Lesson topic No. 22. Nursing process in acute and chronic pyelonephritis.

General information about the disease

This disease is common and is diagnosed in both children and adults. Most often it affects:

• people with a weakened immune system;
• aged people;
• young patients 6–7 years old;
• women during pregnancy.

Inflammation can act as a complication of a bacterial infection, and it does not matter where exactly the “focus” of inflammation is located (in the bronchi, lungs or oral cavity).

Pyelonephritis is often caused by the presence of stones in the urinary system. Stones irritate the kidney, causing inflammation. With a prolonged course of urolithiasis, the process becomes chronic and leads to changes in the structure of tissues.

The disease (in its chronic form) is considered a pathology; it leads to irreversible changes and can cause necrotic processes.

Against the background of pyelonephritis, a carbuncle often develops, in complex cases. If there is a significant disturbance in the outflow of urine, the kidney changes, resembles a “center” of infection, its cavities are filled with urine and pus.

Despite its widespread prevalence and easy diagnosis, the disease often becomes chronic and is caused by exacerbations. But even at these moments the patient may not pay attention to the characteristic symptoms, since they are weakly expressed.

Dulling the vigilance of patients, the chronic form of pyelonephritis leads to complications, against the background of which renal failure develops.

In the acute form of the disease, inflammation develops rapidly and vivid and specific symptoms occur. If pathological processes in the kidneys are not stopped, various complications will arise that can lead to death.

In the chronic form, the disease proceeds latently, without pronounced symptoms. Symptoms are disturbing only during periods of exacerbation.

Causes:

• infection by pathogenic microorganisms;
• systemic hypothermia;
• disruption of the outflow of urine from the pelvis;
• blockage of the ureters with stones.

Pyelonephritis is a dangerous bacterial disease; in order for it to appear, it is necessary to become infected:

• CHAPTER II. Nursing process for glomerulonephritis in children

• coli;
• staphylococcus;
• streptococcus;
• blue-purulent rod-shaped bacterium.

It is these microorganisms that cause the disease; they enter the kidney capsule, causing its inflammation. They can clog the parenchyma with the blood flow, causing pathological changes in the functioning of the organs of the urinary system.

What antibiotics are prescribed for kidney pyelonephritis?

A very large number of people were faced with the question: what antibiotics to take for pyelonephritis? This disease is very common in all segments of the population and affects both adults and children. What kind of illness is this, how is it treated and what drugs help overcome the disease?

Inflammatory processes in the kidneys

The kidneys are one of the most important organs and, as medical practice shows, they are most often susceptible to ailments of varying severity. Kidney diseases appear due to impaired metabolic processes, autoimmune failures or the development of inflammation. The latter type includes pyelonephritis, which affects the area of ​​the kidneys responsible for the function of collecting and excreting urine.

The most vulnerable to the disease are children 7-8 years old (due to the anatomical characteristics of the body), as well as women capable of childbearing.

There are two types of pathology development:

• when pathogenic bacteria enter the kidneys from the bladder;
• the infection is transferred to the organ through the general circulatory system.

Once in the kidney, the microorganism actively produces hostile molecules - antigens, thereby provoking a reaction from the immune system. Having received a signal of danger, it sends neutrophils - white blood cells, whose job is to destroy pathogenic bacteria. But in this situation, they strike not only the products of metabolic processes of bacteria, but also the cells of the organ. This occurs because the immune system perceives damaged tissue as abnormal.

This whole process leads to the development of inflammation with corresponding symptoms and consequences.

The main signs of pyelonephritis include:

• high temperature (up to 39 °C);
• rapid heartbeat (tachycardia);
• discomfort when breathing (shortness of breath);
• spasms of superficial blood vessels (chills);
• sharp pain in the lumbar region;
• headache;
• attacks of nausea.

In addition, among the first signs of pyelonephritis, a change in the color of urine can be noted; from yellow it can become red or green. A general analysis of urine will show an increased level of leukocytes - more than 18 units (the result is influenced by neutrophils excreted in the urine).

Examination of urine under a microscope reveals the presence of microorganisms and an increased number of neutrophil cells (neutrophilia).

This pathology is of two types: acute and chronic (it develops from an acute process due to sufficient elimination of the causative agent of the disease).

As with other diseases caused by pathogenic bacteria, treatment of pyelonephritis with antibiotics is mandatory. They are prescribed in all cases, except for violation of the outflow processes of urine.

Antibiotics for the treatment of pyelonephritis

Before prescribing a course of treatment, the doctor conducts a thorough diagnosis, which is aimed at recognizing the type of bacteria and subsequently confirming the existing disease.

For these purposes, biomaterial is usually taken to inoculate bacteria to determine their type and sensitivity to antibiotic drugs. The latter is associated with the selection of the most effective medicine.

Before the culture result is obtained, the doctor will prescribe broad-spectrum antibiotics suitable for the treatment of kidney inflammation:

1. Penicillins, more precisely from the category of piperacillins, are modern drugs belonging to the fifth generation. Their activity is manifested against both gram-positive and gram-negative bacteria. In the pharmacy you can find drugs of this group with the following names: Piperacillin sodium salt, Isipen, Piprax, Picillin, Pipracil. It is used in the form of intramuscular and intravenous injections.
2. Semi-synthetic drugs from the group of penicillin antibiotics are effectively used. Available in the form of an injection solution and tablets under the following trade names: Ampicillin, Zetsil, Ampicillin sodium salt, Pentrexil, Penodil, etc.
3. Cephalosporins are derivatives of 7-amylocephalosporic acid. There are several generations of these drugs, the most modern of which are the fourth generation. They are distinguished from their predecessors by a wider range of action. The 4th generation cephalosporin antibiotics include the following drugs: Cefanorm, Ladef, Cefepime, Cefomax, Tsepim, etc. They are available only in the form of an injection solution.
4. Drugs belonging to the group of fluoroquinolones are also effectively used to treat inflammation of the kidneys and bladder. These are third-generation drugs (Sparfloxacin, Levofloxacin) and a more modern fourth-generation drug - Moxifloxacin. Despite its fairly wide spectrum of action, it is highly toxic, so the course of treatment should not exceed 7 days.
5. Minoglycoside aminocyclitols are antibiotics of natural and semi-synthetic origin. Act on a narrow range of microorganisms. If we take into account the drugs of the latest (3rd and 4th generations), then these are Tobramycin, Sizomycin, Izepamycin. Most often prescribed for purulent pyelonephritis.
6. Antibiotics belonging to the group of beta-lactams and called carbapenems. They are highly effective and cope with many aerobic and anaerobic microorganisms. The drugs are administered intravenously. These include the following: Jenem, Meropenem (the most common among this group), Doriprex, Invasin.
7. Another large group of antibiotics with the active ingredient chloramphenicol. It is used, among other cases, for the treatment of kidneys. Its action is due to the destruction of bacterial protein synthesis. Among the drugs in this class you can find Nolicin, Leukomecin, Marmacetin, Otomycin, Paraxin, Stamycetan, Treomycin, Chlorbiotic, Chlorotsid and others.

As soon as the culture result is obtained, the doctor selects a new dosage of the drug, depending on the type of microorganism. Until the sensitivity test is ready, treatment is carried out with narrow-spectrum agents that act only on a certain group of bacteria.

If sensitivity to any antibiotic is determined, then all other medications are discontinued. Treatment with a suitable drug is carried out until the causative agent of inflammation is completely eliminated from the organ.

Remedies for acute forms of the disease

Remedies for acute pyelonephritis are selected as follows:

• for E. coli these are drugs from the groups of aminoglycosides, cephalosporins or fluoroquinolones (usually a 14-day course is prescribed);
• To get rid of the Proteus bacterium, antibiotics from the category of gentamicins, nitrofurans, aminoglycosides and ampicillins are taken;
• for enterococcus, combinations of drugs are effective: Ampicillin + Gentamicin; Levomycetin + Vancomycin.

Almost all antibiotics, especially in hospital settings, are used in the form of injections, most often into a vein. Thus, the active substances of the drug enter the kidneys in their entirety through the bloodstream, which means that patients with pyelonephritis will experience a faster recovery.

Requirements for drug therapy

As is known, broad-spectrum antibiotics are not particularly selective and affect the entire microflora of the body. That is why they are prescribed with caution and only in case of urgent need. What properties should the safest drugs from the group of antibiotics have:

1. They should not have a detrimental effect on damaged kidney tissue - the disease already puts a strain on this important organ, so additional damage will lead to dysfunction, and then to kidney failure.
2. The antibiotic should be excreted from the body in urine, since its sufficient concentration in the urine indicates effective treatment.
3. In the case of pyelonephritis, the effect will be from those drugs that have not bacteriostatic, but bactericidal properties. In the first case, the processes in the pathogenic bacterium will be disrupted, but the decay products will not leave the body. This means there is a high risk of relapse. Antibacterial drugs remove harmful organisms completely.

If we evaluate the positive dynamics of treatment with antibiotic therapy, then early and late criteria are taken into account.

The first includes the following:

• decreased body temperature;
• eliminating signs of intoxication;
• improvement of general condition;
• normalization of the cleansing and excretory activity of the kidneys;
• improvement of external indicators (color, transparency) of urine.

If these signs are present during the first two days, we can speak of a successful choice of drugs and their positive effect on kidney tissue.

Late criteria, which are assessed after 14-28 days, include the following indicators:

• cessation of high fever and chills;
• tests a week after the end of treatment show the absence of pathogenic bacteria in the kidneys.

If this result is obtained, it means that the antibiotic has completely removed bacteria from the kidneys and bladder. And the very last criterion is that after three months there is no re-infection.

In the absence of positive dynamics, when the antibiotic does not cope with the task, it is worth replacing the product or supplementing with antimicrobial drugs.

Possible complications

Antibiotics for pyelonephritis, as for any other disease, should only be prescribed by a doctor upon direct consultation.

There is a risk of nephrotoxicity, that is, negative changes in kidney tissue. It is especially dangerous for children, the elderly, and for patients with diabetes and renal failure. In this case, the doctor must be very careful in choosing the dosage and the drug itself.

While broad-spectrum antibiotics have a standard dosage, narrow-acting drugs require a more careful approach and dose selection. This is due to the fact that the amount of the drug less than necessary will allow the microorganism to adapt to its use. A large dose will damage not only the kidneys, but also the liver.

When taking a course of antibiotics, you can get intestinal upset; this happens with large doses of medication and long-term treatment. If you insert the syringe needle incorrectly when injecting, there is a risk of developing an abscess.

Do not forget about individual intolerance to drugs, which manifests itself in the form of an allergic reaction. And this threatens with itching, fever, and rash. In severe cases, this can lead to anaphylactic shock or angioedema.

Any medical procedure, including the administration of antibiotics, requires sterility, because microorganisms and infections can be transferred from the external environment.

An overdose of these drugs contributes to the development of toxic (metabolic) hepatitis, pancreatitis, or leads to impaired renal function - renal failure.

If the drug and dosage are selected correctly, the risk of complications is minimal; at most, side effects may appear, which all medications without exception have.

No matter what drugs are used to treat pyelonephritis, the main thing is that the recovery is effective, completely eliminates the causative agents of the disease and does not put unnecessary strain on the kidneys.

Selecting the necessary therapy for the treatment of pyelonephritis is very difficult, so only a specialist in this field should do this. Self-medication is strictly prohibited, as it can lead to serious complications and consequences.

Compliance with the conditions for the patient's stay in the hospital

A common condition for all diseases and a mandatory requirement is maintaining cleanliness in the room where patients are kept. Wet cleaning in the room must be done at least twice daily; the nurse’s task is to monitor compliance with this rule. In addition, the room must be ventilated twice a day. However, with pyelonephritis, patients should be especially careful about hypothermia and drafts. Therefore, the nurse must ensure that fulfilling one condition does not exclude compliance with the second.

Cleanliness must also be maintained in patient leisure areas, children's playrooms and general premises. If the patient uses a bedpan (children use a potty), or has difficulty holding urine, it is necessary to especially carefully monitor the cleanliness and dryness of bedding and underwear.

A patient with pyelonephritis should spend as much time as possible in a horizontal position, in a warm place. Bed rest is an indispensable condition for successful treatment in this case. Nursing care includes monitoring its implementation, ensuring conditions for good rest and night sleep, as well as maintaining silence in the ward.

Patients with pyelonephritis are prescribed a special diet. Products that help retain water in the body, such as sausage, salted fish, smoked meats, etc., are excluded from consumption. It is recommended to drink as much liquid as possible, mainly fruit and berry juices, decoctions, and herbal teas. The nursing process for pyelonephritis includes, among other things, monitoring the patient’s diet.

If necessary, the nurse talks with the patient’s relatives or parents, if we are talking about a child, explains to them the need to follow the doctor’s recommendations, in particular, following a diet. Makes sure that relatives, trying to please the patient, do not bring him products that are harmful to health. In addition, the nurse can talk with relatives about other topics related to the treatment process, report changes in the patient’s condition, etc.

To effectively carry out doctor’s orders, the nurse not only collects tests correctly and in a timely manner, but also ensures that the prescribed medications are administered to the patient according to the established schedule. In addition, she monitors the patient’s attendance at procedures and various manipulations, instructs him in advance on the procedure for carrying them out, and helps him prepare for them. She also records the results of procedures, changes in the dynamics of the disease and the patient’s condition, and reports all observations to the attending physician.

Studying the stages of nursing care for patients with pyelonephritis

The goal of nursing care is to ensure an acceptable quality of life for the patient depending on his condition, prevent, alleviate, minimize the patient's problems, help the patient and his family with maladaptation associated with the disease, support or restore the patient's independence in meeting basic needs.

Observation of a patient with pyelonephritis made it possible to study the stages of nursing care for this pathology.

Stage I. Collection of information about the patient, nursing examination.

Patient Smirnova E.I. was admitted to the surgical department of the Valuyskaya Central District Hospital. 45 years old, living in the village of Rozhdestveno.

Complaints: constant aching pain in the right lumbar region, increased body temperature with chills, general weakness, headache, decreased appetite, painful frequent urination, increased blood pressure to 160/90.

From the medical history it was found out that he had been ill for the 5th day. The disease began with pain in the right side and painful urination, an increase in body temperature to 38C. She consulted a doctor on the same day, but refused hospitalization. In the evening, the body temperature rose to 38.5C, which forced them to call an ambulance.

From the life history it was found that the woman often suffers from colds and suffers from chronic adnexitis. The work involves hypothermia, as he works as a seller at the market. Smokes, abuses spicy, salty foods.

Objectively: general condition is satisfactory, weight 96 kg, height 164 cm, body mass index - 36. Consciousness is clear. The patient's position is active. The facial expression is normal. Visible mucous membranes are pale pink and clean.

The skin is pale and dry. Visible mucous membranes are pale pink, no pathological changes were detected. Peripheral lymph nodes are not enlarged.

Subcutaneous fatty tissue is overdeveloped and evenly distributed. No pathology was detected from the respiratory and cardiovascular systems. Pulse 86 beats per minute, good filling and tension, rhythmic. Blood pressure 160/100 mm Hg. Art.

No pathology was detected from the gastrointestinal tract.

On the part of the urinary organs, a positive symptom of “tapping” on the right was revealed. Urination is frequent. There is no pastiness or swelling. The stool is not disturbed.

At stage II of the nursing process, we identified the patient’s disrupted needs and problems.

The patient's following physiological needs are impaired: maintaining body temperature, excreting, eating, sleeping, resting, communicating. Therefore, problems arise that require solutions: pain in the right lumbar region, increased body temperature, chills, weakness, headache, decreased appetite, painful frequent urination, increased blood pressure.

The priority problem is pain in the lumbar region on the right, fever, chills, dysuria, lack of information about the disease.

A potential problem is the risk of acute pyelonephritis becoming chronic.

At stage 3, a nursing care plan was developed, including goal setting. Short-term goal - the patient notes a decrease in pain and frequency of urination by the end of the week during treatment and care. The long-term goal is the cessation of pain, the disappearance of dysuric phenomena by the time of discharge from the hospital, and the acquisition of knowledge about risk factors leading to exacerbation of the disease. At stage 4, nursing care was provided for the patient.

Planning and implementation of nursing care included the following

actions (under the guidance of a nurse).

1. Organization and monitoring of compliance with bed rest during periods of fever, dysuria, and intoxication.

2. Control of wet cleaning and regular ventilation of the room. It is necessary to ventilate the room either in the absence of the patient, or by covering him warmly (in the cold season, you need to cover your head). The room should be warm, and the patient should be dressed warmly enough, always wearing socks. When cooling, especially the legs, the patient urinates more frequently;

3. Conducting a conversation about the diet, which includes strict adherence to diet No. 7, limiting salt intake to 3-5 g per day. Forced restrictions are often difficult for patients to tolerate, so it is necessary to explain with great patience that these measures are part of the treatment, that by “irritating” the kidneys with poor nutrition or consuming more than the right amount of salt, we will not be able to achieve the subsidence of the process, normalization of pressure, and therefore We will steadily bring the development of renal failure closer. They recommended foods high in carbohydrates: fruits, vegetables, cookies, slightly alkaline mineral waters, fruit drinks, compotes.

4. Change of bed and underwear. When sweating, it is necessary to promptly change underwear and treat the skin with a low concentration disinfectant solution.

5. Providing assistance with hygiene measures: taught the patient the correct washing technique.

6. Timely implementation of therapeutic and diagnostic interventions (as prescribed by a doctor):

- administration of antibiotics, painkillers, antispasmodics,

uterotonics, monitoring the patient’s medication intake;

— preparation for laboratory research methods: had a conversation about the need to conduct laboratory tests of urine; taught the rules for collecting urine and provided utensils for collecting urine;

— preparation for instrumental research methods: excretory urography.

The patient was informed about the upcoming procedure and the progress of its implementation, and the patient's consent was obtained. The patient was explained that before excretory urography, 3 days before excretory urography, it is necessary to exclude gas-forming products from the diet and empty the bladder immediately before the study. In the evening and morning before the study, the patient was given a cleansing enema.

7. Monitoring diuresis (daily measurement of daily diuresis and calculation of water balance (the ratio between the liquid drunk and urine excreted per day).

The patient is given a container that is comfortable for urination. It is necessary to prepare a measuring cup or other measuring utensils. Measurements begin in the morning. At 6 o'clock in the morning the patient empties his bladder. This urination is not taken into account in the measurement. Then, every time the patient wants to urinate, he does so in an appropriate container and then the urine is poured into a measuring cup to determine its volume. All urine excreted by the patient during the day is taken into account in the same way. The last measurement will be taken on the morning of the new day, at approximately 6 am. In parallel with this, the liquid taken is counted and recorded. It is necessary to take into account not only liquid in its pure form (tea, fruit juice, compote), but also soup and fruit. Normally, 65-75% of the ingested fluid is released. A decrease in these numbers indicates fluid retention in the body and the development of edema, and, conversely, an increase indicates excessive fluid loss, for example, when a patient takes diuretics. Depending on the course of the disease and diuresis data, an appropriate drinking regimen is prescribed. Most often, the calculation of the volume of required fluid (for edema, high blood pressure) is made as follows: the amount of urine excreted per day plus 400 - 500 ml. In patients with this form of chronic pyelonephritis, blood pressure should be measured in the morning and evening.

8. Monitoring of general condition: examination of the skin, counting pulse, respiratory rate, heart rate, measuring blood pressure. To assess the state in dynamics.

10. Conducting exercise therapy classes (to normalize metabolic processes and fulfill the body’s defenses).

11. Providing psychological support.

The nurse's actions in solving priority and potential problems are presented in Table 5.

Table 5

Actions of a nurse when solving priority problems of a patient with pyelonephritis

In the process of implementing the nursing care plan, short-term and long-term goals were achieved, pain symptoms were relieved, and diuresis

returned to normal, no complications of pyelonephritis were observed. Patient

received sufficient information about risk factors and disease prevention.

Before discharge, the patient was given the following recommendations:

— dispensary observation by a local therapist;

- anti-relapse treatment: within 10 days of every month

the patient must take one of the prescribed antibacterial drugs. A new drug is taken every month. In the intervals between taking antibacterial drugs, takes herbal decoctions (lingonberry leaves, birch buds, horsetail, kidney tea) - 10 days each decoction;

— streamline the work and rest schedule, limiting physical activity. Sleep should be at least 8 hours. Daytime rest of 30-40 minutes in a horizontal position is also important. These measures help reduce blood pressure, general weakness, and fatigue;

— diet: exclusion of spicy foods and spices;

- daily measurement of pulse, blood pressure, amount of fluid drunk and excreted, avoid stagnation of urine;

- avoid hypothermia, work in cold rooms, outdoors (especially in the cold season);

— the right choice of clothing: in the autumn-winter period, warm underwear and shoes;

— prevention of exacerbation of pyelonephritis: early detection and treatment of acute infectious diseases (tonsillitis, acute respiratory diseases, etc.), rehabilitation of chronic foci of infection (chronic tonsillitis, carious teeth).

Thus, the main points of nursing care for patients with pyelonephritis are compliance with bed or semi-bed rest during the acute period of the disease with its gradual expansion; maintaining a diet and drinking regime, ensuring sufficient rest and sleep; identifying signs of complications - the development of renal failure, informing the doctor about this; monitoring compliance with diet and treatment prescribed by a doctor, as well as identifying side effects of medications; training in the skills of monitoring general condition, including determining pulse, blood pressure, and urine output; preparing patients for additional research methods; conducting exercise therapy classes, providing psychological support.

Conclusion

Analysis of medical literature and the results of our own research allowed us to draw the following conclusions.

Pyelonephritis is one of the pressing problems of modern nephrology due to its high prevalence, the increasing frequency of latent forms and the lack of effectiveness of treatment.

The clinical picture of acute pyelonephritis (or exacerbation of chronic) is characterized by a sudden onset of the disease with the development of a triad of symptoms: increased body temperature with stunning chills and heavy sweating; pain of varying intensity in the lumbar region (unilateral or bilateral), which intensifies with palpation, walking, tapping in the area of ​​​​the projection of the kidneys (pain in the lateral abdomen is possible); pyuria or leukocyturia.

In the general structure of diseases of the urinary system in the Valuysk region, pyelonephritis ranks second after urolithiasis and occurs equally often in both the population of young working age and the population older than working age, while pyelonephritis more often affects women of childbearing age, which is explained by the anatomical physiological characteristics of the female urinary system. The main risk factors for the occurrence of pyelonephritis and exacerbation of the existing chronic process are hypothermia, occupational hazards, inflammatory diseases of the genitourinary system, urolithiasis, and surgical treatment.

The leading problem in care for pyelonephritis is the patient’s lack of knowledge about his disease, risk factors for exacerbations, possible adverse outcomes of the disease and measures to prevent it. Knowledge of the theoretical aspects of pyelonephritis and the stages of the nursing process contributed to the competent identification of the patient’s priority and potential problems, setting short-term and long-term goals, drawing up a plan and implementing nursing care. In the process of implementing the nursing care plan, short-term and long-term goals were achieved, complications of pyelonephritis were not observed, and the patient was discharged in satisfactory condition.

Currently, with appropriate therapy and correct behavior in relation to one’s health, the prognosis of the disease becomes favorable - it is possible to prevent the development of renal failure and create conditions for the patient to live a full life.

The hypothesis that knowledge of the theoretical foundations of pyelonephritis contributes to the competent identification of patient problems, planning and implementation of nursing care has been achieved.

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36. Fomkin, R.N. Encyclopedia of Clinical Urology [Text] / R.N. Fomkin. – M.: “Scientific Book”, 2010. -144 p.

Medical diagnosis before starting therapy

The treatment will be carried out by a nephrologist; when a specialist is not available, you should consult a urologist.

A number of studies will help diagnose the disease:

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• Ultrasound of the ureters and kidneys;
• analysis of biological secretions for biochemistry;
• extensive urography;
• Urine analysis for bacterial culture and sensitivity to antibiotics.

To identify the presence of stones in organs, structural changes, and foci of infection, CT or MRI may be recommended.

Types and symptoms of pyelonephritis

According to the nature of the disease, there are two types of pyelonephritis in medicine: acute and chronic. In primary pyelonephritis, the symptoms of the disease are mild: there is a feverish state. It is caused by increased body temperature, chills, general fatigue and lethargy, and nausea.

With secondary pyelonephritis, which is characterized by a significant disturbance in the outflow of urine, patients experience severe pain in the lower back against the background of a general deterioration in health and high temperature (up to 40°C). The pain may disappear over time, the temperature may drop to low-grade levels, which, however, does not indicate recovery - the symptoms appear again.

Chronic pyelonephritis also develops if the prescribed treatment was ineffective or not provided at all. It usually takes six months for the disease to become chronic. In case of chronic pyelonephritis, nursing process, medical care and hospital care are mandatory. Quite often, kidney disease that has become chronic makes itself felt not only by high fever and malaise, but also by the appearance of hematuria and hypertension. The combination of these symptoms leads to inevitable renal failure, and can subsequently lead to death.

How to treat pyelonephritis in children?

The basis of treatment for pyelonephritis is antibacterial therapy according to a standard regimen, which is applied until a specific infectious agent is isolated. After this, if necessary, the drug is replaced.

For mild cases of the disease, antibiotic syrups and suspensions intended for children are used. The course is continuous, designed for a period of 5 days to 3 weeks. The drug is replaced on days 7-10 or 14 of therapy.

To start treatment, the following are most often prescribed:

• Amoxiclav;
• Augmentin;
• Cefamandole;
• Cefuroxime;
• Ceftazidime;
• Cefotaxime.

In severe cases of the disease, combination antibiotic therapy using several drugs is indicated. After completing the course, uroantiseptics are prescribed.

Treatment of children under 2 years of age is carried out only in a hospital setting; at an older age, treatment at home is possible.

Additionally, the course of treatment includes drugs that improve blood microcirculation, sorbents for removing bacterial toxins and anti-inflammatory drugs. To improve urine flow, the use of antispasmodics and diuretics is recommended.

With long-term treatment with antibiotics, there is a risk of developing secondary fungal infections. In order to prevent such complications, patients are prescribed probiotics or prebiotics, and, if indicated, antifungal drugs .

Surgical treatment is indicated for the development of purulent processes that are not amenable to conservative treatment, as well as in the presence of mechanical obstacles to the normal outflow of urine. This is necessary to eliminate the prerequisites for recurrence of the disease.

To reduce the load on the kidneys, the patient is prescribed a gentle regime, in severe cases - bed rest. Changing the regimen is carried out according to the doctor's orders.

Stages of the nursing process for pyelonephritis

Therapy is carried out in a hospital, and a large part of it falls on the shoulders of nurses, their responsibilities include:

• care for the patient, provide him with plenty of fluids;
• control body temperature;
• monitor compliance with the regimen and doctor’s recommendations.

If we are talking about an elderly person or a child, the nurse must provide the patient with access to a bedpan or potty.

The staff monitors the progress of the disease and follows the doctor’s recommendations. Participates in setting up IVs or administering injections. The nurse should inform the doctor about any deterioration in the patient’s well-being, keep a temperature chart, and collect tests.

The effective work of a nurse is divided into several stages. By completing all the work, you can evaluate the overall effectiveness of patient care.

Collection of patient information

After the diagnosis is completed, the doctor prescribes treatment for the patient. The nurse should familiarize herself in detail with the patient’s chart, the type and classification of pyelonephritis, for further care.

• Lesson topic No. 24. Nursing process in chronic renal failure.

It is necessary to ask the patient about what exactly is bothering him, the symptoms and side effects of the disease:

• changes in urine;
• past illnesses;
• possible allergies and intolerances;
• interview relatives to find out details.

If necessary, additional tests should be prescribed to get a clearer picture.

It is important to clarify with relatives and the patient who to keep informed of what is happening during treatment. The patient himself or his relatives can make wishes and requests as therapy progresses.

Troubleshooting

With pyelonephritis, problems may arise in some physical disorders, because of this, the patient needs help, namely in measuring temperature, help with eating, urinating, or simply in spending leisure time.

Possible accompanying symptoms resulting from intoxication or inflammation:

• nausea and vomiting;
• chills and high temperature;
• severe headache and fatigue;
• lack of appetite;
• pain in the lower back, abdomen or urethral area;
• frequent and ineffective urge to go to the toilet;
• cloudy urine with flakes.

It is especially important for the nurse to monitor all the patient’s symptoms, since pyelonephritis with complications can go from acute to chronic and end in renal failure.

Care plan and implementation

The main goal of a nurse is to contribute to the rapid recovery of the person who sought help and to prevent complications.

It is imperative to ensure that the patient does not get out of bed during a fever. If this is a child, clear instructions must be given to parents.

The patient may need a bedpan, or a heating pad placed on the back or stomach can be used to relieve symptoms.

After diagnosing and collecting all the information, the nurse must designate a schedule for taking medications, procedures, eating the right food and monitor the implementation of all instructions.

Leisure organization

Leisure time in hospital treatment is very important, since a good mood also has a very positive effect on a person’s recovery, especially if it is a child.

A good book or a child’s favorite toy will help on a subconscious level to shorten the hospital stay.

But it is better to refuse computer or mobile equipment.

Creating comfortable conditions

A person who is in a hospital needs comfort, it is important that the nurse takes into account the wishes of an additional pillow or blanket, or, if possible, a bed near the window. Also in the room there should be a bedside table and a closet for personal belongings.

Mandatory conditions are:

• control over regular ventilation and cleaning of the ward;
• frequent change of bed linen;
• peace and quiet.

Sleep and rest are another important aspect of rapid recovery.

Providing assistance in carrying out hygiene measures

Children or older people often need help when taking a bath; when determining the patient’s needs, the nurse should immediately know who and when to come to the rescue.

Provide organization and control over diet and food intake

The diet is prescribed for both acute and chronic pyelonephritis. It involves avoiding the following products:

• spicy and salty foods;
• carbonated drinks;
• alcohol and caffeinated drinks;
• smoked and fried food.

In the acute type of the disease, protein intake is also limited. At the initial stage, light food is recommended, which is quickly digested.

The nurse must ensure that the kitchen in the hospital takes into account the needs or if food is brought by relatives, then the menu must comply with the requirements.

Follow doctor's orders

The doctor usually visits patients only once a day, in the morning. At the same time, he gives instructions to the nurse, which she in turn applies to help the patient, namely:

• administration of antibiotics at regular intervals;
• taking uroseptics in the prescribed dose;
• passing all tests;
• preparation for ultrasound, x-ray or other diagnostic methods.

Principles of nursing care

Nursing care for pyelonephritis is an important stage of treatment, including following doctor’s orders and monitoring the patient’s general condition.

The nurse after the patient is admitted to the hospital:

1. Informs about the hospital regime and upcoming procedures.
2. Informs about the need to donate biological material (blood, urine, feces).
3. Provides and monitors the timely collection and sending of biological material for research to the clinical laboratory.
4. Informs about the need, as well as the methodology for undergoing instrumental studies of the kidney, which are carried out to monitor the state of health, as well as the dynamics of recovery.
5. Informs about the need for physical procedures, ensures and controls their completion.
6. Prepares the patient for a study or physical procedure.
7. Monitors compliance with doctor's recommendations regarding nutrition and bed rest.
8. Provides emotional and psychological support to the patient.
9. Provides first aid in case of deterioration of health.
10. Monitors the patient's health problems and informs the attending physician about them.

Maintaining a protective treatment regime

This is the creation of conditions for nursing throughout the entire period of treatment in a hospital, adequate care.

This includes:

• monitoring compliance with the cleanliness regime by junior medical personnel;
• creating psychological comfort for patients, especially children;
• providing adequate nutrition;
• correct implementation of the attending physician's prescriptions.

It is necessary to regularly (2 times a day) ventilate the room. Wet cleaning in the ward is carried out at least three times a day. Keep the vessel or pot clean. Linen should be fresh and clean, especially in patients with urinary incontinence. The room should be kept quiet, and the subject should be guaranteed adequate daytime and night sleep.

Leisure organization

The country's legislation provides for compulsory secondary education for children, including those receiving treatment. A nurse in a pediatric nephrology or urology department monitors young patients’ attendance at regular classes with teachers assigned to the hospital and homework.

If we are talking about babies, then the nursing process for pyelonephritis involves performing educational functions. Here, both the organization of leisure activities and games allowed for patients with pyelonephritis, as well as maintaining the cleanliness of the playroom are important.

Providing medication treatment

The nursing process for chronic and acute inflammatory processes in the kidneys includes providing patients with the necessary medications, monitoring their intake, collecting tests and preparing for instrumental examination.

The main direction of treatment of infectious-inflammatory kidney disease is the use of antibacterial, uroseptics, painkillers and antispasmodics, the choice of which is made by the attending physician based on data obtained during diagnostic procedures.

The nurse is responsible for:

• providing patients with necessary medications;
• intramuscular or intravenous administration of antibacterial, antispasmodic, painkillers;
• control of oral drug intake;
• conducting a conversation with the patient or his parents about the need to use prescribed medications and their effectiveness;
• providing information about possible contraindications and adverse reactions that may occur as a result of taking medications.

Attention! The intake and administration of medications is carried out strictly by the clock, at regular intervals. If adverse reactions occur, the nurse informs the attending physician about the need to change the drug.

Treatment of chronic pyelonephritis

Treatment for exacerbations of chronic pyelonephritis is carried out according to a scheme similar to that recommended for the acute form of the disease. For mild cases, outpatient treatment with cephalosporin or penicillin antibiotics is possible.

After eliminating the acute phase, the patient is prescribed anti-relapse treatment lasting from 4 weeks to several years. The duration of treatment is determined individually, depending on the nature of the pathogen, the general health of the patient and his response to treatment.

An important condition for relapse prevention is the elimination of obstacles to the outflow of urine.

If mechanical obstructions are present, the patient may require surgical treatment or bladder catheterization. If the cause of pyelonephritis is kidney stones, after their removal, a course of treatment is prescribed aimed at correcting metabolic processes in the body.

Neurogenic dysfunctions of the bladder are indications for prescribing appropriate drug treatment for a neurological disorder and a course of physiotherapeutic procedures to restore normal nervous regulation.

After eliminating the acute process, a course of treatment with antioxidant drugs is prescribed, in addition - herbal medicine .

For severe pyelonephritis in children under one year of age, treatment may be prescribed to strengthen the immune system. Indications for immunocorrective therapy are:

• Unusual or rare composition of pathogens;
• Ineffectiveness of antibiotic therapy;
• Purulent processes, aggravated by signs of multiple organ failure.

If kidney function is preserved, sanatorium-resort treatment is recommended, but not earlier than 3 months after the exacerbation has resolved.

Implementation of drug treatment

After the attending physician has made all the necessary instructions and prescribed the required medications, one of the most important tasks of the nurse is to administer medication to the patient. Her tasks also include collecting tests (general blood collection and blood collection for biochemistry), warning the patient about upcoming examinations, including informing about their correct completion (do not eat for 8 hours, use cleansing enemas, etc.).

Treatment of pyelonephritis is carried out with the help of antibacterial drugs and uroseptics, which stop inflammation in the kidneys. If pain is present, painkillers and antispasmodics can also be used. The nursing process for glomerulonephritis and pyelonephritis is to provide patients with medications. Every day, the nurse dispenses the required amount of prescribed medications, and also regularly administers intravenous and intramuscular injections of antibacterial and other drugs. Among other things, the nurse must warn the patient about possible side effects from taking medications and urgently inform the doctor if they actually occur.

Features of caring for the elderly and children

The nursing process for pyelonephritis in the elderly has its own key features. Elderly patients are not always able to feed themselves, perform hygiene procedures, or go to the toilet. Therefore, if the patient has certain problems with the implementation of motor processes, the nurse should provide all possible support. This could include feeding with a spoon, wiping the face with a damp cloth, helping with washing and washing while half-bed rest.

Also, when caring for elderly patients, the nurse should pay special attention to regularly measuring vital signs: body temperature, pulse rate, and especially blood pressure. For a patient, being in a state of hypertension—high blood pressure—in combination with hematuria can result in the development of renal failure.

The nursing process for pyelonephritis in children also has its own characteristics. A big role here is played by competent organization of leisure time, without which a small patient may feel dissatisfied and depressed, which will negatively affect the productivity of treatment. Therefore, the nurse should talk with the child’s parents, ask them to bring their favorite toys, books, coloring books - everything that can entertain and cheer him up.

Monitoring dietary recommendations

Nursing care for pyelonephritis includes following the doctor's recommendations regarding nutrition and drug treatment. The nurse conducts a conversation with the patient or his parents (if the patient is a minor) regarding the need and features of the recommended diet.

In case of acute pyelonephritis, the patient must follow a dairy-vegetable diet, eat fruits and vegetables that are rich in carbohydrates. If a child has no appetite and refuses to eat, the sister asks the parents not to force feed him.

During treatment of inflammatory pathology of the urinary organs, it is necessary to strictly observe the drinking regime. The daily volume of liquid consumed (water, mineral water, fruit drinks, compotes, herbal teas and decoctions) during therapy should exceed the age norm by 2.5 times.

Subject to following these recommendations and careful monitoring by a nurse, the patient will quickly cope with the signs of intoxication of the body, restore water and electrolyte balance, which will lead to an improvement in general condition.

Diagnostics

To make a diagnosis of pyelonephritis, a urologist-nephrologist interviews the patient and refers him for tests and instrumental examination.

During the survey, the doctor determines the symptoms, their duration and the presence of other chronic diseases and pathologies of the urinary organs.

The patient donates blood for a general clinical and biochemical study. The results allow us to determine the patient’s condition and the presence of an inflammatory process. General clinical and bacteriological analysis of urine helps to diagnose the inflammatory process in the urinary organs. If the levels of protein, salts, or urea change, the doctor assumes urolithiasis and other pathologies of the urinary system that precede pyelonephritis.

To confirm the diagnosis, the patient undergoes an ultrasound examination of the kidneys with Dopplerography, MRI, X-ray diagnostics, and secretory urography. Based on the data obtained, the doctor determines a plan of treatment and nursing care for the patient.

Diagnosis of the disease

Before starting the nursing process for pyelonephritis, it is necessary to collect an anamnesis. The nephrologist interviews the patient (in the case of treating a child, his parents) regarding the course of the disease and disturbing symptoms. If pyelonephritis is suspected, the patient should undergo tests such as:

• general and biochemical blood test;
• Ultrasound of the urinary system;
• urography;
• urine test for bacterial culture.

After the necessary information has been collected, the doctor draws up a treatment plan. If the patient or his family members have questions, the doctor must answer them. He also provides consultation regarding the timing of therapy and its main points. After the patient is admitted to the hospital, the work of the nurses begins.

Beginning of nursing care

The first stage of the nursing process for pyelonephritis is a conversation with a new patient regarding the daily routine and upcoming procedures and tests. The second stage is a secondary diagnosis of the patient. It consists in identifying factors that can negatively or positively affect the treatment process. The nurse also answers the patient's possible questions and takes into account his wishes.

Based on the testimony of the attending physician and a conversation with the newly arrived patient regarding his well-being and main complaints, the nurse develops a written plan of care. Identifying key issues and assessing future prospects allows the nurse to formulate a plan of care that also contains specific goals. The main goal of the nursing process for pyelonephritis, as with any other disease, is to achieve positive results in the case of nursing intervention.

In addition to the main goal, the nurse must consider and consider two other types of important tasks: short-term and long-term. Usually, short-term goals are achieved during the period of time that the patient is in the hospital. Long-term goals are achieved by the patient himself after discharge from the hospital. They are aimed more at rehabilitation, so they are not always given priority.

Third and fourth stage

In the third stage, after diagnosing the patient and defining goals, a plan of care is created. It, in fact, is not only a written guide that helps the nurse coordinate their actions and save time, but also a kind of report for monitoring the patient’s condition and the material costs of his treatment.

The fourth stage involves the direct implementation of nursing care and support. The nursing process for pyelonephritis in children and adults includes providing assistance with daily activities and needs. For example, a nurse should help the patient get dressed, wash or brush his teeth, and go to the toilet.

What is pyelonephritis

Pyelonephritis is a pathology of an infectious nature, involving the parenchyma and pyelocaliceal system of the kidneys in the inflammatory process. The acute form of the disease develops acutely with a sharp increase in body temperature, difficulty urinating, and sharp pain in the lumbar region. Chronic pyelonephritis is characterized by a long course. Changes in urine levels are observed throughout the year.

Attention! The cause of pyelonephritis is infectious agents (staphylococcus, E. coli). The infection penetrates the kidneys through the bloodstream, lymph, and through the lower urinary organs.

The development of pathogenic microorganisms occurs against the background of unfavorable factors:

• stress, depression, emotional stress;
• decreased immunity;
• chronic diseases;
• poor nutrition;
• sedentary lifestyle;
• diseases of the urinary organs (urolithiasis, narrowing of the lumen of the ureter, anomalies in the structure of the valves, tumor neoplasms).

Pyelonephritis - medical history

Pyelonephritis refers to a non-specific inflammation, which in most cases is caused by gram-negative bacteria present in the normal bacterial flora.

Most often, the inflammatory process is caused by representatives of the coccal flora and the so-called uropathogenic strains of Escherichia coli. As a rule, one type of bacteria is detected in the urine; a mixed infection is relatively rare.

When several types of pathogens are detected the analysis is repeated , since mixed infections are relatively rare, and the analysis error is often associated with a violation of the urine collection technique.

Read our article on how to properly collect urine for analysis.

Some gram-positive bacteria can also be causative agents.

ureaplasma and chlamydia, but such cases are rare.
Candidal pyelonephritis is sometimes detected in children with severe immunodeficiency conditions.
The infectious agent enters the kidney through the bloodstream, and less often through lymph. In children, the main route of infection is ascending. The most common sources of infection are the genitals and large intestine.

The risk of pyelonephritis increases with the need for antibiotic therapy, which often leads to profound changes in the species composition of the microflora and the predominance of potentially dangerous opportunistic species and strains.

Nursing process and diet

It is extremely important for the nurse to monitor the patient's compliance with the principles of proper nutrition. In case of acute and chronic pyelonephritis, the patient is prescribed a special diet - table No. 7 (7a, 7b), which consists of reducing the amount of table salt (up to 6 grams) and protein (up to 70 grams) entering the body daily. The daily volume of fluid consumed is also limited - the amount of fluid received must be equal to the amount excreted.

The nursing process for acute pyelonephritis in children, as in adults, is to provide patients with fractional meals in the hospital (4-6 times a day). The nurse should pay special attention to the dishes and products that the patient consumes. With pyelonephritis, it is prohibited to consume large quantities of salt-containing products: various pickles, smoked meats, canned food, sauces and seasonings. It is advisable to minimize the amount of fat used in dishes; you should also give preference to lean meat and fish.

Sources used:

• https://urohelp.guru/pochki/pielonefrit/sestrinskij-uxod.html
• https://vsepropechen.ru/pochki/bolezni-02/pielonefrit/sestrinskij-uxod-pri-pielonefrite.html
• https://fb.ru/article/412588/sestrinskiy-protsess-pri-pielonefrite-u-detey-i-vzroslyih-etapyi-i-printsipyi
• https://tvoyapochka.ru/prochee/sestrinskij-protsess-pri-pielonefrite

General conclusion

Pyelonephritis is a serious kidney infection that in most cases requires hospitalization and treatment in a hospital setting. Its acute variety is dangerous because there is a possibility of its transformation into chronic, which, however, rarely happens with proper treatment and care. Everyone is susceptible to the disease: children, adults, and the elderly. Often, pyelonephritis develops against the background of difficulty in passing urine, which is associated with kidney stones and prostatitis, as well as against the background of infection in the urinary tract.

With pyelonephritis, the nursing process is an extremely important condition for treatment in a hospital. It consists of five stages, the first two of which consist of a comprehensive examination and diagnosis of the patient, as well as conversations with him and his relatives regarding future treatment. The next two stages represent direct nursing care, which manifests itself in informing the patient about future tests and examinations, performing injections and various procedures, including hygienic ones. The last, fifth stage, is the stage of the final assessment of nursing care, which is based on the patient’s response to treatment and the results of control tests and examinations. After discharge from the hospital, the patient is observed by a nephrologist.