Primary Nursing Diagnosis

Infection (urinary tract) related to instrumentation, contamination, or obstruction

OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Nutritional status; Treatment behavior: Illness or injury

INTERVENTIONS. Infection control; Infection protection; Medication prescribing; Nutritional management; Surveillance; Nutritional management; Infection control

^ PLANNING AND IMPLEMENTATION Collaborative

The goal of therapy is to rid the urinary tract of the pathogenic organisms and to relieve an obstruction if present. The antibiotics chosen depend on the urine culture and sensitivity. Urinary catheterization is used only when absolutely necessary. Surgery is performed only if an underlying defect is causing obstruction, reflux, or calculi. Hypertension is common in patients with chronic pyelonephritis and needs to be controlled with medication. In addition, supportive care

802 Pyelonephritis is important. If the cause of pyelonephritis is renal calculi, dietary management, such as limiting calcium, oxalate, or purines, may be necessary.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Antibiotics

Varies by drug; generally parenteral antibiotics for 3-5 days until the patient is afebrile for 24-48 hr, followed by oral administration for 2-4 wk

Depends on urine culture and sensitivity; common drugs include Ciprofloxacin (Cipro), levofloxacin (Levaquin), ceftriaxone (Rocephin), gentamicin, ampicillin, vancomycin, trimethoprim and sulfamethoxazole (Bactrim)

Eradicate bacteria and maintain adequate blood levels; provide accurate results in serum peak and trough levels

Other Drugs: Most patients are admitted with nausea and vomiting, and the physician may prescribe intravenous fluids to balance hydration. Patients are given analgesics, antipyretics, and antiemetics to control pain, fever, and nausea. Urinary analgesics such as phenazopyridine (Pyridium) may be administered.

Independent

Provide comfort measures for the patient with flank pain, headache, and irritating urinary tract symptoms. Back rubs may provide some relief of flank pain. Sitz baths may provide some relief if perineal discomfort is present. It is helpful to use a pain management flowsheet and alternative distractions and comfort measures (massage, music, positioning, verbal support, imagery). Because the patient is usually febrile, employ measures that promote heat reduction (cool packs, limited bedding, cool room temperature). To promote nutrition and adequate fluid balance, ask the patient his or her fluid preferences. Encourage the patient to drink at least 2000 mL/day to help empty the bladder and to prevent calculus formation but not more than 4000 mL/day, which would dilute the antibiotic concentration and lessen its effectiveness. Initiate measures to ensure complete emptying of the bladder, such as running water or spraying the perineum with warm water. Ensure the patient's privacy during voiding.

Teach women in the high-risk groups strategies to limit reinfection. Encourage the woman to clean the perineum by wiping from the front to the back after bowel movements. Stress the need for frequent hand washing. Explain the need for routine checkups if the patient experiences frequent urinary tract infections. Encourage the patient to notify the physician if she notes cloudy urine, burning on urination, and urinary frequency or urgency.

Blood Pressure Health

Blood Pressure Health

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