Ch. 59 Flashcards
pyelonephritis steps of development (pathophysiology)
- Microbial invasion of renal pelvis
- Inflammatory response
- Resulting fibrosis (scarring)
- Decreased tubular absorption/secretion
- Impaired renal function
pyelonephritis
bacterial infection that starts in the bladder and moves upward to infect the kidneys (upper urinary tract infection)
- acute v chronic
- abscesses can develop on kidneys w/ chronic
- Commonly caused by Escherichia coli or Enterococcus faecalis
acute pyelonephritis
results from bacterial infection with or without obstruction or reflux
- has UTI, sx go away, and pt stops taking ABT before 10 days of full treatment
chronic pyelonephritis
usually occurs with structural deformities, urinary stasis, obstruction, or reflux
pyelonephritis sx
Fever, chills, tachycardia, and tachypnea
Flank, back, or loin pain
Abdominal discomfort
Nausea and vomiting
Burning, urgency, frequency of urination
Nocturia
Tenderness at costovertebral angle- under 12th rib, where ribs meet
classic sx: fever (real fever 102, 103), chills, flank back or loin pain
conditions found with chronic pyelonephritis
- HTN
- inability to conserve sodium (potassium is affected)
- decreased concentrating ability to kidneys
- tendency to develop hyperkalemia and acidosis
electrolytes and acid-base balance is affected
pyelonephritis pt assessment
Patient history
- had a UTI recently? on ABT?
- are you a diabetic? higher risk for infection
- when did sx start? what are the sx?
Physical assessment
- CVA tenderness: palpation and percussion at 12th rib
- baseline v current mental status/LOC
Psychosocial assessment
- coping
- emotional state
Laboratory assessment- urine and bloodwork
- UA
- urine C&S
- BUN and creatinine (kidney involvement/impairment)
- CBC- look at WBC (elevated)
- ESR may be elevated (inflammation)
Imaging assessment
- CT scan: anatomic or structural abnorms
- KUB XR- kidneys, ureters, bladder x-ray
pyelonephritis priority problems
- Pain (flank and abdominal) due to inflammation and infection
- Potential for chronic kidney disease (CKD) due to kidney tissue destruction
pyelonephritis management of pain
DRUG therapy
- PAIN control (tylenol, ibuprofen) and Antibiotics (PCN)
- hospital older adult if IV meds are needed
- most children, adults can handle outpatient treatment with PO ABT
Nutrition/fluid therapy
-fluid intake 2-3L/day
*surgery only done if there is a structural or anatomic abnormalities
preventing pyelonephritis
preventing chronic kidney disease
hydronephrosis
kidney inflammation
- caused by kidney stone high up towards kidney (urine can’t get into ureter to get to the bladder, so urine backs up into kidney and enlarges the kidney)
hydroureter
ureter inflammation
- caused by kidney stone lower in tract closer to bladder (urine can’t get into bladder but can travel from kidney into ureter, so urine backs up into ureter and enlarges the ureter)
assessment for hydroureter/hydronephrosis
- Obtain a history – any childhood urinary tract problems or structural defects.
- Urine patterns, frequency, color, odor, clarity.
- Any recent flank or abdominal pain, chills, fever, malaise→infection.
- Physical exam: Inspect flanks/belly/bladder, gently palpate, percuss looking for lumps, tenderness.
- Gentle pressure on belly can cause urine leakage indicating obstruction.
labs for hydroureter/hydronephrosis
- Urinalysis to check for WBC and bacteria
- BUN and creatinine (elevated with kidney involvement)
- Check for reduced GFR (how well kidneys are filtering wasted- reduced GFR = kidney impairment)
- Diagnostic tests: U/s, CTscan
interventions for hydroureter/hydronephrosis
Urologic interventions (can be done without hospitalization)
- remove stone
Radiologic interventions:
- Nephrostomy drain (tube goes into kidney in the patients back and is connected to leg bag (smaller bag, strapped to leg- can go home with this)
*monitor insertion site for infection, monitor drainage into bag (should be yellow by 2nd day, hematologic in 1st day is normal, educate patient about drainage, when to call provider with s/ of infection
