Nursing 4 Lecture 4 Pyelonephritis

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ncappadonia
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Nursing 4 Lecture 4 Pyelonephritis
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2012-02-03 23:15:21
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Nursing 4 Lecture 4 Pyelonephritis
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  1. Pyelonephritis
    -Bacterial infection in the kidney and pelvis (upper urinary tract)

    -Most common causing organism is e-coli
  2. Key Features of Acute Pyelonephritis:
    • -Fever, chills, tachycardia, and tachypnea
    • -Flank, back, or loin pain
    • -Abdominal discomfort
    • -Nausea and vomiting
    • -Burning, urgency, frequency, nocturia
    • -General malaise or fatigue
    • -Tender costal vertebral angle (CVA)
  3. Assessing CVA Tenderness:
    To elicit CVA tenderness, have the patient sit upright facing away from you or have him lie in a prone position. Place the palm of your left hand over the left CVA, then strike the back of your left hand with the ulnar surface of your right fist (as shown). Repeat this percussion technique over the right CVA. A patient with CVA tenderness will experience intense pain.

    • -Gently palpate, inspect both sides for symmetry, edema, and redness
    • -An advance practical nurse would then percuss each area
  4. Key Features of Chronic Pyelonephritis:
    • -Hypertension
    • -Inability to conserve sodium
    • -Decreased concentrating ability
    • -Tendency to develop hyperkalemia and acidosis
  5. Assessment: Patient History
    • -Ask about a history of UTI's, diabetes, stone disease, and defects of the genitourinary tract
    • -Ask if the UTI's occured w/ pregnancy, and ask the patient about any previous episodes of pyelonephritis or similar sx
    • -Ask about disease or treatment that causes immunosuppression because they can also increase the rx for pyelonephritis

    *Recurrences are common and may lead to a decline in renal function
  6. Assessment: Physical/Clinical Manifestations
    • -Ask about specific manifestations of acute pyelonephritis
    • -Chronic pyelonephritis has a less dramatic presentation, with manifestations related to the infection of kidney function
    • -Ask the patient to describe any vague or non specific urinary sx or abdominal discomfort
    • -The pt w/ chronic often has bacteriuria that causes no sx
    • -Inspect the flanks and gently palpate the CVA for enlargement, asymmetry, edema, or redness: all of which indicate inflammation
  7. Assessment: Psychosocial
    • -Embarrassment
    • -Anxiety
    • -Guilt

    All often associated with sexual habits or practices, may deleay seeking reatment, may be vague with answers.
  8. Assessment: Laboratory
    • UA:
    • -Shows a positive leukocyte esterase and nitrate dip stick test and the presence of WBC's and bacteria

    The urine is cultured to determine whether a gram-negative or gram-positive organism are causing the infection
  9. Assessment: Imaging
    • -KUB and IV urography to diagnose stones or obstructions
    • -These procedures define urinary tract structures and identify defects such as stones, tumors, structural defects, prostate enlargement, and urine reflux caused by incompetant bladder-ureter valve closure
  10. Assessment: Other Diagnostic Testing
    • -Examine urine for antibody coated bacteria and helps identify patients that need long term antibiotic therapy
    • -The gallium scan can identify active pyelonephritis to abcesses in or around the kidney
  11. Nonsurgical Management: Drug Therapy
    • Antibiotics:
    • -Start with broad spectrum
    • -After C&S results return, a more specific drug may be prescribed
    • -Urinary antiseptic drugs (nitrofurantion-Macrodantin) may be prescribed to provide comfort
  12. Nonsurgical Management: Diet Therapy
    • -Involves ensuring nutritional intake has adequate calories for all food groups to ensure healing
    • -Fluid intake is recommended at 2 to 3 liters per day unless other health problems require restrictions
  13. Surgical Management
    • Pyelolithotomy:
    • -Stone removal from the kidney

    • Nephrectomy:
    • -Removal of a kidney
    • -LAST RESORT when all other attempts to rid the infection have failed

    • Ureteroplasty:
    • -Ureter repair or revision
  14. Community-Based Care
    • Home Care Management:
    • -Patient may need assistance with self-care, nutrition, and drug management at home

    • Health Teaching:
    • -Drug regimen, role of nutrition, need for balance of rest and activity, manifestation of disease recurrence, use of coping mechanisms

    • Health Care Resources:
    • -Home health nurse
    • -House keeping services

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