Acute pyelonephritis is a potentially organ- and/or life-threatening infection that
characteristically causes some scarring of the kidney with each infection and may lead to
significant damage to the kidney (any given episode), kidney failure, abscess formation (eg,
nephric, perinephric), sepsis, or sepsis syndrome/shock/multiorgan system failure.
Diagnosing and managing acute pyelonephritis is not always straightforward. In the age range of
5-65 years, it typically presents in the context of a symptomatic (eg, dysuria, frequency, urgency,
gross hematuria, suprapubic pain) urinary tract infection (UTI) with classic upper urinary tract
symptoms (eg, flank pain, back pain) with or without systemic symptoms (eg, fever, chills,
abdominal pain, nausea, vomiting) and signs (eg, fever, costovertebral angle tenderness) with or
without leukocytosis.
-Keep the genital area clean by wiping from front to back, it helps
reduce the chance of introducing bacteria from the rectal area to the urethra.
-Drink more fluid 64-128 ounces. This encourage frequent urination and
flushes bacteria from the bladder.
-Encourage proper food handling preparation.
-Do handwashing before and after urinate.
-Do not delay urination when it is necessary
Special considerations
Patient care is supportive during antibiotic treatment of the underlying infection.
Administer antipyretics for fever.
Encourage fluids to achieve urine output of more than 2,000 ml/day. This helps to empty the
bladder of contaminated urine. Don’t encourage intake of more than 2 to 3 qt (2 to 3 L) because
this may decrease the effectiveness of the antibiotics.
Provide an acid-ash diet to prevent stone formation.
Teach proper technique for collecting a clean-catch urine specimen. Be sure to refrigerate or
culture a urine specimen within 30 minutes of collection to prevent overgrowth of bacteria.
Stress the need to complete prescribed antibiotic therapy, even after symptoms subside.
Encourage long-term follow-up care for high-risk patients.
To prevent acute pyelonephritis:
Observe strict sterile technique during catheter insertion and care.
Instruct females to prevent bacterial contamination by wiping the perineum from front to back
after defecation.
Advise routine checkups for patients with a history of urinary tract infections. Teach them to
recognize signs of infection, such as cloudy urine, burning on urination, urgency, and frequency,
especially when accompanied by a low-grade fever.
Book Source Details
Book Title: Professional Guide to Diseases (Eighth Edition)
Author(s):S p r in g h o u s e
Year of Publication:2 0 0 5
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005
Lippincott Williams & Wilkins.
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