Week 13: Chp 62: Pyelonephritis Flashcards
Risk factor associated with Pyelonephritis
multiple pre-existing UTIs; treated or untreated
UTIs are caused by
- vesicoureteral reflux, which is a retrograde flow of urine from the bladder to the ureters
- obstructions such as benign prostatic hypertrophy (BPH), a stricture, or a urinary stone
- a long-term indwelling urinary catheter
- pregnancy is implicated in the development of acute pyelonephritis, known as pregnancy-induced acute pyelonephritis, as a result of the physiological changes associated with pregnancy, specifically hormonal changes and anatomical changes that lead to the retention of urine
- sexual activity in women
What is pyelonephritis
inflammation of the renal parenchyma and urinary collecting system
what is the most common cause of pyelonephritis
a bacterial infection that occurs as a result of contamination of the urinary meatus with bacteria found in the GI tract that ascend via the ureters to the renal tissue
-an inflammatory process occurs as a result of the bacterial invasion of the renal parenchyma
Most common bacteria to cause pyelonephritis
Escherichia coli
Clinical manifestations
-signs of infection: fever, chills, nausea, and vomiting
-back or flank pain
-costovertebral tenderness and enlarged kidneys are noted by palpation on physical examination
-may also present with symptoms of a UTI: frequent and painful urination and hematuria
-
What are more discriminating symptoms found in the elderly?
fever, acute dysuria (painful urination), new or worse urinary urgency or incontinence, gross hematuria, and suprapubic or costovertebral pain
The nurse correlates which clinical manifestations with the pathophysiology of acute pyelonephritis? A. Nausea and vomiting B. hematuria C. flank pain D. fever E. abdominal pain
A. Nausea and vomiting
B. hematuria
C. flank pain
D. fever
How to diagnose pyelonephritis
- history and physical examination
- laboratory results; urinalysis, urine culture, blood cultures, and CBC
- imaging studies: CT scan or ultrasound
Urinalysis reveals what is pyelonephritis?
can show pyuria (urine containing WBCs or pus), bacteriuria, and hematuria
-White blood cell (WBC) casts may be present
CBC reveals what in pyelonephritis?
leukocytes (WBC) increased with an increase in immature neutrophils (bands); refers to as “shift to the left”; a shift the the left indicated acute infection
Why must Urine cultures be obtained
once urinalysis is obtained and shows infection, a urine culture is conducted to identify the specific pathogen and medication sensitivities
Blood cultures are usually obtained before what?
before starting antibiotic therapy
A CT or ultrasound may reveal what?
reveal renal structures that are reduced in size or hydronephrosis, (edema or retained fluid in the kidneys) sometimes due to obstruction
Treatment for Pyelonephritis
hospitalization allowing treatment with IV antibiotics
-outpatient treatment may be acceptable for patients with mild to moderate illness and those who can be stabilized with oral antibiotics and adequate hydration and discharged under close supervision
>antibiotics
Medications used to treat pyelonephritis
antibiotics
-management depends on severity of symptoms
-treatment includes outpatient treatment with oral antibiotics or short-stay hospitalization with IV antibiotics with the possible continuation of oral antibiotics upon discharge
>broad spectrum antibiotics combined with an aminoglycoside is typically used
>Trimethoprim-sulfamethoxazole (Bactrim)
>fluoroquinolones such as ciprofloxacin (Cipro)
Trimethoprim-sulfamethoxazole (Bactrim)
antibiotic
- commonly used because of its effectiveness and low cost
- contraindicated in patients with a sulfa allergy
Fluoroquinolone: Ciprofloxacin (Cipro)
antibiotic
Why should caution be used when taking the antibiotics trimethoprim-sulfamethoxazole (Bactrim) and Ciprofloxacin (Cipro)?
these antibiotics are contraindicated in children and child-bearing women as a result of the teratogenic effect on bone growth
Supportive Interventions
- fluid replacement
- nonsteroidal anti-inflammatory drugs or narcotic analgesics
- antipyretics
- urinary analgesics (phenazopyridine (Pyridium))
- Cranberry juice
- intake of vitamin C
Supportive Interventions: fluid replacement
encouraged to drink at least eight glasses of fluid daily
-IV fluids may need to be administered during hospitalization if the patient requires fluid replacement to help “flush out” the kidneys and bladder or if the patient is dehydrated as a result of vomiting
Supportive Interventions: Nonsteroidal anti-inflammatory drugs or narcotic analgesics
can be administered to reduce pain
Supportive Interventions: antipyretics
can be prescribed to reduce elevated temperature that may be associated with infection
Supportive Interventions: Urinary analgesics
such as phenazopyridine (Pyridium) help to relieve the symptoms associated with ailments of the lower urinary tract
-can turn urine orange/red
Supportive Interventions: drinking cranberry juice
once believed to increase the acidity of urine, creating an environment that is not conductive to pathogen growth
- may prevent bacteria from sticking to the urinary tract structures
- not a cure
Supportive Interventions: large amount of Vitamin C
also inhibit the growth of bacteria by acidifying the urine
Complications associated with pyelonephritis
recurrent infections or poorly treated pyelonephritis can lead to scarring, chronic kidney disease (CKD), or permanent damage
-may progress to urosepsis; the bacteria can migrate to the bloodstream from the urinary tract, releasing endotoxins that initiate the inflammatory cascade–releasing cytokines and initiating the complement cascade; widespread inflammation alters metabolism and can cause multisystem organ failure as a result of septic shock
Signs of early urosepsis
changes in mental status, fever, tachycardia, tachypnea, hypotension, oliguria (low urine output), and leukopenia
-pyelonephritis can lead to urosepsis
Indications for surgery
emergency surgery indicated for patients with a fever persisting longer than 48 hours or positive blood culture results
- these clinical manifestations may be indicative of an abscess or/ and obstructing calculi, requiring surgical intervention
- indicated in cases where structural anomaly is potentially causing an obstruction that is the cause of infection
Assessment and Analysis: clinical manifestations results as of what?
are related to the inflammatory process that occur because of the infection
- low back or flank pain
- may complain of bladder spasms and burning during urination
- urinary frequency, urgency, hesitancy, and nocturia
- urine has hematuria, cloudy, and foul-smelling
- older women may experience dysuria or incontinence
- patient also experiences fever, chills, nausea and vomiting, anorexia (lack or loss of appetite)
Nursing Diagnoses
- infection r/t an impaired urinary elimination
- ineffective therapeutic regimen management r/t inadequate knowledge of the disorder
Nursing Interventions: Assessment
- vital signs
- pain level
- laboratory analysis
Assessment: Vital signs
hyperthermia is a response to infection to kill the microorganisms
-poorly treated infection may result in hypotension and tachycardia as a result of the vasodilation that occurs in the inflammatory response
Assessment: Pain level
back, flank, or groin pain is a diagnostic indicator of pyelonephritis
-continued pain assessment helps evaluate pain-control effort
Assessment: urinalysis and urine culture
urine tests are the primary diagnostic tool for pyelonephritis
- the urinalysis would indicate pyuria, bacteriuria, and hematuria
- a urine culture will help identify the pathogen
Assessment: a complete WBC count
reveals leukocytosis and immature cells, indicating infection (Leukocytes and a left shift)
Assessment: Blood cultures
positive blood cultures indicate septicemia, an infection within the bloodstream
Nursing Actions
- administer prescribed antibiotics as ordered
- administer prescribed pain meds
- provide adequate hydration, PO or IV as ordered
Actions: administer prescribed antibiotics
important in eradicating the pathogen
-following prescribed antibiotic regimen helps reduce antibiotic resistance
Actions: administer prescribed pain meds
provides comfort to the patient
Actions: provide adequate hydration, PO or IV as ordered
adequate hydration is important in maintaining good urine flow to avoid urine stasis
-hydration may also be necessary to maintain adequate circulating volume in the face of vasodilation associated with inflammation
Nursing Teaching
- explain the disease condition to patient and family
- instruct the patient and family on how to avoid UTIs
- take prescribed medications as ordered
- importance of rest
Teaching Measures to Reduce the Incidence of UTIs
- taking antibiotics as prescribed; symptoms may improve in 1 to 2 days; however, antibiotics should be completed
- proper hygiene, careful cleaning of the perineal area with soap and water with bathing and after defecating, moving back the folds of the labia, and cleaning the area from front to back with each cleaning, especially after urination
- emptying the bladder before and after sexual activity in order to avoid the risk of pathogens entering the urinary tract
- urinating regularly throughout the day, suggesting a micturition frequency of every 3 to 4 hours
- adequate fluid intake; full eight glasses of water is recommended per day
- avoid use of vaginal douches, harsh soaps, bubble baths, powders, and sprays in the perineal area
- signs and symptoms of a UTI; urinary frequency, urgency, hesitancy, change in urine color (e.g. cloudy), pain on urination (dysuria), and fever
- use of unsweetened cranberry juice for the prevention of UTI
Evaluating Care outcomes
with proper treatment, follow-up care, and prevention, the prognosis of pyelonephritis is good, and complications such as damage to renal structures, scarring, and chronic pyelonephritis can be avoided
A well-managed patient
does not experience the symptoms such as burning or pain on urination, urinary frequency, hesitancy, urgency, nocturia, or hematuria
-self-care efforts and compliance with treatment are evident from improvements in symptoms and reductions in recurrent infections
