Pyelonephritis

Presented by Kim Stunkard, RN

For Introduction to Masters NUR 5200

Introduction of Pyelonephritis

Type of bacterial or viral urinary tract infection (UTI) affecting one or both kidneys

Affects those with chronic UTIs and those with structural defects in the urinary tract

At risk populations include pregnant women and those with diabetes

Pathophysiology
Bacteria or virus introduced in the urethra Bacterial or viral infection (most commonly Escherichia coli) begins in bladder and moves up the urinary tract to the renal pelvis, tubules, and interstitial tissue (Cash, 2011) Left untreated or poorly managed, can lead to sepsis as infection moves from kidney to bloodstream Chronic inflammation secondary to infection leads to formation of scar tissue which leads to kidney disease and eventual kidney failure

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PATIENT PRESENTATION

Subjective Findings
Patient complaints include chills, flank pain, and urinary frequency or urgency (Cash, 2011) Less common complaints include nausea, headache, and shortness of breath

Objective Findings
Clinician observations dehydration, guarding, respiratory distress secondary to pain Physical exam findings palpation with tenderness around affected kidney Vital signs fever, orthostatic hypotension, tachycardia Clinical presentation of sepsis

Gold Standard Diagnostic Guideline

Urinalysis with findings hematuria and elevated leukocytes (Bethel, 2012) Computed tomography (CT scan) to observe for renal inflammation Blood cultures with lactate level to rule out sepsis

INTERVENTIONS

Pharmacological

Antibiotic therapy

Fluid resuscitation

Analgesics

(Colgan, 2011)

Non-pharmacological
Encourage fluid intake with water and cranberry juice (Cash, 2011) Alternative pain management approaches

Patient Education and Prevention

Diet
Water, maintain fluid status

Urination habits
Urinate when urge arises Front to back

Clothing
Cotton underwear Avoid tight clothing

(NKUDIC, 2013)

Case Study
A twenty-seven year old woman presents to emergency department with complaints of severe left flank pain and fever. Her vital signs in triage are: Temperature 101.3 F, Blood pressure 114/65, Heart rate 97, Respiratory rate 24, Oxygen saturation 99% on room air, Pain is 6 out of 10.

What testing do you suspect the physician will order?

Case Study, cont.

The physician orders a urinalysis, CBC and blood cultures. He also orders an IV with NS @100ml/hr. The urinalysis reveals gross hematuria and elevated leukocytes. The CBC shows WBCs at 15,000/mm>3. What nursing interventions can you make at this point? What concerns might you have about this patients condition? What treatment options do you suspect the physician will make?

Conclusion
Pyelonephritis is an infectious condition which is easily treated with antibiotic therapy. It can be quite painful and can lead to further issues such as sepsis and kidney failure if not treated. Education on prevention is important, especially in at-risk populations such as pregnant women.

References
Bethel, J. (2012). Acute pyelonephritis: risk factors, diagnosis and treatment. Nursing Standard, 27(5), 51-56. Cash, J. & Glass, C. (2011). Family practice guidelines (2nd ed.). New York, NY: Springer Publishing Company, LLC. Colgan, R., Williams, M., & Johnson, J. (2011). Diagnosis and treatment of acute pyelonephritis in women. American Family Physician, 84(5), 519-526. National Kidney and Urologic Diseases Information Clearinghouse. (2009). How can recurrent UTIs be prevented?. Retrieved from http://kidney.niddk.nih.gov/kudisease/pubs/utiadult/#prevention