UNIT 9 Pyelonephritis, Acute Glomerulonephritis, Kidney Trauma, Polycystic Kidney Disease CHAPTER 62

Question 1

What is Pyelonephritis

Answer 1

A bacterial infection in the kidney and renal pelvis.

Pyelonephritis is a bacterial infection that starts in the bladder and moves upward to infect the kidneys (National Institute of Diabetes and Digestive and Kidney Diseases, 2018).

Question 2

S/S of Acute Pyelonephritis

Answer 2

-Fever, chills
– Increased WBC
– Fatigue
– Nausea and vomiting
– Flank pain
– Nocturia and dysuria
– Bacteriuria and pyuria
– Edema, fluid overload
Fever
* Chills
* Tachycardia and tachypnea
* Flank, back, or loin pain
* Tenderness at the costovertebral angle (CVA)
* Abdominal, often colicky, discomfort
* Nausea and vomiting
* General malaise or fatigue
* Burning, urgency, or frequency of urination
* Nocturia
* Recent cystitis or treatment for urinary tract infection (UTI)

Question 3

S/S of Chronic Pyelonephritis

Answer 3

• Hypertension
• Inability to conserve sodium
• Decreased urine-concentrating ability, resulting in nocturia
• Tendency to develop hyperkalemia and acidosis
  Fatigue
  – Nausea and vomiting
  – Weight loss
  – Polyuria

Chronic pyelonephritis usually occurs with structural deformities, urinary stasis, obstruction, or reflux. Conditions that lead to urinary stasis include prolonged bedrest and paralysis. Obstruction can be caused by stones, kidney cancer, scarring from pelvic radiation or surgery, recurrent infection, or injury

Question 4

Risk factors for Pyelonephritis

Answer 4

History of UTIs, renal surgeries or infections

Question 5

Treatment for Pyelonephritis

Answer 5

Pyelonephritis
Tx –
antibiotics,
hygiene,
fluid restriction,
meds to control symptoms,
watch sodium intake (nutritional considerations – what foods
should they avoid?)
canned foods potato chips, processed meats
Hospitalize if septic

Question 6

What is
acute glomerulonephritis

Answer 6

Inflammation of the glomerulus that develops suddenly from an excess immunity response within the kidney tissues.

Question 7

Risk factor or cause of acute glomerulonephritis

Answer 7

-Can be post infection – usually beta-hemolytic strep (throat) or
-infectious mononucleosis or STI
* May follow other acute viral infection
-Many causes of primary GN are infectious
-Secondary GN can be caused by multisystem diseases (Table 62.2) and can manifest as acute or chronic disease.

Question 8

What life threatening disorder that Acute Glomerulonephritis can cause?

Answer 8

Affects all renal tissues
* Can lead to fluid overload issues
– hypertensive encephalopathy: Hypertensive encephalopathy is a dramatic syndrome characterized by severe elevation of blood pressure, headache, visual disturbances, altered mental status, and convulsions.
– heart failure
– Pulmonary edema

Question 9

S/S of Acute Glomerulonephritis?

Answer 9

-Hematuria, proteinuria
* Edema, shortness of breath (SOB)
* Hypertension and tachycardia
* Increased BUN(10-20), creatinine(0.5-1.1W, 0.6-1.2M), hyperkalemia(3.5-5)
* Hypoalbuminemia(3.5-5)
* Flank pain, headache, & malaise
* Elderly may experience circulatory overload - edema
*Ask about changes in urine elimination pa erns and any change in
urine color, volume, clarity, or odor. The patient may describe blood in the urine as smoky, reddish brown, rusty, or cola colored. Ask about dysuria or oliguria. Weigh him or her to assess for fluid retention.
*neck vein distention
*. Mild-to-moderate hypertension occurs with acute GN as a result of impaired fluid and electrolyte balance with fluid and sodium retention. The patient may have fatigue, a lack of energy, anorexia, nausea, and/or vomiting if uremia from severe kidney impairment is present.

Question 10

Labs and Diagnostics for Acute Glomerulonephritis

Answer 10

Urinalysis, 24-hour urine collection, BUN and creatinine, Glomerular
filtration rate (GFR)
* Kidney biopsy

BUN- 10-20
CREATNINE- 0.5-1.1W 0.6-1.2M
GLOMERRULAR FILTRATION RATE - 90-120ml/min

Question 11

Nursing Interventions for Acute Glomerulonephritis

Answer 11

• Daily weights & vital signs
• I & O
• Treat underlying cause
• Dietary therapy – i.e. limit potassium rich foods
• Drug therapy - antibiotics
• Cardiac management
• Urinary assessment
• Possible dialysis

Question 12

Secondary Glomerulonephritis causes

Answer 12

• Systemic lupus erythematosus (SLE)
• Sustained liver disease (hepatitis B or C, autoimmune hepatitis, and cirrhosis) * Amyloidosis
• Mesangiocapillary glomerulonephritis (MCGN)
• Alport syndrome
• Vasculitis
• Goodpasture syndrome
• IgA nephropathy
• Wegener granulomatosis
• HIV-associated nephropathy
• Diabetic glomerulopathy

Question 13

Would a patient with AGN have hypertension?
A. Yes
B. No

Answer 13

A. Yes

Question 14

Can Glomerulonephritis lead to chronic kidney disease?

A.No
B. Yes

Answer 14

B. Yes

Glomerulonephritis can lead to chronic kidney disease, making it essential to prevent and treat in the older adult who is at greater risk for CKD. In the older adult, symptoms of glomerulonephritis can easily be confused with an exacerbation of heart failure. Older adults with glomerulonephritis have a higher risk of mortality than younger patients with the same diagnosis, adding to the importance of early recognition and prompt intervention (Raman, 2018).

Question 15

What would you find in a urinalysis for a pt with Glomerulonephritis?

Answer 15

Urinalysis shows red blood cells (hematuria) and protein (proteinuria). An early morning specimen of urine is preferred for urinalysis because the urine is concentrated, most acidic, and filled with more intact formed elements at that time

Question 16

Drug therapy for Glomerulonephritis

Answer 16

Managing infection as a cause of acute GN begins with appropriate antibiotic therapy. Penicillin, erythromycin, or azithromycin is prescribed for GN caused by streptococcal infection. Check the patient’s known allergies before giving any drug. Stress personal hygiene and basic infection control principles (e.g., handwashing) to prevent spread of the organism. Teach patients the importance of completing the entire course of the prescribed antibiotic.

Question 17

What is Kidney Trauma?

Answer 17

Trauma to one or both kidneys may occur with penetrating wounds or blunt injuries to the back, flank, or abdomen. Another cause of kidney trauma is urologic procedures. Blunt trauma accounts for most kidney injuries.

Question 18

Can you prevent Kidney Trauma? By doing what in your everyday life?

Answer 18

Preventing Kidney and Genitourinary Trauma
* Wear a seat belt.
* Practice safe walking habits.
* Use caution when riding bicycles and motorcycles.
* Wear appropriate protective clothing when participating in contact sports.
* Avoid all contact sports and high-risk activities if you have only one kidney.

Question 19

Assessment for Kidney Trauma

Answer 19

*Obtain health history, information
about the trauma
* Assess pain, and circulation
* Assess urine – RBC in urine
* Urinalysis, CBC, Hgb, Hct, US, CT,
and KUB

Ureteral or renal pelvic injury often causes diffuse abdominal pain. Urine outside of the urinary tract may be visible. Ask the patient about pain in the flank or abdomen.

Urinalysis shows hemoglobin or RBCs from tissue damage or kidney blood vessel rupture. Microscopic examination may also show red blood cell casts, which suggest tubular damage. Hemoglobin and hematocrit values decrease with blood loss.

Question 20

Nonsurgical Management of Kidney Trauma

Answer 20

A combination of both drug and fluid therapy may be used to replace blood components and coagulation factors.
Drug therapy is used for bleeding prevention or control.
Fluid therapy is used to restore circulating blood volume and ensure adequate kidney blood flow.
During fluid restoration, give fluids at the prescribed rate and monitor the patient for signs of shock.
Take vital signs as often as every 5 to 15 minutes.
Measure and record urine output hourly. Output should be greater than 0.5 mL/kg/hr.

Question 21

Patient Teaching Post Op Kidney Trauma Surgery

Answer 21

Teach the patient and family how to assess for infection and other complications following kidney trauma.

COMPLICATIONS:
The most common complications are urine leakage and delayed bleeding. Instruct the patient to check the pattern and frequency of urination and note whether the color, clarity, and amount appear normal.

• The development of an abscess surrounding the kidney also can occur.

* Instruct the patient to seek medical att ention for worsening hematuria, any worrisome change, or pain with voiding. Chills, fever, lethargy, and cloudy, foul-smelling urine indicate a urinary tract infection or abscess formation.*
Traumatic kidney injury can also cause hypertension from changes in perfusion and activation of the renin- angiotensin-aldosterone system (see Chapter 60). Advise the patient to seek medical care promptly for all new and concerning signs or symptoms.

Question 22

What is Polycystic Kidney Disease

Answer 22

Polycystic kidney disease (PKD) is a genetic disorder in which fluid-filled cysts develop in the nephrons

*a hereditary
disorder
* grape like cysts
containing serous
fluid, blood or urine
* replace normal
kidney tissue

Question 23

S/S of Polycystic Kidney Disease?

Answer 23

Patients with PKD often experience hypertension, abdominal fullness and pain, episodes of cyst bleeding, hematuria, kidney stone formation, infections, and systemic disease.

Ask about pain, constipation, urine changes, hypertension,
headaches
* May have dysuria, nocturia

Pain in the back, flank or abdomen
* Headaches
* Urinary tract infections
* Calculi (stones)
* Hematuria, proteinuria & pyuria
* Fever and chills
* Cysts in the kidneys and other organs

Question 24

Nursing Intervention for Polycystitic Kidney Disease

Answer 24

Medicine to control high blood pressure!
* Medicine and surgery to reduce pain (i.e. guided imagery, &
dry heat).
* Increase fluids to prevent dehydration.
* Antibiotics to resolve infections .
* Dialysis to replace functions of failed kidneys.
* Kidney transplant.
* Genetic counseling advised, especially before childbearing
age.

Question 25

Assessment for Polycystic Kidney Disease

Answer 25

Pain is often the first symptom. Inspect the abdomen. A distended abdomen is common as the cystic kidneys swell and push the abdominal contents forward.

• Abdominal or flank pain
• Hypertension
• Nocturia
• Frequent urinary tract infections * Increased abdominal girth
• Constipation
• Hematuria (bloody urine)
• Sodium wasting and inability to concentrate urine in early stage
• Progression to kidney failure with anuria (Holt, 2018)

Question 26

What health promotion tips can help manage hypertension?

Answer 26

Blood pressure control and lifestyle and dietary modifications are necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Nursing interventions include education for self-management. Dietary salt of less than 2 g/day is now advised. Calorie restriction with weight reduction has been shown to decrease blood pressure (Rizk, 2018).

Drug therapy with angiotensin-converting enzyme inhibitors (ACEIs) to reach a blood pressure below 130/80 mm Hg in all patients with PKD or 110/75 mm Hg in young adults with preserved kidney function is recommended (Rizk, 2018). These drugs also help control the cell growth aspects of PKD and reduce microalbuminuria. Additional antihypertensive drugs, such as calcium channel blockers, beta blockers, and vasodilators, may be used (see Chapter 33).

Question 27

Would an NSAID like aspirin be used for a patient with Polycystic Kidney Disease for pain management?
A. No
B. Yes

Answer 27

A. No

Because PKD-related pain is chronic, a multidisciplinary pain management approach is helpful. Drugs may include OPIODS along with ACETOMINOPHEN. NSAIDs are used cautiously because they can reduce kidney blood flow. Aspirin-containing drugs are avoided to reduce bleeding risk.

Question 28

Complementary therapy of Polycystic Kidney Disease

Answer 28

Complementary therapy includes positioning and the application of dry heat to the abdomen or flank. Teach the patient methods of relaxation and comfort using deep breathing, guided imagery, or other strategies (see Chapter 5 for pain management). When pain is severe, cysts can be reduced by needle aspiration and drainage; however, they usually refill. When the quality or severity of pain abruptly increases, assess for infection.

Question 29

Patient teaching for Polycystic Kidney Disease

Answer 29

Measure and record your blood pressure daily and notify your primary health care provider about consistent changes in blood pressure.
* Take your temperature if you suspect you have a fever. If a fever is present, notify your physician or nurse.
* Weigh yourself every day at the same time of day and with the same amount of clothing; notify your primary health care provider or nurse if you have a sudden weight gain.
* Limit your intake of salt to help control your blood pressure once hyperfiltration is no longer a symptom of your disease (once chronic kidney disease [CKD] is present).
* Notify your primary health care provider or nurse if your urine smells foul or has a new occurrence of blood in it.
* Notify your primary health care provider or nurse if you have a headache that does not go away or if you have visual disturbances because these are symptoms of a stroke or bleeding in the brain.
* Monitor bowel movements to prevent constipation drink 2l -3L a day to prevent constipatrion.
* maintaining dietary fiber intake, and exercising regularly. Explain that pressure on the large intestine may occur as the polycystic kidneys increase in size. These recommendations for bowel management might change, particularly when ESKD develops. Advise the patient about the use of stool softeners and bulk agents, including careful use of laxatives, to prevent chronic constipation.