Planning nursing care for a patient suffering from pyelonephritis. What is pyelonephritis. Nurse work plan

- one of the most common infectious diseases inflammatory diseases urinary tract. Inflammation develops in the pyelocaliceal system and can spread to the intermediate tissue of the kidneys.

This pathology affects children from the neonatal period and up to about 5 years. At the age of up to 3 months, the disease is more often detected in boys, after 2 years - in girls. We will consider below what treatment is carried out for pyelonephritis in children.

Untimely treatment of pyelonephritis in childhood is fraught with the transition of the disease to a chronic relapsing form.

Pyelonephritis - medical history

Pyelonephritis means non-specific inflammation, which in most cases caused by gram-negative bacteria present in normal bacterial flora.

Most often, the inflammatory process is caused by representatives of the coccal flora and the so-called uropathogenic strains of Escherichia coli. As a rule, one type of bacteria is detected in the urine; a mixed infection is relatively rare.

When several types of pathogens are identified the analysis is repeated, since mixed infections are relatively rare, and analysis errors are often associated with a violation of the urine collection technique.

Read our article on how to properly collect urine for analysis.

The causative agents can also be some gram-positive bacteria, ureaplasma and chlamydia, but such cases are rare. Candidal pyelonephritis is sometimes detected in children with severe immunodeficiency conditions.

The infectious agent enters the kidney through the bloodstream, and less often through lymph. In children, the main route of infection is ascending. The most common sources of infection are the genitals and large intestine.

The risk of pyelonephritis increases if necessary, antibiotic therapy, which often leads to profound changes in the species composition of the microflora and the predominance of potentially dangerous opportunistic species and strains.

Risk factors

The prerequisites for the probable development of an inflammatory reaction are conventionally divided into local and general. TO general include factors that in one way or another weaken the body’s resistance to infection:

• Stress;
• Hypovitaminosis;
• Physiological or pathological immunodeficiency;
• Past acute infectious diseases;
• Overwork, etc.

Local factors associated with the functioning of the kidneys and excretory system generally. These include:

• Disorders of urine outflow associated with the presence of mechanical obstacles;
• Vesicopelvic reflux.

Forms of the disease

By flow The pathological process is distinguished:

1. Spicy;
2. Chronic pyelonephritis.

About origin the pathological process can be primary, resulting from direct kidney damage, or secondary. Secondary include inflammatory processes that arise against the background of an existing pathology.

The acute process develops suddenly, progressing rapidly in a matter of hours or days.

With timely adequate therapy, in most cases the patient ends in recovery.

Pyelonephritis can develop as complication of untreated acute inflammatory process, or as an initially chronic inflammatory process.

The course of the inflammatory process is sluggish, long-term, with periodic exacerbations. The disease lasts for years and decades, accompanied by a gradual replacement of functional kidney tissue connective tissue. Typical complications chronic pyelonephritis – arterial hypertension and renal failure.

Symptoms

Symptoms of pyelonephritis are conventionally divided into general infectious and nephrological (local). General infectious symptoms predominate in the development of the disease in infants. These include:

• Increased temperature, fever;
• Nausea, vomiting, lack of appetite;
• Pain in joints and muscles;
• Slow growth;
• General weakness.

In infants, stool disorders, a grayish tint of the facial skin are possible, and meningeal and neurotoxicosis signs appear against the background of fever.

Local symptoms indicate impaired renal function:

• Pain in the abdomen, lower back or side on the affected side;
• Cloudiness, change in color and odor of urine;
• Pain when urinating.

At acute form disease, blood pressure remains within the limits age norm. Sometimes there is a slight swelling of the eyelids in the morning, pronounced edematous syndrome is uncharacteristic.

Chronic pyelonephritis has a latent and more common recurrent form. Hidden form develops as a complication of acute infectious process, is asymptomatic. The presence of pathology is indicated by a persistent slight increase in temperature.

Clinical manifestations of recurrent chronic pyelonephritis resemble the course of the acute form. For children, the manifestation of nonspecific general infectious symptoms is more typical.

If in a patient with recurrent chronic pyelonephritis in successive episodes of exacerbation, different types pathogens, they are considered as individual cases acute pathological process.

Recurrent form of the disease is often complicated by anemia, hypertension and leads to the development of renal failure.

Due to non-specificity clinical manifestations a final diagnosis can only be made on the basis of laboratory examination data.

Diagnostics

When collecting anamnesis and physical examination, the doctor pays attention to signs of general intoxication, impaired diuresis, the presence of visible anomalies and signs of inflammatory processes in the area of ​​the external genitalia. It is possible to detect pain on the affected side.

IN complex laboratory examinations except general clinical tests blood and urine include:

1. Blood chemistry;
2. Urinalysis according to;
3. Urine culture with antibiogram;

An ultrasound of the kidneys and bladder is required. According to indications, CT scan, Doppler ultrasound, nephroscintigraphy, etc. may be prescribed.

Changes in urine with pyelonephritis

Basic laboratory symptom pyelonephritis – presence of bacteria in urine. Sometimes concomitant leukocyturia is detected, but the severity of the lesion and the number do not correlate with each other.

Some patients have red blood cells in their urine. Erythrocyturia may indicate urolithiasis, necrotic changes in the papilla, inflammation of the bladder lining, abnormalities anatomical structure kidneys, venous outflow disorders.

Detection of traces of blood in urine not a specific symptom, the doctor prescribes additional examinations to identify the causes of erythrocyturia.

Sometimes a small number of cylinders are detected in the urine, but cylindruria is not a diagnostic sign.

The characteristic manifestations of pyelonephritis are decreased specific gravity of urine and a sharp shift in pH towards alkalization.

In patients with acute pyelonephritis, after recovery, the indicators return to normal. In chronic - low specific gravity of urine is constantly determined and can be combined with glucosuria, acidosis and others clinical symptoms dysfunction of the tubules.

How to treat pyelonephritis in children?

The basis of treatment of pyelonephritis is antibacterial therapy according to the standard scheme, which is applied before the isolation of a specific infectious agent. After this, if necessary, the drug is replaced.

At mild flow diseases, antibiotic syrups and suspensions are used intended for. The course is continuous, designed for a period of 5 days to 3 weeks. The drug is replaced on days 7-10 or 14 of therapy.

To start treatment, the following are most often prescribed:

• Augmentin;
• Cefamandole;
• Cefuroxime;
• Ceftazidime;
• Cefotaxime.

At severe course combination antibiotic therapy using several drugs is indicated. After completing the course, they are assigned uroantiseptics.

Treatment of children under 2 years of age is carried out only in a hospital setting; at an older age, treatment at home is possible.

Additionally, the course of treatment includes drugs that improve blood microcirculation, sorbents for removing bacterial toxins and anti-inflammatory drugs. For improve urine flow The use of antispasmodics and diuretics is recommended.

At long-term treatment antibiotics there is a risk of developing secondary fungal infections. In order to prevent such complications, patients are prescribed probiotics or prebiotics, if indicated - antifungal drugs.

Surgery indicated for the development of purulent processes that cannot be treated conservative treatment, as well as in the presence of mechanical obstacles to the normal outflow of urine. This is necessary to eliminate the prerequisites for recurrence of the disease.

To reduce the load on the kidneys, the patient is prescribed a gentle regime, in severe cases - bed rest. Changing the regimen is carried out according to the doctor's orders.

Treatment of chronic pyelonephritis

Treatment for exacerbations of chronic pyelonephritis is carried out according to a scheme similar to that recommended for the acute form of the disease. In mild cases it is possible ambulatory treatment with the use of cephalosporin or penicillin antibiotics.


After eliminating the acute phase the patient is prescribed anti-relapse treatment lasting from 4 weeks to several years. The duration of treatment is determined individually, depending on the nature of the pathogen, general condition the patient's health and response to treatment.

An important condition for relapse prevention is the elimination of obstacles to the outflow of urine.

If there are mechanical obstacles, the patient may need to surgical treatment or bladder catheterization. If the cause of pyelonephritis is kidney stones, after their removal a course of treatment is prescribed aimed at correction of metabolic processes in organism.

Neurogenic bladder dysfunctions are indications for appropriate drug treatment neurological disorder and a course of physiotherapeutic procedures to restore normal nervous regulation.

After elimination acute process a course of treatment with antioxidant drugs is prescribed, additionally - phytotherapy.

For severe pyelonephritis in children under one year of age, treatment may be prescribed to strengthen the immune system. Indications for immunocorrective therapy are:

• Unusual or rare composition of pathogens;
• Ineffectiveness of antibiotic therapy;
• Purulent processes, aggravated by signs of multiple organ failure.

Nursing process in illness

Nurse of the pediatric nephrology department monitors compliance with the regimen prescribed by the doctor and other appointments. If necessary, provides first aid emergency assistance and calls the doctor on duty to the patient.

A small patient should be provided with access to a potty; visiting the bathroom is excluded. The room should be warm; while the patient is being ventilated, the patient should be dressed warmer to exclude the possibility of hypothermia.

Ventilation is carried out twice a day, wet cleaning- 3 times. The nurse keeps the potty and bed linen clean, especially if the client is incontinent. It is also important to maintain acoustic hygiene and ensure conditions for adequate sleep.

The nurse's responsibilities include maintaining contact with the patient's parents, explanatory conversations about the need to comply with the regimen prescribed by the doctor.

Nursing staff supervise school-age patients' attendance at classes and are also responsible for organizing children's leisure time preschool age, performing the functions of a teacher.

In full swing acute inflammation the patient is prescribed diet limited in salt and protein. On days 7-10, the restrictions on protein and salt content are somewhat relaxed, with the exception of cases aggravated by arterial hypertension.

Food should only be fresh and include raw fruits and vegetables. Spicy, fatty and fried foods, as well as strong broths are prohibited. The patient is recommended drinking plenty of fluids.

Patients with chronic form for pyelonephritis, a more strict prescription is prescribed. All types of canned food are excluded from the diet, especially pickles and marinades, smoked foods, spicy, fried and spicy foods.

The consumption of vegetables with a pungent taste (onions, garlic, radishes, radishes), as well as those containing a large number of acids (in particular, sorrel). Are subject to the ban sour fruits and berries. All carbonated drinks are prohibited. Must be on the menu include watermelon, melon and pumpkin.

Daily drinking norm – not less than 2 l, with a predominance of vitamin drinks: rosehip decoction, freshly squeezed juices, compotes, as well as slightly alkaline therapeutic and prophylactic mineral waters.

In the patient's diet must be present:

• Dairy and vegetarian soups;
• Lean meat, fish and poultry;
• Eggs;
• Dairy products;
• Cereals;
• Raw, boiled, steamed vegetables.

Among sweets, jam, honey and sugar are allowed.

Diet assigned individually, depending on the features pathological mechanism diseases, the presence of complications and concomitant pathologies.

Treatment at home

After discharge from the hospital or during initial outpatient treatment, drug and diet therapy is carried out in accordance with the doctor’s prescriptions. Additionally it can be recommended herbal medicine course.

The medicinal mixtures include herbs that have anti-inflammatory, tonic, diuretic and uroseptic effects.

Pyelonephritis – very serious illness, so application folk recipes, drawn from any sources, must be agreed with the doctor.

Disease prevention

Primary prevention of pyelonephritis in children comes down to the following measures:

1. Providing a complete balanced diet.
2. Skills training intimate hygiene and monitoring the implementation of relevant procedures. For infants, timely diaper change and washing.
3. Treatment of infectious diseases regardless of the location of the lesion.
4. Compliance with drinking regime.

Timely bowel and bladder emptying is very important. If a child has to endure it for a long time, there is a risk of urogenic kidney infection.

The set of secondary prevention measures additionally includes compliance with doctor’s prescriptions (maintenance therapy, diet). Children who have had acute pyelonephritis, within 3 years are under follow-up with a nephrologist.

Patients who have suffered pyelonephritis, which developed as a result of obstruction of the urinary tract, as well as with a chronic recurrent form of the disease, are registered at the dispensary for life.

The professor of the Department of Pediatrics will share information about pyelonephritis in children in the video:

Pyelonephritis- a nonspecific inflammatory process with damage to the pyelocaliceal system, interstitial tissue and renal tubules with subsequent damage to the glomeruli and blood vessels.

Predisposing factors are diabetes mellitus, gout, insufficient potassium levels, abuse of analgesics, extrarenal foci of inflammation (urogenital area), allergies.

There are acute and chronic pyelonephritis.

Acute pyelonephritis

The cause is infection (Escherichia coli, staphylococcus, Proteus, enterococcus, streptococcus).

Sources of infection (chronic tonsillitis, furunculosis, mastitis, adnexitis, etc.), violation of asepsis during urological operations.

Acute pyelonephritis develops quite quickly under the influence of physical overexertion and cooling. Penetration of infection into kidney tissue possibly hematogenous, lymphogenous and urinogenic route.

Morphologically, acute pyelonephritis can be serous and purulent. At serous- the kidney is enlarged, dark red. Histologically, numerous perivascular infiltrates are found in the interstitial tissue.

Spicy purulent pyelonephritis manifests itself in the form of pustular nephritis, abscess and kidney carbuncle. Multiple small pustules ranging in size from a pinhead to a pea are found in the cortex and medulla.

Clinical picture. Chills, then body temperature rises, complaints of general malaise, weakness. The main symptom is lower back pain, a positive Pasternatsky sign, and frequent painful urination are noted.

The course of acute pyelonephritis has some features depending on the age of the patient. In older people, it often has a faded, atypical character, without a temperature reaction or chills. The disease is especially severe in patients weakened by previous diseases.

In them, despite the severe course of the disease, leukocytosis may be moderate or absent, and sometimes leukopenia is observed.

Acute pyelonephritis can be complicated by paranephritis, subdiaphragmatic abscess, necrosis of the renal papillae with the development of acute renal failure, bacteremic shock, and peritonitis.

Diagnostics. OAK - pronounced leukocytosis (up to 30x10 /l), a shift in the leukocyte formula to the left, an increase in ESR.

ABOUTA.M.- proteinuria from traces to 1.04 g/l, leukocyturia (pyuria), often - hematuria, cylindruria, bacteriuria.

TANK - dysproteinemia, sometimes an increase in creatinine and urea.

Ultrasound, excretory pyelography(urography) - an increase in the size of the kidney.

Chromocystoscopy - slowing down the release of indigo carmine on the affected side.

Treatment. Hospitalization to the nephrology department (for purulent pyelonephritis - to the urology department) is required. Prescribe bed rest, drinking plenty of water, several glasses of mineral or ordinary water, compote, milk, fruit juices per day in addition to the normal daily drinking ration. Heating pads have a good effect. For severe pain, antispastic drugs are used. Papaverine, platyphylline, belladonna extract reduce spasm and improve urine flow.

Before prescribing antibiotics, it is necessary to conduct a bacteriological examination of urine, identify the bacterial flora and determine its sensitivity to a particular antibiotic. The basic rule of antibacterial therapy is the appointment of optimal (sometimes maximum) doses, early initiation and sufficient duration.

If it is impossible to determine the sensitivity of the microflora, broad-spectrum antibiotics are prescribed (cephalosporins, ristomipine, sumamed, vancomycin, vibramycin, etc.). Avoid prescribing nephrotoxic antibiotics (aminoglycosides, polymyxin). If the bacterial flora is insensitive to antibiotics, sulfonamide drugs are prescribed (etazol, biseptol). They can be combined with nitrofurans (furagin, furazolidone, furadonin, etc.). If improvement does not occur, then surgical treatment is resorted to (for an abscess, kidney carbuncle) .

After inpatient treatment, outpatient treatment is carried out for another 6 months in order to prevent the transition of acute pyelonephritis to the chronic form.

Prevention. It is necessary to prevent inflammatory diseases of the urethra and bladder, beware of hypothermia, sanitize the oral cavity and nasopharynx, follow the regimen prescribed by the doctor for sore throat, otitis media, etc.

Chronic pyelonephritis immune-mediated nonspecific inflammation, predominantly of interstitial tissue in combination with damage to the urinary tract, followed by damage to the renal glomeruli and blood vessels. It is a consequence of untreated or undiagnosed acute pyelonephritis.

Etiology. Chronic pyelonephritis is caused by bacteria and their associations. Associated factors are similar to acute pyelonephritis.

Pathogenesis. The development of pyelonephritis is based on autoimmune reactions, urodynamic disorders (reduced outflow), and urinary tract infection.

Macroscopically, the kidney is reduced in size, wrinkled, its surface is lumpy with cicatricial retractions. The capsule is difficult to remove; the mucous membrane of the pelvis shows signs of inflammation.

Histologically: inflammatory infiltrates alternate with areas of sclerosis in the interstidium; in the glomeruli - fibrosis phenomena. Eventually the kidney shrinks (nephrosclerosis), develops uremia- cause of death of the patient.

Clinical picture. Symptoms of the disease depend on the form of pyelonephritis, unilateral or bilateral damage and other factors. There are several main clinical forms of chronic pyelonephritis:

1) latent form- paucity of clinical manifestations (fatigue, loss of appetite, weight loss, sometimes low-grade body temperature). Some patients experience heaviness in the lower back and a weakly positive Pasternatsky sign. In OAM - slight proteinuria and leukocyturia;

2) hypertensive form - symptoms of arterial hypertension (sometimes malignant), fundus changes and changes in urine;

3) recurrent form occurs more often than others. It is characterized by alternating exacerbations and remissions. Exacerbations are accompanied by pain in lumbar region, dysuric phenomena, increased body temperature, signs of intoxication. The course of the disease is 10-15 years or longer, eventually developing chronic renal failure;

4) anemic form - symptoms of hypochromic anemia. Urinary syndrome is mild and unstable;

5) hematuric form - constant micro- or macrohematuria. Clinical manifestations are scanty. The diagnosis is difficult.

Diagnostics. OAK __leukocytosis with a shift to the left during exacerbation, anemia, increased ESR.

OAM- leukocyturia, microhematuria (not always), decreased relative density of urine, proteinuria and cylindruria.

Survey urography- reduction in kidney size.

Excretory pyelography - deformation of the cups and pyelocaliceal structures.

Kidney ultrasound- asymmetric changes in the kidneys.

Radioisotope scanning- diffuse nature of the changes, reduction in kidney size.

Needle biopsy carried out when there are difficulties in diagnosis.

Treatment. During the period of exacerbation, patients with chronic pyelonephritis are hospitalized: with primary - in the therapeutic or nephrological department, with secondary - in the urological department. Bed rest until symptoms disappear.

Diet- spicy foods and seasonings, rich broths, and strong coffee are excluded. In the absence of contraindications, it is recommended to take 2-3 liters of liquid. For all forms, it is recommended to include watermelons, melons, and pumpkin in the diet.

Etiotropic therapy- elimination of causes causing disturbances in urodynamics and renal circulation, as well as antibacterial therapy (uroantiseptics, antibiotics, nitrofurans, fluoroquinolones, quinolines).

The choice of drug is made taking into account the type of pathogen and its sensitivity to the antibiotic.

We must remember and not prescribe aminoglycosides (gentamicin, kanamycin, brulamycin) - nephrotoxic antibiotics.

Uroantiseptics are prescribed from the first days of long-term treatment - nitrofurans (nitraxoline, nevigramon, 5-NOK, etc.).

Drugs that correct blood circulation in the kidney (trental, chimes), medicinal plants, and physiotherapy are used. Symptomatic treatment includes antihypertensive drugs, diuretics, iron supplements, and hemostatic agents.

Non-drug treatments- Ultraviolet irradiation of blood, plasmapheresis, sanatorium-resort treatment.

Treatment of chronic pyelonephritis should continue for 6-12 months, with a change of antibiotics, uroantiseptics, herbal medicine and physiotherapy.

Prevention.

Primary prevention consists of timely and complete treatment of acute pyelonephritis, acute cystitis, and treatment of concomitant diseases (diabetes mellitus, gout).

Secondary prevention is aimed at preventing relapses of pyelonephritis in the clinical examination system. It includes: following a diet (limiting spicy, salty foods and increasing the amount of liquid); periodic intake of mineral waters (“Smirnovskaya”, “Borjomi”); restriction of severe physical activity; elimination of the causes of urodynamic disturbances; planned anti-relapse treatment with uroantiseptic drugs; phytotherapy; sanatorium-resort treatment during remission (Zheleznovodsk, Berezovskie Mineralnye Vody).

Possible problems patient with pyelonephritis: lack of knowledge, dysuric phenomena, fever, chills, pain in the lumbar region, etc. In the organization nursing care models are used: V. Henderson - to meet the needs of the patient with acute pyelonephritis; D. Orem - at chronic pyelonephritis and its complications (improving the patient’s self-care); M. Alen - at the stage of medical examination (“health through development”).

Prevention - component medicine. The social and preventive direction in protecting and strengthening the health of the people includes medical, sanitary, hygienic and socio-economic measures. Creating a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task of the state. There are individual and public prevention. Depending on the state of health, the presence of risk factors for the disease or severe pathology in a person, 3 types of prevention are considered.

Primary prevention is a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, rational mode work and rest, rational high-quality nutrition, physical activity, health improvement environment and etc.).

Primary prevention includes socio-economic measures of the state to improve lifestyle, environment, education, etc. Preventive activities are mandatory for everyone medical workers. It is no coincidence that clinics, hospitals, dispensaries, and maternity hospitals are called medical and preventive institutions.

Secondary prevention is a set of measures to eliminate pronounced risk factors, which, under certain conditions (reducing immune status, overexertion, adaptation failure) can lead to the onset, exacerbation or relapse of the disease.

A number of experts propose the term “tertiary prevention” as a set of measures for the rehabilitation of patients who have lost the ability to fully live. Tertiary prevention aims at social (building confidence in one’s own social suitability), labor (the possibility of restoring work skills), psychological (restoring the behavioral activity of the individual) and medical (restoring the functions of organs and systems) rehabilitation.

Most effective method secondary prevention is medical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, rational consistent recovery.

The most important integral part everyone preventive measures is the formation of medical and social activity among the population and attitudes towards a healthy lifestyle.

The role of the nurse in primary prevention for acute pyelonephritis:

The nurse must play no small role in the patient's lifestyle. – paraphrase It is necessary to reconsider the patient’s lifestyle; lack of movement leads to stagnation of urine, an increase in its concentration and, as a result, the formation of sand and stones.

The nurse must also form the correct concept of nutrition. The purpose of the diet for pyelonephritis is to shift the urine reaction to the alkaline side by increasing the amount of alkalizing foods. In acute form of pyelonephritis, all food consumed should be easily digestible and fortified. Salt and foods containing it in large quantities - pickles, marinades, canned food and smoked meats - put a lot of stress on the kidneys. Reduce, or better yet, eliminate them from your diet! Soup made with recycled meat broth is useful. IN rich soup there are a lot of substances that irritate kidney tissue. Vegetable broths with the addition of boiled meat into a ready-made dish.

Must be observed water balance, the kidneys need to be “washed,” thus clearing them of bacteria and salts. That is why the volume of daily fluid should be at least 1.5-2 liters. Remember, tea and coffee are not friends of the kidneys. A clean one is suitable for this role. drinking water without gas, non-concentrated compotes and herbal infusions. Very helpful cranberry juice, which contains large amounts of vitamin C, which improves immunity. In addition, the drink has a disinfecting effect and is recommended for daily use as a preventive measure for kidney and urinary tract diseases.

It is very important to explain to the patient the need to empty the bladder regularly: during the daytime - at least once every 2-3 hours. With prolonged retention, urine becomes concentrated, which is fraught with the precipitation of salts, which irritate the mucous membranes of the kidneys and urinary tract, causing inflammation. In addition, with long-term patience, the bladder becomes overstretched, and urine rushes back to the kidneys - a disease such as renal-vesical reflux is formed.

The role of the nurse in secondary prevention of acute pyelonephritis:

Clinical examination is one of the crucial moments in the management of a patient with acute pyelonephritis. For persons who have suffered acute pyelonephritis, it is necessary to establish dynamic monitoring (clinical examination), since the disappearance of pyuria and bacteriuria does not always mean the elimination of the inflammatory process. In many cases, this only indicates its subsidence. Any extraneous (intercurrent) infection, weakening of the body due to overwork, malnutrition or other reasons can lead to re-infection(reinfection) or exacerbation of a latent (sluggish) infection in the kidney.

Acute pyelonephritis, which occurs without complications in the dispensary register for 2 years, and then, if all is well, is removed from the dispensary register. Clinical examination is carried out by a nephrologist at the clinic at the place of residence. A person who has had acute pyelonephritis needs to visit a doctor once every 3-4 months, undergo tests (general urine analysis, Nechiporenko urine analysis) and follow all instructions. The nurse conducts a census of the population in the area, determines the age, gender, social composition, compiles lists of people observed in other medical institutions, examined at the place of work, and monitors the fulfillment of doctor’s visit deadlines. To ensure the completeness and timeliness of the appearance of those undergoing medical examination, it is important to work with the card index. The nurse notifies patients in advance of the need to appear for an appointment with a doctor, the days and hours of attendance. The nurse also participates in preventive examinations, conducting a number of measurements (anthropometry, thermometry, spirometry, blood pressure measurement, intraocular pressure etc.), prepares medical documentation, organizes, if necessary, active visits and examination of the patient at home. Monitors the implementation of prescribed treatment by patients, conducts outreach work, convincing them to take the necessary courses of treatment. Further work nurse consists of fulfilling medical prescriptions prescribed for each medical examination, ensuring control over the implementation of the regime and doctor’s prescriptions.

Then and only then can one prevent the transition of acute pyelonephritis to chronic, which is recognized more often with symptoms of increasing renal failure, increased blood pressure, the appearance of edema, significant deterioration in health and loss of ability to work.

CONCLUSION

Acute pyelonephritis (AP) is one of the most common urological diseases, occurs in at least 30% of the population. In countries around the world, out of 10 million people, 400 thousand suffer from acute pyelonephritis. Patients make up 30–40% of the total population of urological hospitals.
The variety of causes and clinical forms of AP makes disease prevention challenging task, which should be individualized as much as possible depending on the clinical form of the disease.
Preventative treatment is based on the recommendations of the nurse. Prevention and metaphylaxis (prevention of relapse) of acute pyelonephritis is based on treatment metabolic disorders, timely treatment chronic pyelonephritis and restoration of impaired urine outflow.

Therapeutic measures in acute pyelonephritis should consist of carrying out the necessary preventive treatment in order to prevent relapse. Relapses of the disease, depending on one form or another of the disease, occur in 10–40% of patients with AP without preventive treatment.

Ministry of Health of the Moscow Region

State budgetary professional educational institution Moscow region

"MOSCOW REGIONAL MEDICAL COLLEGE No. 1"

Specialty: 02/34/01 “Nursing”

Cyclic methodological commission of the Central Medical Committee “disciplines and professional modules of the specialty “General Medicine” “Nursing” “Midwifery”:

PM 02 Participation in recreational diagnostic and rehabilitation processes

MDK 02.01 Nursing care for various diseases and conditions of therapeutic patients

3rd year, 5th semester

Methodological development

for teachers and students

practical classes

on this topic:

" ".

Compiled by: teacher – N.A. Popova

Moscow 2018

Lesson objectives:

Educational

1. Generate, systematize and consolidate knowledge on the topic “ atwith pyelonephritis».

2. Acquire the ability to implement nursing process.

3. Perform nursing procedures, educate the patient and family on care issues, advise the patient and family on issues of self-monitoring, nutrition, and physical activity.

Developmental

Develop mental abilities and skills independent work, logical, analytical and clinical thinking.

Understand the essence and social significance his future profession, show a steady interest in her.

Use information and communication technologies in professional activity. Organize your own activities based on the goal and ways to achieve it.

Educational

Teach students to work collectively and individually

To form a conscious attitude towards the importance of studying MDK 02.01

Contribute to the formation of personality, cultivate responsibility, accuracy, patience and tact when communicating with a patient, a sense of duty. Treat historical heritage and cultural traditions with care, respect social, cultural and religious differences.

Be able to:

work with regulatory, accounting and reporting documentation;

carry out the nursing process when caring for a patient (collect information and assess the patient’s needs);

identify patient problems;

set goals and plan nursing interventions;

assess the patient’s ability to self-care;

establish psychological contact with the patient;

conduct drug therapy as prescribed by a doctor (distribution medicines, carrying out intravenous, intramuscular, subcutaneous injections);

determine the patient’s respiratory rate (respiratory rate), blood pressure (blood pressure), pulse and enter the data into the temperature sheet;

prepare the patient for research;

advise the patient and his family on prevention issuespyelonephritis.

Know:

the content of the main federal and regional regulatory documents regulating the activities of nursing personnel;

causes and predisposing factors for the occurrence of the disease;

clinical manifestations;

the role of the nurse in diagnosing the disease;

principles of treatment;

the patient's problems with this disease;

preventionwith pyelonephritis.

During the lesson, work on developing competencies:

Students must master professional competencies:

PC 1. Work with regulatory and administrative documentation and apply the basics of legal knowledge to implement professional functions in the field of urology;

PC 2. Know the risk factors leading topyelonephritis.

PC 3. Resolve patients’ problems with this pathology;

PC 4. Carry out the nursing process when caring for the patient;

PC 5. Ensure that patients are prepared for studies prescribed by the doctor;

PC 6.

PC 7. Communicate effectively with the patient and his environment in the process of professional activity;

PC 8. Carry out prevention.

PC 9.Present information in a form understandable to the patient, explain to him the essence of the interventions;

PC 10.Comply with the principles of professional ethics.

Students must master general competencies:

- OK 1 Understand the essence and social significance of your future profession, show sustained interest in it

OK 2 Organize your own activities, choose standard methods and methods of performing professional tasks, evaluate their implementation and quality

OK 3 Make decisions in standard and non-standard situations and take responsibility for them

OK 4 Search and use information necessary for the effective performance of professional tasks, professional and personal development

OK 5 Use information and communication technologies in professional activities

OK 6 Work in a team and team, communicate effectively with colleagues, management, and consumers

OK 7 Independently determine the tasks of professional and personal development, engage in self-education, consciously plan and carry out advanced training

OK 8 Organize workplace in compliance with the requirements of labor protection, industrial sanitation, infection and fire safety.

Type of lesson: seminar

Duration:60 minutes

Location: college auditorium

Teaching methods:

- information and development ( familiarization with regulatory documents regulating medical activities in endocrinology

- partially search (solving problematic and situational problems)

Group discussion (analysis life situations, evidence-based explanation, exercises, encouragement).

Pedagogical technologies:

Pedagogy of cooperation (development of abilities through humanization of pedagogical relations; activity planning)

Group technologies (completing a common task; discussing a common task; general conclusion teacher)

Lesson equipment:

1. Didactic educational material:

Theoretical information to deepen and systematize students' knowledgefor pyelonephritis:

Multimedia material;

Control material:

Situational tasks;

Schemes to fill out;

Test forms.

Elements of simulation technology

- manipulation table;

Instruments (robe, shoe covers, mask, cap, glasses, shields, gloves, syringes, ampoules,phantom for intravenous injections, arm trainer for intravenous injections)

Interdisciplinary connections are aimed at improving the student’s mental and analytical activity in all disciplines studied in the course.

LITERATURE

Federal Law No. 323-FZ of November 21, 2011 “On the basics of protecting the health of citizens in Russian Federation»;

Federal Law of November 29, 2010 No. 326-FZ (as amended on December 3, 2011) “On mandatory health insurance In Russian federation";

№ 246-FZ "On amendments to the Federal Law “On the Sanitary and Epidemiological Welfare of the Population”;

General professional aspects of the activities of paramedical workers: textbook / edited by S.I. Dvoinikov. – M.: GEOTAR – Media, 2015. – 432 p.: ill.

Order of the Ministry of Health dated September 30, 2015. No. 683n “On approval of the Procedure for organizing and implementing prevention non-communicable diseases and carrying out activities to form healthy image life in medical organizations";

Order of the Ministry of Health of the Russian Federation dated December 21, 2012. No. 1344n “On approval of the procedure for conducting dispensary observation of patients with chronic non-infectious diseases.”

Obukhovets T.P. Fundamentals of Nursing (Tutorial), Rostov-on-Don, Phoenix, 2014

S.A. Mukhina, I.I. Tarnovskaya Practical guide to the subject

“Fundamentals of Nursing” Textbook for medical schools and colleges, 2nd edition, revised and expanded, Moscow, 2009

« Nursing in therapy with a primary course medical care » Textbook for medical schools and colleges T. N. Yartseva, R. N. Pleshkan, E.K. SabchukMoscow, 2005

Raduzhny N.L. Internal diseases Mn: VSh, 2010, 365 p.

Pirogov K. T. Internal diseases, M: EKSMO, 2012.

Sirotko V. L, All about internal medicine: textbook for graduate students, Mn: VS, 2014.

Fundamentals of Nursing. Manipulation algorithms: tutorial/ Shirokova N.V. et al. 2013.

Electronic resource:

Medical information portal:

http://domashniy-doktor.ru/index.php/2011-08-02-17-46-41/19-2011-08

File archive for students:

http://www.studfiles.ru/preview/6065923/

Description of the lesson:

time, min.

Methodical

Organizational part, target setting

The teacher checks the readiness of the audience for the lesson and the appearance of the students. Marks those who are absent. Informs the topic of the lesson, goals and plan.

Motivation for studying the topic

The teacher notes the importance of studying the topic for the professional activities of nurses, the importance of this topic for the implementation of professional skills.

3

Initial knowledge control.

The task is distributed in test form.

1 0

Students answer the proposed tests

4

Work on mistakes. Test control analysis is carried out

The teacher invites students to collectively discuss the answers to the test control

5

Oral survey of students on the topic studied in order to determine the level of mastery educational material

1 0

Students make oral reports on previously received homework and discuss collectively the main sections of the topic

6

Teacher explaining material not learned independently

1 0

Students are offered a multimedia presentation onpyelonephritis.

In the process of presenting the material, this topic is discussed and commented on.Students listen, write down, unlearned, independently on the topic

Explanations for solving a situational problem

5

The teacher gives recommendations for solving problems

Solving situational problems, performing the manipulations specified in the task

30

Students practice clinical situation skills while solving problems and perform the manipulations specified in the problem.

Summing up the lesson

The teacher focuses on the basic concepts of the topic, emphasizes the importance of this topic for the implementation of professional skills,gives ratings with comments

Homework

The teacher names the topic of the next lesson according to the calendar and thematic plan, and indicates the literature for preparation.

Bottom line

90 minutes

Nursing care, observation, dependent and independent interventions at pyelonephritis.

Motivation

In the structure of organ diseases urinary system:

In Russia – from 5.6 to 27.5%

In Western Europe - from 4 to 25%.

In the USA - 5-10%.

Pyelonephritis is the most common kidney disease in all age groups.

The disease is detected in 8-20% .

AND young and middle-aged people get sick 6 times more often And .

In children, pyelonephritis ranks second after respiratory diseases.

Questions on the topic

" Nursing care, observation, dependent and independent interventions for pyelonephritis ".

Definition of pyelonephritis?

Causes of pilonephritis?

What is affected by pilonephritis?

Symptoms of pyelonephritis?

Is it divided by the nature of the flow?

Routes of entry?

What is observed in a blood test for pyelonephritis?

Which table is used in the treatment of pyelonephritis?

Complications of pyelonephritis?

Prevention of pyelonephritis?

PYELONEPHRITIS

Pyelonephritis is an infectious and inflammatory disease of the kidneys affecting the pyelocaliceal system, interstitial tissue and renal tubules.

Classification

acute/chronic

Primary – cases of the disease without previous lesions of the MVS

Secondary – develops against the background of existing anatomical changes in the MVS, occurs more often

1-sided / 2-sided

According to the patency of the urinary tract

Non-obstructive

Obstructive

Forms of acute pyelonephritis

Serous

Destructive

Apostematous pyelonephritis

Kidney carbuncle

Kidney abscess

Variants of the course of chronic pyelonephritis

latent

hypertensive

recurrent

anemic

hematuric

asymptomatic

Epidemiology

The most common disease of the kidneys and urinary tract, women are more often affected (anatomical features + hormonal background– promotes dilatation, hypotension, dyskinesia of the urinary tract).

Etiology

Infection: most often Escherichia coli, Pseudomonas aeruginosa, Staphylococcus, Proteus, Klebsiella, Enterococcus, Streptococcus, and possibly viruses.

Ways of infection entering the kidney:

hematogenous (with inflammation)

lymphogenous

urogenic (ascending infection)

Predisposing factors

1. Urodynamic disturbances and urinary stasis due to:

anomalies in the development of the urinary tract

urolithiasis disease

narrowing of the ureters

prostate adenoma

pathological reflux (for example, vesicoureteral)

pregnancy

2. Reduced body resistance due to:

overwork

hypothermia

hypovitaminosis

3. Contributing to infection:

frequent instrumental studies MBC, catheterization

foci of chronic infection

4. Accompanying illnesses: diabetes mellitus, tuberculosis.

5. Long-term use oral contraceptives, GKS.

Pathogenesis

Impaired urodynamics and stagnation of urine contribute to the penetration and proliferation of microbes. They are directly introduced into the kidney tissue and pelvis. Bacteria and endotoxins damage the kidney tissue, causing the development of infectious inflammation.

Clinic

Intoxication syndrome

The temperature rises to 39-40°C, lasts 5-7 days, then decreases to low-grade levels and persists for another 1-3 weeks.

Tremendous chills, profuse sweating. There may be nausea, vomiting, and muscle pain.

The patient's face is haggard, the tongue is dry and coated.

Increase in temperature in the evenings to subfebrile levels

Temperature rises to 38-39°C.

Chills, weakness, increased fatigue, sweating, loss of appetite, headache, nausea, vomiting, thirst.

Pain syndrome

The pain can be intense or aching, in the form of a sensation constant pressure, voltage. They do not change with changes in body position, but can intensify with a deep breath or palpation of the abdomen.

Objectively: positive Pasternatsky’s sign, pain and tension in the abdominal muscles on the side of the affected kidney.

Minor intermittent pain in the lower back of an aching or pulling nature

Pain in the lumbar region on 1 or 2 sides varying intensity. There may be a feeling of constant coldness in the lower back.

Dysuric syndrome

Pollakiuria, stranguria, polyuria, maybe nocturia

Changes from other systems

Tachycardia, blood pressure is reduced or normal

Increased blood pressure, intense pulse.

Anemia

Upon inspection:

Puffiness of the face, pastiness of the eyelids in the morning, hands, feet.

Skin gray-earthy color, dry, flaky.

The tongue is dry, coated with a grayish coating.

Chronic pyelonephritis.

Clinical forms.

latent– urinary syndrome not expressed, no clinic;

hypertensive –Blood pressure, urinary syndrome is mild;

recurrent– the course of the disease with periods of exacerbations and remissions. In case of exacerbation, the clinical picture of acute pyelonephritis;

hematuric– occurs against the background of anemia, the predominance of red blood cells in the urine, can lead to an anemic form;

anemic –pyelonephritis clinic, anemic syndrome clinic (weakness, dizziness, shortness of breath, flashing “spots”; in severe cases, fainting);

asymptomatic –There are no complaints, urinary syndrome occurs periodically.

Complications:

Acute renal failure

Bacteremic shock

Arterial hypertension

Anemia

chronic renal failure

Urolithiasis disease

Laboratory and instrumental studies:

1. CBC: leukocytosis with a shift to the left, increased ESR, anemia.

2. OAM: leukocyturia, pyuria, proteinuria, cylindruria, bacteriuria. Hematuria is less common.

3. Tests according to Nechiporenko, Amburge, Addis-Kakovsky: leukocyturia (methods of quantitative counting of red blood cells and cylinders in the daily volume of urine (Addis-Kakovsky method), in 1 ml of urine (according to Nechiporenko) and in 1 minute (according to Amburge)). Urinalysis according to Nechiporenko allows you to more accurately determine the degree of bacteriuria, and therefore draw a conclusion about the intensity of inflammation and its nature.

4. Zimnitsky test: polyuria, nocturia.

5. Urine culture. Bacteriuria, if more than 50-100 thousand microbial bodies are detected in 1 ml of urine

6. Ultrasound. To assess the degree of disturbance in the passage of urine and detect obstacles to its outflow, ultrasound of the kidneys, excretory urography, ascending urography, radioisotope renography and scintigraphy are performed.

7. Excretory urography(IV, descending) X-rays are taken at 5, 15, 20, 30 minutes after IV administration of the contrast agent.

8. Radioisotope research.

Diagnosis is difficult due to the lack of clear clinical manifestations. In addition to the usual laboratory tests blood and urine, the basis of the diagnostic search is X-ray, radioisotope and other instrumental research methods that make it possible to detect the replacement of kidney tissue with connective tissue.

To assess the degree of kidney damage, perform plain radiography, excretory and ascending pyelography, chromocystoscopy, radioisotope renography and kidney scanning and ultrasound.

To identify complications of pyelonephritis from of cardio-vascular system An ECG and fundus examination are prescribed.

Treatment

Treatment of acute and chronic pyelonephritis:

1. Hospitalization for acute pyelonephritis and exacerbation of chronic.

2. Bed rest for the period of intoxication.

3. Positional therapy: the patient should take a knee-elbow position for 5 minutes 2-3 times a day. It is recommended to empty bladder every 1.5-2 hours, sleep on the side opposite the diseased kidney (improves the outflow of urine from upper sections profit center).

4. Diet: varied food, fortified, high-calorie. The amount of salt is 6-10 g per day. Spicy dishes, meat broths, smoked meats, canned food, coffee, pepper, mustard, onions, and alcoholic beverages are excluded. A dairy-vegetable diet and cereals are recommended. Drink plenty of fluids(compotes, rosehip decoction, tea with lemon, cranberry juice - has an antiseptic effect) up to 2.5-3 liters per day, if there are no contraindications. Products with a diuretic effect are recommended: watermelon, melon, pumpkin.

5. Etiotropic treatment: a/b according to the sensitivity of the microflora (nephrotoxic a/b, such as sulfonamides) are not recommended):

penicillins: amoxicillin, ampiox (microbes are immune, for pregnant women)

cephalosporins (for mild forms, not purulent, Cefipime - any microbes)

macrolides: sumamed, azithromycin, clarithromycin

nitrofurans: furazidin

fluoroquinolones: nolicin, levofloxacin (the most modern, the advantage is a long half-life)

8-hydroxyquinoline derivatives: nitroxoline

glycopeptides: vancomycin, ristomycin

aminoglycosides (extremely toxic to hearing)

carbapenems: meropenem (only under strict supervision)

6. Detoxification therapy: 5% glucose, physical. solution, hemodez, rheopolyglucin.

7. Antiplatelet agents to improve microcirculation in the kidneys: chimes.

8. Antispasmodics for pain: papaverine, no-spa, baralgin.

9. Symptomatic therapy: antipyretics, for chronic diseases. pyelonephritis, antihypertensives, treatment of anemia.

10. Herbal medicine (anti-inflammatory and diuretic effect): lingonberry leaf, yarrow, bearberry, St. John's wort, sage, rose hips, horsetail, celandine, juniper berries, raspberry leaf, chamomile, parsley, birch buds.

11.Physiotherapy.

12.When stored pyelonephritis in the remission phase, it is possible to conduct courses of alternating a/b and herbal medicine.

13. Surgical treatment for the development of complications.

Prevention

1. Elimination of the causes contributing to the disturbance of urodynamics.

2. Avoid hypothermia.

3. Sanitation of foci of chronic infection.

4. Treatment of concomitant diseases.

5. Maintain hygiene of the external genitalia.

6. For chronic pyelonephritis dispensary observation see a nephrologist, regularly monitor urine tests.

Assignment in test form

Pyelonephritis is one of the common kidney diseases in adults and children. A special role in the treatment and rehabilitation of such patients belongs to the nurse, a professional in the field of patient care. The duty of these workers in white coats is to provide get well soon and prevention of possible complications.

Urinary tract diseases also include nephropathies, glomerulonephritis, urolithiasis and others. But whatever the diagnosis, most diseases are accompanied by inflammatory process, impaired functioning of the organ, and sometimes the gradual development of renal failure.

The functions and tasks of nursing care for patients with pyelonephritis can be divided into stages.

Patient care during an exacerbation period

The nursing process for pyelonephritis has as its goal the provision of the most gentle regimen for the body and kidneys. This may include:

• compliance monitoring bed rest;
• provision of emergency first aid;
• strict adherence to the doctor’s instructions.

It is necessary to exclude the patient from visiting the sanitary room. To do this, the child must have access to a bedpan or potty. The room (ward) must be warm, and the ward must be warmly dressed to avoid hypothermia, including during ventilation.

If we're talking about about a child or an elderly person, then on average medical personnel there is an obligation to maintain constant contact with the patient’s parents or relatives. The nurse should conduct accessible form conversations with them, explaining the need to adhere to bed rest, especially during the period of exacerbation, when the patient is already stronger.

Maintaining a protective treatment regime

This is the creation of conditions for nursing throughout the entire period of treatment in a hospital, adequate care.

This includes:

• monitoring compliance with the cleanliness regime by junior medical personnel;
• Creation psychological comfort for patients, especially children;
• providing adequate nutrition;
• correct implementation of the attending physician's prescriptions.

It is necessary to regularly (2 times a day) ventilate the room. Wet cleaning in the ward is carried out at least three times a day. Keep the vessel or pot clean. Linen should be fresh and clean, especially in patients with urinary incontinence. The room should be kept quiet, and the subject should be guaranteed adequate daytime and night sleep.

Leisure organization

The country's legislation provides for compulsory secondary education for children, including those receiving treatment. A nurse in a pediatric nephrology or urology department monitors young patients’ attendance at regular classes with teachers assigned to the hospital and homework.

If we are talking about babies, then the nursing process for pyelonephritis involves performing educational functions. Here, both the organization of leisure activities and games allowed for patients with pyelonephritis, as well as maintaining the cleanliness of the playroom are important.

Diet food

A nutritionist who is part of the hospital staff is required to monitor the work of the catering unit (kitchen) in terms of providing certain categories of patients dietary nutrition. She not only creates a menu based on needs medical institution and budget. The result of her activities is quality control of food prepared for patients.

Patients with acute symptoms of pyelonephritis should eat high-calorie, dairy-vegetable foods, boiled fish and eggs. A large amount of vegetables and fruits are consumed, which increase urine output, as this helps flush out the pathogen from the kidneys. Liquids should be consumed at least 2 liters per day. Cranberry juice is especially useful, as when consumed, a special hippuric acid is formed, which has bactericidal properties. You can also drink juices, tea, rosehip decoction.

It is necessary to limit salt to 4 g per day when blood pressure rises. It is better not to add salt to prepared food, as this allows you to regulate the amount of product consumed. If the patient suffers from edema, the nurse keeps a record of the fluid consumed and excreted in the urine. She makes recommendations to parents and relatives regarding food products that are given to the patient.

Compliance dietary recommendations necessary in preparation for an x-ray examination of the kidneys. It is necessary to limit the number of foods that increase gas formation (bread, vinaigrette, milk, sugar). On the eve of the test, if the patient suffers from constipation, the nurse will perform a cleansing enema.

Collection of urine tests

Monitoring the patient’s condition and diagnosing pyelonephritis is impossible without a urine test. There are many methods for collecting urine and physiological samples. But anyway a necessary condition A successful procedure will include proper toileting of the external genitalia and ensuring proper storage and delivery of containers to the laboratory.

A woman is being washed while she is lying on the bed. To do this, a vessel is placed under the pelvis, the patient spreads her legs, and the nurse pours warm water from a jug onto the perineum.

In men, before collecting the analysis, the head of the penis and the entrance to the urethra are treated with an antiseptic. The staff has the responsibility to explain to the patient and his relatives the need for tests and to teach collection rules.

For general analysis, urine is collected in a sterile container and sent to the laboratory. This should be done within an hour.

Fulfilling doctor's orders and monitoring

This set of responsibilities includes:

• administration of medications;
• collection of urine for testing;
• control of preparation for certain examinations and ensuring the presence of the patient during manipulations;
• informing patients and their relatives about certain diagnostic activities and rules for preparing for them, as well as possible side effects of medications;
• recording changes in the patient’s general condition (timely measurement of blood pressure and temperature, monitoring the volume of urine excreted, entering data into a control sheet).

Any changes in condition should be reported to your doctor.

Properly organized care will lead to the recovery of a patient with pyelonephritis in as soon as possible. Achieving these goals is an indicator of a properly organized nursing process.