as septicemia
Sexual activity in women (frequency of more than 3 times per week within the past 30 days)
Spermicide use
Pregnancy
Neurogenic bladder
Structural urinary tract abnormalities
Lower urinary tract infection (UTI)
Indwelling urinary catheter
Nephrolithiasis
Prostatic enlargement
Stress incontinence
Diabetes
Previous history of acute pyelonephritis (within the past year)
Overview-Incidence
Acute pyelonephritis is more common in women than in men.
It affects all ages but increases after age 50.
Pyelonephritis is very common, with 12 to13 cases occurring annually per 10,000 in women and 3 to 4 cases per 10,000 in men. Overall incidence is 250,000 cases diagnosed annually with approximately 192,000 cases requiring admission to the hospital.
Acute pyelonephritis occurs in approximately 20% to 30% of all pregnancies with women who experience asymptomatic bacteriuria.
Overview-Complications
Renal calculi
Renal failure
Renal abscess
Renal papillary necrosis
Multisystem infection
Septic shock
Chronic pyelonephritis or renal damage
Emphysematous pyelitis or cystitis
Assessment-History
Pain over one or both kidneys, occasionally suprapubic
Urinary urgency and frequency
Burning during urination
Dysuria, nocturia, hematuria
Anorexia, vomiting, diarrhea
Fatigue, malaise, weakness
Symptoms that develop rapidly over a few hours or a few days
Chills, rigors
Assessment-Physical Findings
Pain on flank palpation (costovertebral angle tenderness); suprapubic tenderness
Cloudy urine; gross hematuria
Ammonia-like or fishy odor to urine
If present, fever of 100° F (37. 8° C) or higher (may be absent in the elderly)
Shaking chills
Irritability, sepsis, GI symptoms, inadequate weight gain or loss, and jaundice or gray skin color (infants and children)
Negative pelvic examination findings in females (to rule out pelvic inflammatory disease)
Diagnostic Test Results-Laboratory
Urinalysis and culture and sensitivity testing reveal pyuria, significant bacteriuria, low specific gravity and osmolality, and slightly alkaline urine pH or proteinuria, glycosuria, and ketonuria (less common).
White blood cell count, neutrophil count, and erythrocyte sedimentation rate are increased.
Diagnostic Test Results-Imaging
Kidney-ureter-bladder radiography reveals calculi, tumors, or cysts in the kidneys or urinary tract.
Excretory urography shows asymmetrical kidneys, possibly indicating a high frequency of infection.
Computed tomography identifies changes in renal parenchymal perfusion, evidence of perinephric fluid.
Renal ultrasonography may reveal infection.
Treatment-General
Identification and correction of predisposing factors for infection, such as obstruction or calculi
Short courses of therapy for uncomplicated infections
Rest
Treatment-Diet
Increased fluid intake
Treatment-Activity
Rest during the initial period; gradually increase activity as infection resolves.
No return to work for approximately 2 weeks.
Treatment-Medications
7- to 14-day course of I.V. or oral antibiotics, such as ciprofloxacin (Cipro), levofloxacin (Levaquin), ceftriaxone sodium (Rocephin), gentamicin sulfate (Garamycin), ampicillin, amoxicillin (Amoxil), vancomycin hydrochloride (Vancocin), cephalexin (Keflex), trimethoprim-sulfamethoxazole (TMP-SMX), ampicillin sodium-sulbactam sodium (Unasyn), aztreonam (Azactam), meropenem (Merrem I.V.), piperacillin sodium-tazobactam sodium (Zosyn), ticarcillin disodium -clavulanate sodium (Timentin), cefpodoxime proxetil (Vantin), and amoxicillin-clavulanate potassium (Augmentin)
Urinary analgesics such as phenazopyridine hydrochloride (Azo-Standard)
Antipyretics, such as acetaminophen or ibuprofen , as needed
Treatment-Surgery
Drainage of abscess or removal of obstructing calculus, if indicated
Nursing Considerations-Nursing Diagnoses
Acute pain
Excess fluid volume
Fatigue
Impaired physical mobility
Impaired urinary elimination
Risk for ineffective renal perfusion
Risk for infection
Nursing Considerations-Expected Outcomes
report increased comfort
maintain fluid balance
express feelings of energy and decreased fatigue
perform activities of daily living within the confines of the disorder
maintain urine specific gravity within the designated limits
identify risk factors that exacerbate decreased tissue perfusion and modify lifestyle appropriately
develop no signs or symptoms of infection.
Nursing Considerations-Nursing Interventions
Give prescribed drugs, such as antibiotics, urinary analgesics, and analgesics. Ensure patent access if I.V. antibiotic therapy is ordered.
Inspect urine for color, clarity, and odor.
Provide comfort measures to minimize pain.
Implement measures to reduce body temperature as appropriate, such as wearing lightweight, loose clothing; use cooling blankets as necessary to reduce significantly elevated body temperature.
Encourage bed rest and activity limitations during initial therapy; assist with gradual resumption of activity as condition improves.
Implement energy conservation measures; cluster nursing activities to promote rest.
Encourage the patient to increase fluid intake. Administer oral and/or I.V. fluids as ordered.
Urge good perineal hygiene practices; encourage frequent and complete voiding.
Obtain specimens for laboratory testing, including repeat urine cultures, complete blood counts, and blood cultures as indicated.
Nursing Considerations-Monitoring
Vital signs
Intake and output
Characteristics of urine
Pattern of urination
Daily weight
Results of urine cultures and renal function studies
Nursing Considerations-Associated Nursing Procedures
12- or 24-hour timed urine collection
Blood pressure assessment
Calculating and setting an IV drip rate
Fall prevention
Health history interview and physical assessment
IV bag preparation
IV bolus injection
IV catheter insertion
IV pump use
IV secondary line drug infusion
IV solution change
IV time tape use
IV tubing change
Indwelling urinary catheter (Foley) care and management
Indwelling urinary catheter (Foley) irrigation
Intake and output assessment
Intermittent infusion device drug administration
Nutritional screening
Oral drug administration
Pain management
Pulse assessment
Pulse oximetry
Straining urine for calculi
Temperature assessment
Urine glucose and ketone tests
Urine pH
Urine specific gravity
Urine specimen collection from an indwelling urinary catheter (Foley)
Urine specimen collection, random
Venipuncture
Weight measurement
Patient Teaching-General
disorder, diagnosis, and treatment, including the fact that most patients respond to treatment in approximately 48 hours
temperature monitoring, with notification of the practitioner if temperature is higher than 100° F (37.8° C)
prescribed drug therapy, including drug names, dosages, schedule for administration and duration of therapy, and possible adverse effects
possible changes in the color of urine; for example, phenazopyridine will turn urine orange and stain clothing that comes into contact with urine
possible signs and symptoms of hypersensitivity reactions to prescribed drugs and the need to notify the practitioner
need to complete the full course of therapy, even if feeling better
appropriate hygienic toileting practices, including wiping the perineum from front to back after bowel movements for women
need for rest and minimal activity, including not returning to work for 2 weeks
signs and symptoms of recurrent infection
proper technique for collecting a clean-catch urine specimen
routine follow-up examination and urine cultures, if indicated, especially if the patient has a history of UTIs.
THIS SET IS OFTEN IN FOLDERS WITH...