F Pyelonephritis is a bacterial invasion of the
F Pyelonephritis is a bacterial invasion of the renal calices, parenchyma and renal pelvis. F Usually an ascending infection from the lower urinary tract, but it may be of blood – borne origin. F This condition may be acute / chronic and symptomatic / asymptomatic. F It may affect one / both kidneys.
Pathophysiology & Etiology v Enteric bacteria, such as E. coli, is most common pathogen; other gram – negative pathogens include proteus species, Klebsiella and Pseudomonas Gram – positive bacteria are less common, but include Enterococcus and Staphylococcus aureus
v Bacterial infection usually ascends from the lower urinary tract; however hematogenous migration is possible. v Pyelonephritis can result from urinary obstruction such as vesicoureteral reflux (Incompetence of ureterovesical valve, which allows urine to regurgitate into ureters, usually at time of voiding), other renal disease, trauma, or pregnancy.
v Low – grade inflammation with interstitial infiltrations of inflammatory cells may lead to tubular destruction and abscess formation. v Chronic pyelonephritis may result in scarred, atrophic, and nonfunctioning kidneys.
Signs & Symptoms A Flank pain (With / without radiation to A A A groin) Fever (Often in excess of 102°F) Chills General malaise Nausea, Vomiting, Anorexia Urgency, Frequency, and dysuria may be present Foul – smelling, cloudy urine
• Diagnosis may be difficult in the elderly in which the presenting symptoms may be confusion, deterioration of general health, and incontinence.
Nursing Interventions Reducing Body temperature ¦ Administer / teach self – administration of antibiotics as prescribed, and monitor for effectiveness and adverse effects. ¦ Assess vital signs frequently, and monitor intake and output; administer antiemetic medications to control nausea and vomiting. ¦ Administer antipyretic medications as prescribed and according to temperature.
m Report fever that persists beyond 72 hours after initiating antibiotic therapy; further testing for complicating factors will be ordered. m Use measures to decrease body temperature if indicated; cooling blanket, application of ice to armpits and groins. m Correct dehydration by replacing fluids, orally if possible, or I. V m Monitor CBC, blood cultures, and urine studies for resolving infection.
Relieving Pain m Administer / teach self – administration of analgesics, and monitor their effectiveness. m Use comfort measures, such as positioning, to locally relieve flank pain. m Assess pt’s response to pain control measures.
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