A urinary tract infection is described by location: urethritis, cystitis and pyelonephritis. Show Acute pyelonephritis is an infection of the renal parenchyma and pelvic-calyceal system as result of bacterial ascent along the ureters from the bladder to the kidneys. Although rare, pyelonephritis can occur by haematogenous spread, more commonly occurring in immunocompromised patients or neonates and the common organism is the highly virulent Staphylococcus Aureus. It is a clinical syndrome characterised by urinary symptoms (frequency, urgency, dysuria) and flank pain, fever and nausea or vomiting. Pyelonephritis can progress to septic shock, renal failure +/- multi-organ failure. The female population, ages 15-29, predominate. Escherichia Coli is the most prevalent organism >80%. 5-20% prevalence are Klebsiella species, Proteus species, Enterbacter species or Pseudomonas species. The following populations should be considered complicated pyelonephritis or high risk, have a low threshold for admission and prior to consideration of discharge should be discussed with Renal or General Medical Team:
Yes, if uncomplicated: Healthy, non-pregnant female. They must tick the following criteria:
Can your patient be discharged home?No, not if your patient has:
Please refer to the Sepsis Pathway. Discharge adviceAt discharge the patient must be aware they should be followed up within 72 hours. Advise them to return to the Emergency Department if they experience any worsening of symptoms / persistent fevers / night sweats. They should see their GP within 72 hours for review of the results of the urine culture. Further References and Resources
Nursing Management
Learn about the nursing care management of patients with acute renal failure in this nursing study guide. What is Acute Renal Failure?Renal failure results when the kidneys cannot remove the body’s metabolic wastes or perform their regulatory functions.
PathophysiologyAlthough the pathogenesis of ARF and oliguria is not always known, many times there is a specific underlying problem.
Statistics and IncidencesHere’s the statistics and incidences for acute renal failure:
CategoriesAcute renal failure (ARF) has four well-defined stages: onset, oliguric or anuric, diuretic, and convalescent. Treatment depends on stage and severity of renal compromise. ARF can be divided into three major classifications, depending on site: Prerenal
Renal (or intrarenal)
Postrenal
PhasesThere are four phases of ARF: initiation, oliguria, diuresis, and recovery.
CausesThe causes of ARF depend on its categories: prerenal, intrarenal, and postrenal.
Clinical ManifestationsAlmost every system of the body is affected by the failure of the normal renal regulatory mechanisms.
PreventionPreventing renal failure involves the following:
ComplicationsDepending on the duration and severity of ARF, a wide range of potentially life-threatening complications can occur.
Assessment and Diagnostic FindingsAssessment and diagnosis of a patient with ARF include evaluation for changes in the urine, diagnostic tests that evaluate the kidney contour, and a variety of normal laboratory values. Urine
Blood
Urine tests
Blood tests
Other tests
Medical ManagementThe objectives of treatment of ARF are to restore normal chemical balance and prevent complications until repair of renal tissue and restoration of renal function can occur.
Nursing ManagementThe nurse has an important role in caring for the patient with ARF. Nursing AssessmentAssessment usually focuses on the characteristics of the urine.
Nursing DiagnosisBased on the assessment data, appropriate nursing diagnoses for a patient with ARF include:
Nursing Care Planning & GoalsMain Article: 6 Acute Renal Failure Nursing Care Plans The goals for a patient with ARF are:
Nursing InterventionsNursing interventions are aimed at restoring renal function and reducing potential causes of increased renal injury.
EvaluationA successful nursing care plan has achieved the following:
Discharge and Home Care GuidelinesThe nurse plays an important role in teaching the patient and family with ARF.
Documentation GuidelinesThe focus of documentation in a patient with ARF include:
Practice Quiz: Acute Renal FailureHere’s a 5-item quiz about the study guide. Please visit our nursing test bank for more NCLEX practice questions. 1. Acute renal failure caused by parenchymal damage to the glomeruli of kidney tubules results in all of the following except: A. Decreased GFR. B. Increased urine specific gravity. C. Impaired electrolyte balance. D.Impaired electrolyte balance. 2. Oliguria is a clinical sign of ARF that refers daily to a urine output of: A. 1.5L B. 1.0L C. Less than 400ml D. Less than 50ml 3. A fall in CO2-combining power and blood pH indicates what state accompanying renal function? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. 4. Hyperkalemia is a serious electrolyte imbalance that occurs in ARF and results from: A. Protein catabolism. B. Electrolyte shifts in response to metabolic acidosis. C. Tissue breakdown. D. All of the above. 5. Potassium intake can be restricted by eliminating high-potassium foods such as: A. Butter. B. Citrus fruits. C. Cooked white rice D. Salad oil. Answers and Rationale 1. Answer: B. Increased urine-specific gravity.
2. Answer: C. Less than 400ml.
3. Answer: C. Respiratory acidosis.
4. Answer: B. Electrolyte shifts in response to metabolic acidosis.
5. Answer: B. Citrus fruits.
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