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Infections of the upper urinary tract are called pyelonephritis. This is an infection of renal pelvis,
tubules, (tubes), in the kidneys. The bacteria may enter through the bladder via the ureters or through
blood stream. Pyelonephritis describes a syndrome caused by the inflammation (irritation, swelling, pain,
damage) of the tubes (renal tubules) that carry urine from the kidneys to the bladder (upper urinary tract)
and the renal (kidney) interstitium (tissue surrounding the renal structures).

Many times this upper UTI is caused by reflux of urine up through the ureters from a faulty valve,
that is suppose to prevent this from happening. Sign and symptoms are chills and fever; flank pain. A
urinalysis will show bacteria, pus. The s/s are pretty much the same as for the lower UTI except the
bacteria in the urine found on the urinalysis are coated with antibodies that happens only in the renal
pelvis. An upper UTI is more serious due to the fact it can cause damage and death to tissues in the
kidneys if not treated.

Pyelonephritis can be acute (sudden) or chronic (prolonged) in nature.

Acute pyelenophritis often occurs after bacterial contamination of the urethra or after introduction of an
instrument, such as catheter or a cytoscope.

Chronic pyelenophritis is more likely to occur after chronic obstruction with reflux or chronic disorders. It
is slowly progressive and usually is associated with recurrent acute attacks, although the client may not
have a history of acute pyelenophritis.

• Causes

o Enteric bacteria
o Ureterovesical reflux
o Urinary tract obstruction
o Pregnancy
o Trauma
o Incorrect aseptic technique
o Diabetes mellitus
o Staphylococcal or streptococcal infections

• Pathophysiology

• Bacterial infection from a second source spreads to the renal pelvis, causing an inflammatory
• Cell destruction from trauma to the renal pelvis initiates an acute inflammatory response.

• Complications

• Chronic renal failure

• Hypertension
• Septicemia
• Clinical manifestations

• Characterized by enlarged kidney, focal parenchyma abscesses and accumulation of polymorph

nuclear lymphocytes around and in the renal tubules.
• Nursing Diagnosis

Risk for Deficient Fluid Volume. A common diagnosis is Risk for Deficient Fluid Volume related to fever,
nausea, vomiting, and possible diarrhea.

Acute Pain. Another common nursing diagnosis is acute pain related to an inflammatory process in the
kidney and possible colic.

Readiness for Enhanced Self- Care. Client teaching is important to promote self-care and to prevent
recurrent teachings. Write the diagnosis Readiness for Enhanced Self-Care to prevent recurrent

• Diagnostic test findings

 Excretory urography (which consists of imaging the kidneys and urinary tracts before and after
the administration of intravenous contrast material): atrophy, blockage, or deformity of kidney

 Urine culture and sensitivity: bacteria

 Urine chemistry: pyuria, hematuria; leukocytes, WBCs, and casts; specific gravity greater than
1.025; albiminuria

 Hematology( study of blood): increased WBCs

 24-hour urine collection: decrease creatinine clearance

• Assessment findings

 Elevated temperature  Burning on urination

 Chills  Frequency of urination

 Nausea and vomiting  Urgency of urination

 Flank pain  Headache

 Chronic fatigue  Anorexia

 Bladder irritability  Weight loss

 Hypertension  Odoriferous, concentrated urine

 Dysuria

• Medical management

 Diet: soft, high-calorie, low protein

 IV therapy: saline lock, electrolyte and  Antibiotics: cefazolin (Ancef0, cefoxitin
fluid replacement (Mefoxin), co- trimoxizole (Bactrim)

 Activity: as tolerated  Urinary antiseptics: phenazopyridine

 Monitoring: vital signs, I/O, urine pH,
and specific gravity  Antiemetic: prochlorperazine
 Laboratory studies: WBCs, urine
protein, and urine culture and sensitivity  Alkalinizers: potassium acetate, sodium
 Treatments: warm, moist compress to
flank  Sedative: oxazepam (Serax)

 Fluid intake: 3qt (3L)/day  Peritoneal dialysis and hemodialysis

 Analgesic: meperidine (Demerol)

• Nursing interventions

 Maintain the patient’s diet  Provide rest periods

 Encourage fluids 3qt (3L)/ day  Provide skin, mouth and perineal care
 Assess renal status and fluid balance  Encourage frequent voiding
 Monitor and record vital signs, I/O,  Individualize home care instructions
laboratory studies, daily weight, o Void frequently
specific gravity, and urine for blood, o Return to the physician
protein, and pH immediately if symptoms
 Administer medications, as prescribed reoccur
 Allay the patient’s anxiety o Take prescribed medications
 Provide hot, moist compresses and for entire duration of
warm baths prescription
 Prevent chilling
• Evaluation

The client will maintain fluid balanced intake and output, maintenance of adequate hydration, and an
absence of manifestations of dehydration.

The client will be able to report either that there is no pain or that pain is controlled.

The client will have the knowledge of the treatment regimen and understand how to prevent recurrent
infections as evidenced by the client’s statements and no recurrence of infection.