Last updated on May 17th, 2022 at 01:30 pm
Pyelonephritis Nursing Care Plans Diagnosis and Interventions
Pyelonephritis NCLEX Review and Nursing Care Plans
Pyelonephritis, more commonly known as kidney infection, is a form of urinary tract infection (UTI) that starts in the urethra or bladder and spreads to one or both kidneys.
Pyelonephritis necessitates immediate medical intervention as it can permanently damage the kidneys if not treated appropriately, or the bacteria can spread to the bloodstream and can cause a more life-threatening infection.
The urinary tract is the body’s drainage system in normal conditions. It includes two kidneys, two ureters, a bladder, and a urethra. Healthy kidneys purify the blood 24 hours a day, seven days a week, these two bean-shaped organs are located at the middle of the back, just below the ribs.
One kidney sits on each side of the spine. The kidneys are the primary filter in the body. Every day, the kidneys clean around 150 gallons of blood. It produces roughly 1-2 quarts of urine per day by drawing water and waste from the blood, Urine usually flows from the kidneys to the bladder and then out the urethra.
The kidneys may not function well when they are damaged. Mild or acute kidney injury can be easily reversible. However, major damage to the kidneys may require medical treatment such as dialysis. The treatment for pyelonephritis may require hospitalization and usually includes the use of antibiotics.
Symptoms of Pyelonephritis
Signs and symptoms of pyelonephritis may include:
- Fever
- Chills
- Back, side (flank) or groin pain
- Abdominal pain
- Frequent urination
- Strong, persistent urge to urinate
- Burning sensation or pain when urinating
- Nausea and vomiting
- Pus or blood in the urine or hematuria
- Urine that smells bad or is cloudy
Severe pyelonephritis can lead to life-threatening complications. It is strongly recommended to seek immediate medical attention if the symptoms include a combination of severe nausea, vomiting, and bloody urine.
Causes of Pyelonephritis
- Bacteria. Pyelonephritis is most commonly caused by bacteria, It can multiply and migrate to the kidneys if they enter the urinary tract through the urethra.
- Infected prosthetic joint or heart valve. Bacteria from an infection elsewhere in the body can potentially move to the kidneys through the bloodstream.
- Complication of kidney surgery. Pyelonephritis may be a rare complication of kidney surgery.
Risk Factors of Pyelonephritis
- Pyelonephritis can be related to a number of factors, including:
- Gender. Women’s urethras are shorter than men’s, making it simpler for bacteria to enter the bladder from outside the body. Because the urethra is so close to the vagina and anus, bacteria have an increased likelihood to reach the bladder. An infection in the bladder can extend to the kidneys. A kidney infection is considerably more likely in pregnant women.
- Obstruction in the urinary tract. An obstruction includes anything that slows the flow of urine or makes it difficult to empty the bladder while urinating, such as a kidney stone, a structural abnormality in the urinary tract, or an enlarged prostate gland in males.
- Weakened immune system. It is a condition in which the body’s defenses are compromised. Medical disorders that affect the immune system, such as diabetes and HIV, fall into this category. Certain medications, such as those used to prevent transplanted organ rejection, have a similar effect.
- Nerve damage around the bladder. Nerve or spinal cord damage can block the sensations of a bladder infection so that it is unremarkable that it’s advancing to a kidney infection.
- Prolonged use of a urinary catheter. Urinary catheters are tubes that are used to empty the bladder of urine. During and after various surgical procedures and diagnostic testing, a catheter may be placed. If the patient is confined to a bed, it may be used all the time.
- Vesicoureteral reflux. A condition that causes urine to flow in the wrong direction, small amounts of urine from the bladder flow back up into the ureters and kidneys in vesicoureteral reflux, people with this syndrome are more likely to get pyelonephritis during childhood and adulthood.
Diagnosis of Pyelonephritis
To confirm pyelonephritis, some tests may be done, such as:
- Medical History – An assessment will be done to determine the onset and severity of symptoms and general health history.
- Urine Tests – Urinalysis or urine culture is done to check the presence of bacteria, blood or pus in the urine.
- Blood Tests – A blood sample is taken for a culture, a laboratory test to check bacteria or other organisms present in the blood.
- Voiding Cystourethrogram – This procedure is done by injecting a contrast dye to take X-rays of the bladder when full and while urinating.
- Kidney Ultrasound- May be performed to create images of kidneys and ureters to show if there are wounds or stones that block the urinary tract.
Treatment for Pyelonephritis
- Medication. In the case of Pyelonephritis, antibiotics are the first line of defense. The classification of antibiotics and the duration of the medication is based on the health and bacteria found in the urine test. The signs and symptoms should usually cure up after a few days of treatment. However, antibiotics may be required for a week or more. Then, a repeat urine culture may be recommended to check that the infection has resolved.
- Hospitalization. For severe Pyelonephritis, hospitalization may be advised. Antibiotics and fluids may be administered through a vein in the arm as part of the treatment (intravenously). The length of hospital stay is determined by the severity of the condition.
- Treatment of recurrent kidney infection. Kidney infection can be caused by an underlying medical condition such as a misshaped urinary tract. In that situation, the patient may be referred to a nephrologist, a kidney specialist, or a urologist for evaluation. A structural abnormality may require surgery.
Prevention of Pyelonephritis
- Increase fluid intake. Fluids particularly water can aid in the removal of microorganisms from the body when urinating
- Urinate when needed. When there is the urge to urinate, avoid delaying urination.
- Empty the bladder after intercourse. Urinating as quickly as possible after intercourse helps to eliminate bacteria from the urethra, lowering the chance of getting an infection.
- Wipe carefully. After urinating or having a bowel movement, it is advised to wipe from front to back to prevent bacteria from migrating to the urethra.
- Avoid using feminine products in the vaginal area. Using deodorant sprays or douches in the genital area can be irritating.
Nursing Diagnosis for Pyelonephritis
Pyelonephritis Nursing Care Plan 1
Acute Pain
Nursing Diagnosis: Acute Pain related to the infection or inflammation of the urinary tract including the urethra, bladder, and other urinary tract structures secondary to Pyelonephritis, as evidenced by burning urination, decreased physical activity, guarding behavior, lower back and bladder area spasm.
Desired Outcomes:
- The patient will be able to use pharmacological and nonpharmacological strategies to relieve pain.
- The patient will be able to report a remarkable pain control at less than 3 to 4 on a scale of 0-10 level.
- The patient will be able to report relief or total absence of pain.
| Pyelonephritis Nursing Interventions | Rationale |
| Assess the patient’s pain description, including the quality, nature, and degree of the pain. | Burning when urinating, flank pain, lower abdominal or suprapubic pain are all symptoms of pyelonephritis. Some patients with persistent infections, on the other hand, are asymptomatic. This information will aid in the choice of intervention. |
| Examine the patient for symptoms of pyelonephritis. | Dysuria (painful, burning sensation, or difficult urination), urine frequency and urgency, and nocturia or voiding two or more times at bedtime are all common indications and symptoms of pyelonephritis. Excess white cells in the urine and bleeding of the irritated bladder wall can also cause pyuria or bad-smelling or murky urine and hematuria or bloody urine. |
| Monitor the patient’s laboratory and diagnostic studies as indicated: -WBC count -Urinalysis -Bacteria in the urine -Urine culture and sensitivity -Computed tomography -Ultrasound and kidney scans | Increased WBC count is a systemic response to infection. Urinalysis or urine culture is used to assess for pyuria, bacteria, and blood cells in the urine that is associated with the inflammation process during infection. Colony count of greater than 100,000 CFU/mL of urine during a clean-catch midstream or catheterized specimen indicates infection, although lower counts may also indicate UTI. Urine culture and sensitivity test is used to identify the infecting organism and to determine the most effective and suitable antibiotic. Additionally, a test for sexually transmitted infections is performed if acute urethritis is suspected. CT Scan is used for detecting renal calculi, pyelonephritis, and abscess. Ultrasound is used for detecting obstruction, abscesses, tumors, and cysts. |
| Apply a heating pad to the patient’s lower back or suprapubic area. | Heat applied to the perineum might help reduce pain and spasms. |
| Encourage the patient to increase the oral fluid intake, unless contraindicated. | Increasing fluid consumption to 2 to 3 liters per day aids urine production, dilutes urine, relieves bladder irritation, improves renal blood flow, and flushes microorganisms from the urinary system. |
| Encourage the patient to void on a regular basis and when the urge is felt. | To avoid bladder distention, lower bacterial urine counts, reduce urine stasis, and prevent reinfection, frequent voiding every 2 to 3 hours to completely empty the bladder is recommended. |
Pyelonephritis Nursing Care Plan 2
Impaired Urinary Elimination
Nursing Diagnosis: Impaired Urinary Elimination related to urinary urgency, frequent urination, and hesitancy secondary to pyelonephritis, as evidenced by pain during urination.
Desired Outcomes:
- The patient will be able to achieve normal urinary elimination patterns including the absence of urinary urgency, oliguria, and pain during urination.
- The patient will be able to demonstrate effective methods to prevent urinary infections.
| Pyelonephritis Nursing Interventions | Rationale |
| Instruct the female patient to wipe from front to back. | This method prevents bacteria from spreading from the anal region to the vagina and, eventually, the urethra. Perineal hygiene helps to reduce the risk of contamination and recurrent infection. |
| Advise the patient to drink cranberry juice as recommended. | Cranberry juice (approximately 8 to 10 oz) is helpful in preventing and controlling pyelonephritis symptoms. Bacterial adhesion to uroepithelial cells in the urinary system has been demonstrated to be reduced. |
| Determine the patient’s age and gender. | Pyelonephritis is more common in females than in males in younger ages, but the difference narrows as they get older. Pyelonephritis affects about one in every five women at some point in their lives. Because of anatomical defects and decreased bladder tone, older persons are more likely to get pyelonephritis caused by inadequate bladder emptying. |
| Limit the use of indwelling bladder catheters for the patient when managing incontinence as possible. | The use of a catheter greatly raises the risk of pyelonephritis. Each day that a urinary catheter is inserted, the risk of catheter-associated pyelonephritis rises. Regular toileting, for example, can help avoid infection. If an indwelling catheter is required, adhere to stringent guidelines to avoid infection and urosepsis. |
| Examine the patient’s urinary pattern. The following considerations may be included in an assessment and physical examination: -Inquiring about the presence of symptoms such as frequency, urgency, dysuria, and nocturia in the client. -Identifying whether or not there is pain in the bladder area. -Identifying the urine’s properties. Take note of the color, cloudiness, and if there is a foul odor. -Identifying the frequency and volume of urine. How much and how often does the patient do it. | Can assist in identifying characteristics that may predispose a patient to pyelonephritis and serve as a basis in choosing relevant interventions. |
Pyelonephritis Nursing Care Plan 3
Hyperthermia
Nursing Diagnosis: Hyperthermia related to inflammation and infectious process secondary to Pyelonephritis, as evidenced by an increase in body temperature on an above normal range and a flushed warm-to-touch skin, increased heart rate, and body malaise.
Desired Outcomes:
- The patient will be able to maintain a core temperature that is within the normal range.
- The patient will be able to blood pressure and heart rate within normal limits.
| Pyelonephritis Nursing Interventions | Rationale |
| Assess the patient for signs and symptoms of increased body temperature, Advise the patient to report the signs and symptoms particularly excessive perspiration, hot and dry skin, or being too hot. | Sweating, shivering, headaches, heated skin, and general malaise are all signs of an elevated body temperature. |
| Monitor the patient’s Vital Signs particularly the temperature, as indicated. | To determine the necessary intervention. |
| Provide a tepid sponge bath as needed. | A non-pharmacological measure to allow evaporative cooling is a tepid sponge bath. Alcohol should not be used because it might quickly chill the skin and produce shivering. |
| Encourage the patient to increase oral fluid intake. | Fluid will help to avoid dehydration brought on by a rise in temperature. |
| Encourage the patient to use a hypothermia blanket and the use of bath towels to wrap the extremities when feeling cold. | When the body temperature needs to be lowered quickly, use cooling blankets that circulate water. To prevent shivering, set the temperature regulator to 1°C below the client’s current temperature. |
| Advise the patient to maintain adequate sleep and rest periods in between activities. | Adequate rest is necessary to cut down on metabolic demands and oxygen usage. |
| Administer antipyretic medications as needed. | Medications will help in bringing the body temperature down rapidly. |
| Monitor the patient’s pulse rate and blood pressure. | As hyperthermia advances, the heart rate and blood pressure increase. |
| Measure and document the patient’s temperature accurately every hour or as often as indicated, or if the patient’s condition changes. | Making accurate treatment decisions and assessing temperature changes will be easier if there is a consistent monitoring of temperature. If necessary, use two temperature monitoring modes. When compared to core temperature methods, all non-invasive methods for measuring body temperature have accuracy and precision variations unique to each type and approach. |
| Adjust and monitor environmental factors as necessary such as the patient’s room temperature and bed linens. | The room temperature may be regulated to a close match to the patient’s body temperature, blankets and linens may be altered as needed to keep the patient warm. |
| Provide adequate nutritional support for the patient. | Hyperthermia causes higher energy demands and a high metabolic rate, which necessitates the consumption of food. Because fever causes a loss of appetite, the food must be appealing to the patient. |
Pyelonephritis Nursing Care Plan 4
Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to unknown background, nature, and treatment of urinary tract infection secondary to pyelonephritis, as evidenced by multiple questions about the disease, recurrent urinary tract infection, and giving inaccurate information about the disease.
Desired Outcome: The patient will be able to verbalize knowledge of pyelonephritis’ causes and treatments, manage the risk factors, and complete the medical treatment.
| Pyelonephritis Nursing Interventions | Rationale |
| Explain to the patient the causes of pyelonephritis how to prevent them, and the necessary treatment. | UTI recurrences and the current occurrence of pyelonephritis on a regular basis could suggest that the patient is having trouble understanding the disease and adhering to the prescribed treatment plan. |
| Instruct the patient about measures on how to avoid pyelonephritis and other urinary tract infections. Interventions may include: Perform recommended hygienic measures such as showering rather than bathing in a tub. Bacteria may enter the urethra in the bathwater. Encourage the patient to void when an urge is felt. Because it can result in the stasis of urine when the urge to void is neglected. Advise the patient to perform perineal hygiene every after a bowel movement. This will help in preventing the migration of the bacteria in the urethral opening and in the vaginal opening in women. Explain the importance of frequent bladder emptying. It will prevent bladder distention and promote adequate blood supply to the bladder wall. Advise the patient to use tampons for periods. Sanitary napkins keep the bladder opening area drier, hence limiting the growth of bacteria. Thus, tampons are advised during menstruation.Advise the patient to avoid wearing tight-fitting or constricting undergarments made of non-cotton or non-breathing materials. These fabrics can increase moisture which can provide an environment for bacterial growth. Cotton fabric and loose-fitting clothing are encouraged. | The purpose of patient education is to resolve the current infection and prevent it from recurring. |
| Assess the patient’s ability to learn and apply new information. | Self-efficacy is a term that describes a person’s belief in their own capacity to execute a task. Increased self-efficacy in the learner’s ability to learn the necessary information or skills may be the first step in health teaching about urinary health. |
| Establish an environment with mutual respect, openness, trust, and collaboration. | When educating the patient about the disease the patient may have varying values and views about health and illness, demonstrating respect is extremely important. |
| Include the patient in the development of the teaching plan, beginning with the establishment of learning objectives and goals at the start of the session. | Setting goals allows the patient to anticipate what will be discussed and what the patient can expect throughout the session. Adults tend to focus on the “here-and-now” rather than working on achieving small goals towards better health. |
Pyelonephritis Nursing Care Plan 5
Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to acute lower back pain and difficulty in urination secondary to pyelonephritis, as evidenced by facial grimace, guarding behavior, limited movements, and inability to perform activities of daily living.
Desired Outcomes:
- The patient will be able to perform activities of daily living.
- The patient will verbalize relief from pain or total absence of pain.
| Pyelonephritis Nursing Interventions | Rationale |
| Assess the patient’s understanding of the causes of activity intolerance related to pyelonephritis. . | Causative elements might be physical or psychological, and they can be transitory or permanent. Identifying the cause will assist the nurse in guiding the nursing intervention |
| Determine the patient’s nutritional need, including the fluid intake | During physical exertion, adequate energy reserves are required and adequate fluid intake will help in resolving the problem. |
| Examine the patient’s emotional reaction to physical activity restrictions. | Depression brought on by an inability to do things can be stressful and frustrating. |
| Establish an activity guideline with goals and involve the patient and the significant others in the planning. | When the patient is involved in goal-setting, it boosts motivation and collaboration. |
| Assess the patient’s need for additional assistance at home. | When it comes to aiding the patient in conserving energy, coordinated efforts are more meaningful and effective. |
| Allow the patient to do the activity at a slower pace, for a longer period of time, with more rest or pauses, or with assistance if needed. | It aids in the development of activity tolerance. |
| Advise the patient not to engage in non-essential activities or procedures. | Patients with low activity tolerance should focus on the most vital tasks first. |
| Provide a commode at the bedside of the patient | Using a commode consumes less energy than using a bedpan or walking to the restroom. Thus, it will promote adequate urinary elimination. |
| Encourage the patient to engage in physical exercise that is appropriate for his or her energy level. | Helps to foster a sense of independence while remaining realistic about the limitations. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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