3. PYELONEPHRITIS A bacterial infection in the kidney and renal pelvis- the upper urinary tract. It is either the presence of active organisms in the kidney of the effects of kidney infections. an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis.
4. ACUTE PYELONEPHRITIS CHRONIC PYELONEPHRITIS results from repeated or continued upper urinary tract infection or the effects of such infections. involves chronic inflammation and scarring of tubules and interstitial tissues of the kidney. common cause: renal failure other causes: UTI’s, hypertension, severe vesicoureteral reflux, obstruction of the urinary tract. is the active bacterial infection. It involves acute intestinal inflammation, tubular cell, necrosis, and possible abscess formation. results from an infection that ascends to the kidney from the lower urinary tract. risk factors: pregnancy, obstruction, and congenital malformation onset is typically rapid.
17. Urine culture and sensitivity tests may be ordered to identify the infecting organism and the most effective antibiotic. Culture requires 24 to 72 hours, so treatment to eliminate the most common organism is initiated without culture. Related nursing care: Provide client with sterile container. After cleaning, tell client to begin voiding and collect specimen in a clean container. If client is unable to void, it may be necessary to obtain a specimen with a urinary catheterization.
18. Intravenous pyelography(IVP), also know as excretory urography, is used to evaluate the structure and excretory function of the kidneys, ureters, and bladder. As the kidneys clear and intravenously injected contrast medium from the blood, the size and shape of the kidneys, their calices and pelvises , the ureters, and the bladder can be evaluated, and structural or functional abnoramilities, such as vesicoureteral reflux, may be detected. Related nursing care before the procedure: Ask about allergy to seafood, iodine, or radiologic contrast dye. Notify physician if allergies are known. Withhold food for 8hours prior to test. Clear liquids are allowed. Laxative and enema or suppositories are use to clear the bowel of feces and gas. Obtain baseline vital signs and record. After the test Monitor vital signs and urine output. Increase fluid intake after the test is completed.
19. Voiding cystourethrographyinvolves instilling contrast medium into the bladder, then using x-rays to assess the bladder and urethra when filled and during voiding. This study can detect structural or functional abnormalities of the bladder and urethral strictures. This test has a lower risk of allergic response to the contrast dye than IVP. Related nursing care: Tell the client that the bladder will be filled and during filling, he/she will be ask to describe the first urge to void, and the sensation of being unable to delay urination any longer.
20. Manual pelvic or prostate examinations are done to assess for structural changes of the genitourinary tract, such as prostatic enlargement, cystocele, or rectocele.
22. Nursing Diagnosis Acute pain related to infection and inflammatory process in the urinary tract. Rationale: Pain is a common manifestation of both lower and upper UTI. Urinary tract pain is caused by distention and increase pressure within the tract. The inflamed bladder wall and urethra causes dysuria, pain and burning on urination. Bladder spasms develop causing severe, stabbing discomfort. Pain associated with pyelonephritis is often steady and dull, localized to the outer abdomen or flank region.
23. Nursing Diagnosis Impaired urinary elimination related to inflammation as evidenced by: frequency, urgency and dysuria. Rationale: Inflammation of the bladder and urethral mucosa affects the normal process and patterns of voiding, causing frequency, urgency, and dysuria.
24. Nursing Diagnosis Deficient knowledge related to lack of information about risk factors for pyelonephritis. Rationale: Clients with pyelonephritis is at an increase risk for future UTI and needs to understand the disease process, risk factors, measures to prevent the current infection, diagnostic procedures and home care. Failure to complete the full course of therapy and follow-up could lead to continued bacteriuria and recurrent infections.
35. ACUTE GLOMERULONEPHRITIS Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. Inflammation of the glomerular capillary membrane. It can result from systemic diseases or primary glomerular diseases. Most common form: Acute streptoccocalglomerulonephritis.
36. ACUTE GLOMERULONEPHRITIS Post streptococcal AGN. Primary glomerular diseases include IgA nephropathy, mesangial proliferative disease, membroproliferative disease, and antiglomerular basement membrane disease. Infectious causes include staphylococcus bacteremia, pneumococcal bacteremia, meningococcemia, and mycoplasma. Viral causes include hepatitis A, Influenza A and B, Adenovirus, EBV, cytomegalovirus, measles, and mumps. Multi-system diseases include SLE, Henoch-Schonleinpurpura (HSP), necrotizing fasciitis, Goodpasture syndrome, Wegener granulamatosis, TTP, hemolytic uremic syndrome, and cryoglobunemia.
39. Diagnostic Erythrocyte sedimentation rate (ESR) – is a general indicator of inflammatory response. It maybe elevated in acute post-streptococcal glomerulonephritis. KUB (kidney, ureter, bladder abdominal x-ray) – may be done to evaluate kidney size & rule out other causes of manifestations. The kidneys maybe enlarged in acute glomerulonephritis. kidney scan – a nuclear medicine procedure, allows visualization of the kidney after intravenous administration of a radioisotope. In glomerulonephritis, the uptake & excretion of radioactive material are delayed.
40. Related nursing care: - assess the client for allergies to iodine, x-ray dye & seafood - tell the client to remain NPO for 4hrs. Prior to test - laxative or enemas to remove gas or fecal material from the bowel Biopsy – most reliable diagnostic procedure for glomerular disorders. It helps to determine the type of glomerulonephritis, the prognosis, & the appropriate treatment. It is done percutaneously by inserting a biopsy needle through the skin into the kidney to obtain a tissue sample.
41. Related nursing care before the procedure: - NPO status from midnight before the procedure - inform consent is required for kidney biopsy - instruct the patient not to breathe when the needle is inserted to prevent kidney motion After the procedure: - monitor closely for bleeding during the first 24hours. - monitor urine output for quantity. - avoid coughing & strenuous activities after the procedure.
42. Blood Urea Nitrogen (BUN) – measures urea nitrogen, the end product of protein metabolism. Normal BUN values: 5-25mg/dl. Urinalysis – shows RBC & proteins in the urine of clients with glomerular disorder. A 24hr urine specimen is use to determine the amount of protein in the urine. Normal value: <2-3/HPF, no RBC casts
44. Nursing Diagnosis Excess fluid volume related to plasma protein deficit in sodium & water retention Rationale: When proteins are lost in the urine, the oncotic pressure of plasma falls, fluid shifts into the interstitial spaces. The body response to this fluid shift by any sodium & water to maintain intravascular volume, leading to excess fluid volume.
45. Nursing Diagnosis Fatigue related to plasma protein loss & anorexia Rationale: Fatigue is a common manifestations of glomerular disorders. Anemia , loss of proteins, anorexia compound this fatigue. The ability to maintain usual physical & mental activities are impaired.
46. Nursing Diagnosis Risk for infection related to compromised immune system secondary to medical treatment Rationale: The effects of both glomerular & treatment with anti-inflammatory & cytotoxic drugs can depress the immune system, increasing the risk for infection. The anti-inflammatory effects of corticosteroid may also mask early manifestations of infections.
53. Chronic Glomerulonephritis Typically the end stage of other glomerular disorder. Slow, progressive distraction of the glomeruli & a gradual decline in renal function are characteristics of chronic glomerulonephritis. Kidneys decrease in size symmetrically & their surfaces become granular. Eventually, entire nephrons are lost.
54. Etiology No evidence of predisposing infection can be found The course of chronic glomerulonephritis is extremely varied.
56. Assessment Common signs & symptoms – not oftenly recognized until s/sx of renal failure develop. Neck vein distention from fluid overload Periorbital and peripheral edema Feet slightly swollen at night Weightloss and nocturia Headache especially in the morning, dizziness and GI disturbances – most common Dyspnea on excertion (DOE) Blurring of vision
57. Diagnostics Urinalysis – fixed specific gravity of 1.010, variable proteinuria and urinary casts Blood studies related to renal failure progression : hyperkalemia, metabolic acidosis, anemia, hypoalbuminemia, electrolyte – imbalances Chest X-ray: cardiac enlargement and pulmonary edema ECG: may reflect left ventricular hypertrophy Impaired nerve conduction; mental status changes
59. Nursing Diagnosis Excess fluid related to destruction of glomeruli and decrease renal funtion Rationale: In chronic glomerulonephritis, kidneys cannot excrete adequate urine to maintain a normal extracellular fluid balance. Rapid weight gain and edema indicate fluid retention. In addition, heart failure and pulmonary edema may develop.
60. Nursing Diagnosis Imbalance nutrition: Less than body requirements related to inability to absorb CHON and nutrients secondary to renal insufficiency Rationale Anorexia associated with chronic glomerulonephritis often interere with food intake and nutrition. Nutrition needs is further aggravated because of the progressive destruction of the glomeruli. Kidneys decrease in size and their surfaces become roughened, impairing renal function.
61. Nursing Diagnosis Ineffective role performance related to fatigue & muscle weakness Rationale: Manifestations and treatments of glomerular disorders can affect the ability to maintain usual roles and activities. Fatigue and muscle weakness may limit physical and social activities.
66. Dialysis – to minimize the risk of complications of renal failure - to keep patient in optimal physical condition - to prevent fluid and electrolyte imbalances
67. Nursing Interventions B. Nursing Management Record inatake and output q4-8 hrs Report changes in fluid and electrolyte status, and in cardiac and neurologic status Educate patient about prescribed treatment plan and risk of non-compliance Instruct recommended diet and fluid modifications; provide medication teaching. Provide patient and family assistance about dialysis and long-term implications.
