Pyelonephritis
Disease aka kidney
infection - more
serious infection
UTI in bladder
spreads up the
ureters and to
the kidneys**
If that
infection
gets bad
enough it
can
migrate &
sort of
climb up
the Ureters
to infect
the
kidneys.
Causes Urinary
retention -
BPH -
Holding
urine too
long - nurse
bladder
Kidney
stones -
renal
calculi - can
hold back
urine –
Foley
catheters -
E Coli -
MOST
COMMON –
bacteria in
colon gets
into urethra
- Wiping
back to
front -
scrapes
ecoli into
urethra
S/S CVA:
Costoverte
bral
tenderness
Dull flank
pain that
extends to
umbilicus**
**
Low back
and flank
pain
Bladder
spasms
Burning
during
urination
Frequency
Urgency
Hesitancy
and
nocturia
Cloudy and
foul-
smelling
urine
Fever/Chills
Tachycardia
Question:
Pt reporting
dysuria and
frequency
… which
test does
the nurse
anticipate
to be
ordered? -
Urine
culture
Complicati
ons:
Confusion,
UTI -
quickly
turns into
urosepsis -
infection in
the blood
that infects
the brain
Diagnosti Cloudy & Tip***Assest 1st
cs and smelly Interventions 2nd
Lab Work Urine
WBC
Nitrites
Bacteria
BUN and
Creatinine
Increased
CRP and
ESR
Increased
(Inflammati
on)
Urine
Culture &
Sensitivity -
Over
10,000
organisms/
ml
Cultures
FIRST then
antibiotics
Treatmen Cranberry Juice—encourage it
t and Antibiotics: (acidifies urine)
Managem Sulfonamid
ent es &
Levofloxaci
n
Antipyretics
Give
analgesics
for the pain
Intervent Increase NO Douching –
ions Fluid Intake NO Spermicidal contraceptive –
2000 mL NO Perineal deodorants –
water daily NO Synthetic fabrics “Nylon” “Spandex” –
– NO Bubble Baths –
Void after Wipe FRONT to back
sex
Take
cranberry
supplement
s
Avoid:
Caffeine &
Alcohol
Nursing Interventions:
Assess vital signs.
Hyperthermia is a response to infection to kill the microorganisms. Poorly
treated infection may result in hypotension and tachycardia as a result of the
vasodilation that occurs in the inflammatory response.
• Assess pain level.
Back, flank, or groin pain is a diagnostic indicator of pyelonephritis.
Continued pain assessment helps evaluate pain-control efforts.
• Laboratory analysis
• Assess urinalysis and urine culture
Urine tests are the primary diagnostic tool for pyelonephritis. The urinalysis
would indicate pyuria, bacteriuria, and hematuria. A urine culture will help
identify the pathogen.
• Complete WBC count
A complete WBC count reveals leukocytosis and immature cells, indicating
infection.
• Blood cultures
Positive blood cultures indicate septicemia, an infection within the
bloodstream.
Actions
• Administer prescribed antibiotics as ordered.
Administering prescribed antibiotics is important in eradicating the pathogen.
Following the prescribed antibiotic regimen helps to reduce antibiotic
resistance.
• Administer prescribed pain medications.
Following the prescribed medications helps in providing comfort to the
patient.
• Provide adequate hydration, PO or IV as ordered.
Adequate hydration is important in maintaining good urine flow to avoid
urine stasis. Hydration may also be necessary to maintain adequate
circulating volume in the face of vasodilation associated with inflammation.
■ Teaching
• Explain the disease condition to the patient and family.
It is important that the patient and family can detect early signs and
symptoms of pyelonephritis in order to obtain treatment in the early stages,
avoid the use of more aggressive antibiotic therapy, reduce antibiotic
resistance due to lack of knowledge regarding prescribed medication
regimen, and prevent further complications such as chronic pyelonephritis.
• Instruct the patient and family on how to avoid UTIs (Box 62.1).
Instructing the patient and family on avoidance of frequent UTIs helps to
prevent complications such as chronic
