PYELONEPHRITIS
DEFINITION
Kidney infection (pyelonephritis) is a specific type of urinary
tract infection (UTI) that generally begins in your urethra or bladder and
travels up into your kidneys.
pathways
SIGNS and
symptoms
Pyelonephritis may start with similar symptoms. However, once the
infection has spread to the kidney, signs of more severe illness usually
result:
· Back pain or
flank pain
· Fever (usually present)
and/or chills
· Feeling sick
(malaise)
· Nausea and
vomiting
· Confusion (especially
in the elderly)
Pyelonephritis may cause noticeable changes in the urine, such as:
· Blood in the urine
(hematuria)
· Cloudy or
foul-smelling urine
· Pain when urinating
·
Increased frequency or urgency of urination
CAUSES
· Most cases of pyelonephritis start off as lower urinary tract
infections, mainly cystitis and prostatitis.
· Typically occurs when
bacteria enter your urinary tract through the tube that carries urine from your
body (urethra) and begin to multiply.
· Bacteria from an
infection elsewhere in your body also can spread through your bloodstream to
your kidneys.
· Bacteria found in
stool (such as E. coli or klebsiella) are most common
· When urine flow slows
or stops, bacteria can more easily travel up the ureters. Some causes of urine
obstruction include:
- Benign prostatic hypertrophy (BPH)
- Abdominal or pelvic masses (as from cancer)
- Stones in the bladder,
ureters, or kidneys
classification
ACUTE PYELONEPHRITIS
DEFINITION
Acute pyelonephritis is a sudden and
severe kidney infection. This condition causes the kidneys to swell, can
permanently damage the kidneys, and can even be life threatening.
SIGN & SYMPTOM
Symptoms usually
appear within one to two days after the infection begins. They may be different
in children and the elderly than they are in adolescents and non-elderly
adults.
RISK FACTOR
· Women more prone to
kidney infections than men.
· The elderly also have
an increased risk of kidney infections.
· People with
suppressed immune systems, such as those with diabetes, AIDS or
cancer.
· There are also other
factors that can make you vulnerable to infection, such as:
©
undergoing a cystoscopic examination,
©
having urinary tract surgery,
©
having an enlarged prostate,
©
certain medications,
©
nerve or spinal cord damage
DIAGNOSTIC TEST & IMAGING STUDIES
In the outpatient setting, pyelonephritis is usually
suggested by a patient’s history and physical examination and supported by
urinalysis results.
Urinalysis can include the following:
· Dipstick leukocyte
esterase test (LET) - Helps to screen for pyuria
· Nitrite production
test (NPT) - To screen for bacteriuria
· Examination for
hematuria (gross and microscopic) and proteinuria
Imaging studies :
·
CT Scan - To identify alterations in
renal parenchymal perfusion; alterations in contrast excretion, perinephric
fluid, and nonrenal disease, gas-forming infections, hemorrhage, inflammatory
masses, and obstruction
· Magnetic resonance
imaging (MRI) – To detect renal infection or masses and urinary obstruction, as
well as to evaluate renal vasculature
· Ultrasonography - To screen for
urinary obstruction in children admitted for febrile illnesses and to examine
patients for renal abscesses, acute focal bacterial nephritis, and stones (in
xanthogranulomatous pyelonephritis)
· Scintigraphy - To detect
focal renal abnormalities
· CT and MR urography - Used in the
evaluation of hematuria
TREATMENTS
·
Antibiotics are the first course of action against acute pyelonephritis.
·
If the type cannot be identified, a broad-spectrum antibiotic will be
used.
·
Although treatment can cure the infection within two to three days, the
medication must be taken for the entire prescription period, usually 10 to 14
days. Antibiotics options are:
© Levofloxacin
© Ciprofloxacin
© Co-trimoxazole
© Ampicillin
·
Recurrent kidney infections may result from an underlying medical
problem. Surgery may be needed to remove any obstructions or correct any
structural problems in the kidney that are causing the problem.
COMPLICATIONS
·
Chronic kidney disease
·
Recurring kidney infections
·
The infection spreading to areas around the kidneys
·
Acute kidney failure
·
Kidney abscess
CHRONIC PYELONEPHRITIS
DEFINITION
Chronic inflammation
of the renal parenchyma and pelvis resulting from bacterial infection that
often associated with a kidney stone or with narrowing of the urinary
passageways.
ETIOLOGY
Chronic infection of the kidney
resulting from vesiculourethral reflex or obstruction.
CLINICAL MANIFESTATION
Most
patients with non – obstructive chronic pyelonephritis do not have specific
symptomatology of the disease and present with the sequaele of hypertension or
end – stage renal disease. Significant urologic symptoms usually occur in
patients with obstruction.
DIAGNOSTIC TEST
Radiographic –
kidney with non – obstructive ( reflux ) chronic pyelonephritis are small with
localized thinning of renal cortex and clubbing / dilatation of underlying
calyces. Obstructive chronic pyelonephritis produces diffuse thinning of the
renal cortex and uniform dilatation of calyces ( secondary to hydronephrosis
).
TREATMENT
Treatment of infection
and correction of underlying defect are dialysis or renal transplantation in
patients with end – stage renal disease.
COMPLICATIONS
· Papillary necrosis
· Acute renal failure
· Chronic renal failure
· Kidney stones
· Hypertension in 30% of patients after more than 9-10 years of
evolution.
NURSING DIAGNOSIS
Nursing Diagnosis: Acute pain related to disease process
Goal: Patient complain the
pain is minimal
1) Assess sign and
symptoms of pain
R : Assessment allows for care plan modification , as needed
2) Help patient into a
comfortable position and use pillows to splint or support painful areas
R: To reduce muscle tension or spasm and to redistribute
pressure on body parts
3) Encourage patient to
do diversional therapy such as listening music, reading
R: To reduce their concern about the pain
4) Provide patient with
information to help increase pain tolerance for example reason for pain and
length of time it will last
R: This educates patient and encourages compliance in trying
alternative pain-relieves measures
5) Administer analgesic
medication when alternative methods of pain control inadequate
R: To reduce patient pain
6) Advise patient to urinate every 2-3
hours
R: To prevent the build up of urine in the
urinary vesicles and cause patient pain
7) Palpation of the bladder every 4 hours
R: To determine the presence of bladder
distention and if it happen patient will feel pain
Nursing Diagnosis: Hyperthermia related to disease process
Goal: Patient fever will be reduce
1) Monitor and document temperature 2
hourly
R: For monitor patient health status
2) Remove blankets / excessive clothing
if necessary
R: To reduce heat in the body
3) Encourage patient to drink plenty of
water at least 8 glasses per day
R: Patient heat will be excrete through urine
and fever will be reduce
4) Perform tepid sponging if patient
temperature 39o above
R: To reduce patient heat
5) Promote good ventilation with switch
on the air conditioner
R: Patient will feel more comfortable and
heat will be reduce
6) Administer antipyretic as prescribed
R: To reduce fever
7) Administer antibiotic as prescribed
R: Patient fever because of infection, so
give antibiotic can reduce patient fever
Nursing Diagnosis : Knowledge Deficit related to Less
Expose To The Disease
Goal: Patient knowledge
will be increase and able to understand about their disease
1) Asses the client’s understanding
R : We can know if patient understand about
their diseases
2) Expose client to other patients with same
disease.
R : To reduce clients anxiety
3) Always explain to client whenever
providing some procedure to them
R : They do not know what us doing so must explain to reduce
their anxiety
4) Teach patient about sign and symptoms of
pyelonephritis
R: If patient know the sign and symptoms ,patient can seek the
doctor early
5) Encourage family member to participate
R : Client will feel more comfortable if have family member
REFERENCES
BOOKS
- Sharon.L (2011). Medical Surgical Nursing, (Ed 8th) United States of America : Elsevier Mosby
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