Pyelonephritis Study Guide PDF

PYELONEPHRI TIS Dr. Sibi Peter, PhD,RN,CCRN PYLENONEPHRITIS  An inflammation of the renal parenchyma and collecting system  Categorized as acute or chronic ETIOLOGY AND PATHOPHYSIOLOGY  Most common cause is bacterial infection  Frequently by bacteria which are normally fou...

PYELONEPHRI TIS Dr. Sibi Peter, PhD,RN,CCRN PYLENONEPHRITIS  An inflammation of the renal parenchyma and collecting system  Categorized as acute or chronic ETIOLOGY AND PATHOPHYSIOLOGY  Most common cause is bacterial infection  Frequently by bacteria which are normally found in the intestinal tract  May sometimes be caused by fungi, protozoa or virus infection ETIOLOGY AND PATHOPHYSIOLOGY  Pre-existing factor is often present  Vesicoureteral Reflux  Dysfunction of the lower urinary tract  Commonly caused by urinary tract catheterization and use of indwelling catheters CLINICAL MANIFESTATIONS  Symptoms may vary from mild fatigue to more severe symptoms  Sudden onset of:  Fever  Chills  Vomiting  Malaise  Flank Pain  Dysuria  Urinary Urgency  Urinary Frequency DIAGNOSTIC STUDIES  Complete History  Physical Examination  Urinalysis  Complete Blood Count (CBC)  Urine Culture  Blood Cultures  Usually obtained in the hospitalized patient with severe Pyelonephritis DIAGNOSTIC STUDIES  Ultrasound of the urinary system may be performed to identify anatomic abnormalities  Imaging studies such as an IVP or CT scan, requiring IV injection of contrast are not commonly performed in the early stages TREATMENT Treatment for mild symptoms includes:  Outpatient management or short hospitalization  Broad spectrum antibiotics, which are switched to sensitivity guided therapy  Fluoroquinolones  Adequate Fluid Intake  NSAIDs or Antipyretic Drugs  Follow Up Urine Culture TREATMENT Treatment for severe symptoms includes:  Hospitalization  Parenteral antibiotics  Oral antibiotics when patient tolerates PO  Adequate fluid intake  NSAIDs and antipyretic drugs  Follow up urine culture and imaging studies NURSING MANAGEMENT  Encourage adequate fluid intake  Monitor urinary elimination  Obtain midstream voided specimen for urinalysis  Provide the patient optimal pain relief with prescribed analgesics  Explain the rationale for antibiotic therapy to enhance patient compliance NCLEX QUESTION #1 Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? A. Jaundice B. Costovertebral angle tenderness and chills C. Burning sensation on urination D. Tenderness at Mcburney’s Point Answer: B Rationale: Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection. Tenderness at Mcburney’s Point indicates apendicitis. NCLEX QUESTION #2 A client diagnosed with pyelonephritis asks the nurse “What is this disease?” The nurse’s best response “Pyelonephritis is an: A. inflammation of the kidney and renal pelvis. B. inflammation of the prostate gland. C. inflammation of the urethra D. inflammation of the bladder Answer: A Rationale: Pyelonephritis is an inflammation of the kidney and renal pelvis. Prostatis is an inflammation of the prostate gland. Urethritis is an inflammation of the urethra. Cystitis is an inflammation of the bladder. NCLEX QUESTION #3  A client with pyelonephritis is being discharged from the hospital, the nurse provides instructions to the client to prevent recurrence. The nurse determines that the client understands the information that was given when the client states an intention to: A. increase fluids for 2 days if signs and symptoms of a urinary tract infection develop B. take the prescribed antibiotics until all symptoms subside C. return to the physician's office for scheduled follow-up urine cultures D. decrease fluid intake if frequent urination occurs Answer: C Rationale: The client with pyelonephritis should take the full course of antibiotic therapy that has been prescribed and return to the physician's office for follow-up urine cultures if instructed. The client should learn the signs and symptoms of a urinary tract infection, and report them immediately if they occur. The client should also drink 3 L of fluid per day.