Pyelonephritis

  1. General information
    1. Inflammation of the renal pelvis; may be unilateral or bilateral, acute or chronic
    2. Acute: infection usually ascends from lower urinary tract
    3. Chronic: thought to be a combination of structural alterations along with infection, major cause is ureterovesical reflux, with infected urine backing up into ureters and renal pelvises; result of recurrent infections is eventual renal parenchymal deterioration and possible renal failure
  2. Medical management
    1. Acute: antibiotics, antispasmodics, surgical removal of any obstruction
    2. Chronic: antibiotics and urinary antiseptics (sulfanomides, nitrofurantoin); surgical correction of structural abnormality if possible
  3. Assessment findings
    1. Acute: fever, chills, nausea and vomiting; severe flank pain or dull ache
    2. Chronic: client usually unaware of disease; may have bladder irritability, chronic fatigue, or slight dull ache over kidneys; eventually develops hypertension, atrophy of kidneys.
  4. Nursing interventions: acute pyelonephritis
    1. Provide adequate comfort and rest.
    2. Monitor I&O.
    3. Administer antibiotics as ordered.
    4. Provide client teaching and discharge planning concerning
      1. Medication regimen
      2. Follow-up cultures
      3. Signs and symptoms of recurrence and need to report
  5. Nursing interventions: chronic pyelonephritis
    1. Administer medications as ordered.
    2. Provide adequate fluid intake and nutrition.
    3. Support client/significant others and explain possibility of dialysis, transplant options if significant renal deterioration.

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