pyelonephritis/nephrolithiasis Flashcards
pyelonephritis
kidney infection
clinical manifestations of pyelonephritis
mild fatigue to sudden onset of chills, fever, vomiting, flank pain (CVA tenderness)
tests for pyelonephritis
UTI diagnosis
WBC with Diff
imaging tests
blood culture –> if suspect bacteremia or urosepsis
what would a CDC with diff show if positive for kidney infection
shift to the left = increase N, increase bands (immature)
CVA tenderness
costovertebral angle tenderness
-indicative of an upper UTI
-NOT AN EXPECTED FINDING
pyelonephritis
inflammation and infection of parenchyma
parenchyma: functional unit of organ
kidneys –> renal cortex and renal medulla
care for mild symptoms
outpatient management
-fluids
-NSAIDs/antipyretics (fever-reducer)
-FU urine culture + imagings
-broad ATB, then sensitivity-guided once cultures available (14-21 days)
care for severe symptoms
hospitalization
-fluids (IV initially, switch to oral when N/V/dehydration subside)
-NSAIDs/antipyretics
-FU urine culture + images
-IV antibiotics - switch to oral when tolerates intake
nephrolithiasis
kidney stone
what is indicated when a ureter is obstructed for ANY reason?
nephrostomy tube
nephrostomy tube insertion
surgically inserted into renal pelvis through a small flank incision –> external bag for closed drainage of urine
urine pathway with nephrostomy tube
urine still made in kidney, but bypasses ureter, bladder and urethra and excretes in bag
consideration with nephrostomy tube
if excessive pain or drainage around exit site –> possible blockage
TEMPORARY option
nephrostomy tube irrigation
strict aseptic/sterile technique
gently instill no more than 5mL of sterile NS into renal pelvis
*HCP order needed
diagnostic studies for nephrolithiasis
-careful H&P
-non-contrast spiral CT GOLD STANDARD
-ultrasound
-intravenous pyelogram (IVP)
-urinalysis (assessing hematuria, crystalluria, pH)
-retrieval/analysis of stones
5 major categories of kidney stones
- calcium oxalate (most common)
- calcium phosphate
- uric acid
- cystine
- struvite (magnesium ammonium phosphate)
symptoms of an acute attack of kidney stones
*pain: flank pain (strongest pain sensations known)
*renal colic: dull, one-sided pain in back or side
*N/V
*infection
*obstruction
how to treat pain, infection, obstruction for kidney stones
pain: NSAIDs and opioids
infection: systemic antibiotics
obstruction:
<4mm - pass spontaneously
>4mm - need stent replacement (metal casing that amens ureter and opening or urethra larger)
removal of stones
what do you evaluate/prevent and teach patients with kidney stones?
evaluate cause of stone and prevent further development
teach: adequate hydration, how to strain urine
dietary changes for pt with kidney stones
low oxalate
low calcium (controversial - stones may not come from calcium)
low purine (if uric acid stone/pt has gout)
foods high inn oxalate
WANT TO AVOID THESE IF HAVE KIDNEY STONES
dark roughage*
spinach*
cocoa*
nuts*
asparagus
cabbage
tomatoes
beets
celery
parsley
runner beans
chocolate
instant coffee
tea
Worcestershire sauce
foods high in purine
sardines
herring
muscles
liver
kidney
goose
venison
meat soups
sweetbreads
moderate: chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
foods high in calcium
Milk
cheese
ice cream
yogurt
sauces containing milk
all beans (except green beans)
lentils
fish (sardines, kippers, herring, salmon)
dried fruits
nuts
Ovaltine
chocolate
cocoa
endourologic procedures
lithotripsy - outpatient procedure
disintegrates/pulverizes stones via shock waves
internal lithotripsy approach
(direct)
-cystoscopic approach (through urethra to bladder)
-percutaneous approach (through skin)
-laser
external lithotripsy approach
(indirect)
-stones broken down and washed out
-non invasive (MAJOR advantage)
complications:
hemorrhage, infection, retention of stone fragments
post-procedure lithotripsy
hematuria – expected
stent placed to facilitate passage of fragments – removed after 1-2 weeks
NOT EXPECTED: decrease in urine output; may imply obstruction
nursing considerations of kidney stones
goal: pt education - lower risk factors through lifestyle and dietary changes
fluid intake –> water preferred
*3L/day to PREVENT
*NOT to force fluids when MANAGING a stone (no evidence to support it works)
dietary restrictions - determined by type of stone
nursing implementation
reduction of risk factors
-sedentary/immobilized person
-adequate fluid intake
-turn q 2 hours
-stand(m)/sit up(f) to pee on regular basis
-encourage ambulation
monitor passing of stones –> filter all urine through gauze or other filter
