Gender Ethnicracial And Life Span Considerations

Pyelonephritis occurs more often in women than in men because the female urethra is much shorter than the male urethra. The incidence of pyelonephritis is highest in white females, and in particular adolescent and young adult females who are sexually active. Men, however, are more susceptible if they have an obstruction from prostatic hypertrophy, cancer, urinary stones, or urethral stenosis. Pyelonephritis is also seen in elderly men with indwelling catheters.

Pyelonephritis DRG CategoT

Mean LOS: Description:

^ ASSESSMENT

HISTORY. Question the patient carefully to determine if he or she has experienced dysuria, frequency, and urgency (signs of an irritative urinary tract) before seeking care. Ask if the patient is voiding in small amounts or experiencing nocturia. It is important to determine if these symptoms are a change from the patient's usual voiding patterns. Ask for a description of the urine, which may be foul-smelling, cloudy, or bloody, and of any pain; discomfort resulting from pyelonephritis usually occurs in the flank, groin, or suprapubic areas. Also question the patient about any flulike symptoms, such as malaise, nausea, vomiting, chills, headache, and fatigue.

The pain may radiate down the ureter toward the epigastrium and may be colicky if it is associated with a renal calculus.

PHYSICAL EXAMINATION. If you suspect acute pyelonephritis, determine if the patient is febrile. Inspect the urine for color, cloudiness, blood, or presence of a foul odor. Percussion or deep palpation over the costovertebral angle elicits marked tenderness. Not all of these signs may be present. Lower urinary tract symptoms are absent in approximately 15% of women. Flank pain, tenderness, and fever may also be absent. In chronic pyelonephritis, the early symptoms are minimal. Assess the blood pressure because often these patients present with hypertension. There may be irritating urinary tract symptoms, but they are milder in nature than in acute pyelonephritis.

PSYCHOSOCIAL. To prevent permanent kidney damage, acute and chronic pyelonephritis needs to be diagnosed promptly and treated appropriately. Assess the patient's ability to care for herself or himself, as well as her or his learning capabilities, support systems, financial resources, and access to healthcare. Identify and alleviate barriers to ensure a prompt, efficient plan of care to help the patient regain a sense of wellness.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Urine culture and sensitivity

Urinalysis

Negative cultures

Minimal red and white blood cells; moderate clear protein casts; negative for protein

Presence of bacteria Pyuria, leukocyte castes

Identifies bacterial contaminants; most common is Escherichia coli

Shows the presence of white blood cells and pus

Other Tests: Blood cultures; complete blood count; x-ray of kidney, ureter, bladder; blood urea nitrogen; creatinine; renal ultrasound; intravenous pyelogram; cystourethrogram

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