Pyelonephritis is a nursing process. Nursing care for a child. Requirements for drug therapy

Ministry of Health of the Moscow Region

State budgetary professional educational institution of the 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 carry out the 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, independent work skills, logical, analytical and clinical thinking.

Understand the essence and social significance your future profession, show a steady interest in it.

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 of medications, intravenous, intramuscular, subcutaneous injections);

determine the patient's respiratory rate (respiratory rate), blood pressure level ( blood pressure), pulse and enter 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' knowledgewith 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 fundamentals of protecting the health of citizens in the 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 secondary medical 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 promote a healthy lifestyle 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: textbook / 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:

Reference point.

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.

Initial knowledge control.

The task is distributed in test form.

1 0

Students answer the proposed tests

Work on mistakes. Test control analysis is carried out

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

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

1 0

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

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

The teacher gives recommendations for solving problems

Solving situational problems, performing the manipulations specified in the task

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 diseases of the 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 inflammatory disease kidneys with damage to 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 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 of MVS, catheterization

foci of chronic infection

4. Concomitant diseases: 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

CHRONIC PYELONEPHRITIS (remission/exacerbation)

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 feeling of constant pressure and tension. They do not change with changes in body position, but may increase with deep breath, 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 lumbar region on 1 or 2 sides of 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.

The skin is gray-earthy in color, dry, flaky.

The tongue is dry, coated with a grayish coating.

Chronic pyelonephritis.

Clinical forms.

latent– urinary syndrome is not expressed, there is 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:

Paranephritis – inflammation of the perinephric tissue

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 done at 5, 15, 20, 30 minutes after intravenous administration of a contrast agent.

8. Radioisotope research.

Diagnosis is difficult due to the lack of clear clinical manifestations. In addition to the usual laboratory tests of 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 the cardiovascular 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 the bladder every 1.5-2 hours, sleep on the side opposite the diseased kidney (the outflow of urine from the upper parts of the bladder improves).

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 water (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, follow-up with a nephrologist, regular monitoring of urine tests.

Assignment in test form

List of abbreviations

BP - blood pressure

WHO - world health organization

PN – pyelonephritis

medicinal product

AKI – acute pyelonephritis

ESR – erythrocyte sedimentation rate

Ultrasound – ultrasound examination

CRF - chronic pyelonephritis

CNS - central nervous system

RR – respiratory rate

HR – heart rate

ECG – electrocardiogram

Introduction

Pyelonephritis is inflammation of the kidney tissue. Pyelonephritis can affect a person of any age, but more often it affects:

· children under 7 years of age whose disease is associated with anatomical developmental features;

· girls and women aged 18-30 years, in whom the appearance of pyelonephritis is associated with the onset of sexual activity, pregnancy or childbirth;

· elderly men suffering from prostate adenoma.

In addition to the above, one of the most common causes of pyelonephritis is urolithiasis and frequent attacks renal colic.

With all these diseases and conditions, the outflow of urine from the kidney is disrupted, which allows microorganisms to multiply in it. Factors such as decreased general immunity body, diabetes mellitus, chronic inflammatory diseases. In its course, pyelonephritis can be acute and chronic.

Pyelonephritis is the most frequent illness kidneys in all age groups. There are differences in the incidence of pyelonephritis in men and women at different times. age periods. In general, women predominate among patients with pyelonephritis.

At the age of 2 to 15 years, girls suffer from pyelonephritis 6 times more often than boys, almost the same ratio is observed between men and women in young and middle age. In old age, pyelonephritis occurs more often in men. These differences are associated with impaired urodynamics and urinary tract infections at different ages in representatives of different sexes.

Pyelonephritis may be independent disease, but more often complicates the course of various diseases (urolithiasis, prostate adenoma, diseases of the female genital organs, tumors genitourinary system, diabetes mellitus) or occurs as a postoperative complication.

Uncomplicated kidney infections occur in the absence of structural changes in patients without serious concomitant diseases; they are usually observed in outpatient practice.

Complicated infections occur in patients with various obstructive uropathy during catheterization Bladder, as well as in patients with concomitant pathologies (diabetes mellitus, congestive heart failure, immunosuppressive therapy, etc.). In elderly patients, complicated infections are common.

A special place is occupied by senile pyelonephritis - the main problem of the geriatric nephrology clinic. Its frequency increases with each decade of an older person’s life, reaching 45% in men and 40% in women in the tenth decade.

This work did not aim to discuss in detail all aspects of this disease, and the main focus is on issues antibacterial therapy pyelonephritis. However, it is advisable to briefly dwell on the differential diagnosis of urinary tract infections, since the timeliness of diagnosis largely determines the prognosis of treatment.

Subject of study.

Nursing process for pyelonephritis

Object of study.

Nursing process.

Purpose of the study.

Studying nursing process with pyelonephritis

To achieve this research goal it is necessary to study:

· etiology and contributing factors for the occurrence of PN;

· clinical picture and diagnostic features of this disease;

· examination methods and preparation for them;

· principles of treatment and prevention of PN;

· complications;

Manipulations performed by a nurse;

Features of the nursing process in this pathology.

To achieve this research goal it is necessary to analyze:

· two cases describing the nurse’s tactics when implementing the nursing process for a patient with this disease;

· the main results of examination and treatment of patients with PN, necessary to fill out the sheet of nursing interventions.

To achieve this goal, it is necessary to use all possible research methods, such as:

· scientific and theoretical analysis of medical literature on PN.

biographical (analysis of anamnestic information, study medical documentation).

· empirical observation, additional research methods:

Organizational (comparative, complex) method;

Subjective method of clinical examination of the patient (history collection);

Objective methods of examining the patient (physical, instrumental, laboratory);

· biographical (analysis of anamnestic information, study of medical documentation);

· psychodiagnostic (conversation).

Practical significance:

Detailed disclosure of material on the topic course work“Nursing process for pyelonephritis” will improve the quality of nursing care

1. Pyelonephritis

Pyelonephritis is an inflammatory disease of the kidneys predominantly bacterial etiology, characterized by damage to the renal pelvis, calyces and kidney parenchyma (mainly its interstitial tissue).

1.1.Etiology

The cause of pyelonephritis is always an infection. Factors promoting development infectious process in the kidney:

Disorders of urine flow

Narrowing of the ureter

Kidney development abnormalities

Hydronephrosis,

Reflux,

Tumor,

Pre-existing kidney disease, especially interstitial nephritis Immunodeficiency conditions (treatment with cytostatics and/or prednisolone, diabetes mellitus, immune defects) Hormonal imbalance(pregnancy, menopause, long-term use contraception)

1.2.Pathogenesis

Local foci of infection play a leading role in the occurrence of pyelonephritis during the antibacterial period. They may be

· tonsils,

· paranasal sinuses

· carious teeth,

· lungs,

· biliary tract,

· purulent skin lesions,

· osteomyelitis.

For women, the main source of kidney infection is the genitals with acute and chronic inflammation in them. This pathogenetic factor is predominant in women, which, along with some anatomical and physiological features, explains the highest frequency of pyelonephritis in females, amounting to over 80%.

1.3 Clinic and classification

The disease begins suddenly, the temperature rises sharply to 39-40 ° C, and

· weakness,

· headache,

· profuse sweating,

· nausea and vomiting.

· pain in the lower back, usually on one side.

According to the course, acute or chronic pyelonephritis is distinguished

Acute pyelonephritis

The following factors play an important role in the occurrence of pyelonephritis: the type and nature of the infectious agent; the presence of changes in the kidney and urinary tract that contribute to the fixation of the pathogen in them and the development of the process; routes of infection into the kidney; general condition of the body and its immunobiological reactivity. Clinical picture. The initial stage of the disease is interstitial serous pyelonephritis, which is not accompanied by destruction of renal tissue; later, a stage of purulent inflammation occurs, characterized by the destruction of renal tissue at the site of inflammation. Depending on the nature of the changes in the renal parenchyma, the following forms of acute purulent pyelonephritis are distinguished:

· apostematous,

carbuncle

kidney abscess.

The symptoms of acute pyelonephritis largely depend on the degree of disturbance in the passage of urine. In primary acute pyelonephritis, local signs are mild or absent. The patient's condition is serious, it is noted

general weakness

· increase in body temperature to 39-40°,

profuse sweat

· pain throughout the body,

nausea, sometimes vomiting,

dry tongue

Tachycardia

In secondary pyelonephritis, caused by a violation of the outflow of urine from the kidney, a characteristic change in symptoms is observed in the acute phase. As a rule, the deterioration of the patient's condition coincides with a sharp increase in pain in the lumbar region or an attack of renal colic due to a violation of the outflow of urine from the renal pelvis. At the height of pain, chills occur, which are replaced by fever and a sharp increase in body temperature. Then the body temperature drops critically to subfebrile, which is accompanied by profuse sweating; the intensity of pain in the kidney area gradually decreases until it disappears. However, if the obstruction to the outflow of urine is not eliminated, after several hours of improvement in well-being, the pain intensifies again and a new attack of acute pyelonephritis occurs. The course of acute pyelonephritis varies depending on

body condition

· age,

· previous condition of the kidneys and urinary tract.

Children are characterized by the severity of intoxication syndrome, as well as the development of the so-called abdominal syndrome (severe pain not in the lumbar region, but in the abdomen). In primary pyelonephritis, local signs are mild or absent. The patient's condition is serious. There is general weakness, stunning chills with an increase in temperature to 39-40 C and heavy sweat, tachycardia, loss of appetite, nausea, vomiting, dry mouth. With secondary pyelonephritis, caused by a violation of the outflow of urine from the kidney, the deterioration of the patient’s condition coincides with increased pain in the lumbar region or an attack of renal colic. At the height of the pain, chills occur, then an increase in body temperature to low-grade levels and heavy sweating. If the obstacle to the outflow of urine is not eliminated, then after several hours of apparent improvement in the condition, a new attack of pyelonephritis occurs again. The clinical picture of acute pyelonephritis depends on the condition of the body, age, gender, previous condition of the kidneys and urinary tract. In weakened patients, elderly and senile people, clinical manifestations

less pronounced

· absent

· or perverted.

A picture of a general infectious disease or sepsis without signs of damage to the urinary organs, a picture of an acute abdomen, signs reminiscent of meningitis, etc. are observed. Emphysematous pyelonephritis occurs as a severe septic disease. More often it occurs with undisturbed passage of urine, and therefore there are no symptoms of renal colic. There is severe pain in the area of the affected kidney due to gas infiltration of the perirenal tissue and destruction of the renal parenchyma. Its most typical clinical signs are

- stubborn feverish woman,

− abdominal pain,

− nausea, vomiting

- when examining urine, pyuria.

Chronic pyelonephritis

Chronic pyelonephritis may be a consequence of untreated acute pyelonephritis (more often) or primary chronic, that is, it may proceed without acute phenomena from the onset of the disease. In most patients, chronic pyelonephritis occurs in childhood, especially in girls. In 1/3 of patients, a routine examination fails to identify undoubted signs of pyelonephritis. Often, only periods of unexplained fever indicate an exacerbation of the disease. IN last years Cases of combined disease with chronic glomerulonephritis and pyelonephritis are increasingly being reported.

May leak under masks.

1. Latent form - 20% of patients. Most often there are no complaints, and if there are, then weakness, increased fatigue, and less often low-grade fever. Women may experience toxicosis during pregnancy. A functional study reveals nothing, except for a rare unmotivated increase in blood pressure and mild pain when tapping the lower back. Laboratory diagnosis. Repeated tests are of decisive importance: leukocyturia, moderate, no more than 1 - 3 g/l proteinuria + Nechiporenko test. Stengheimer-Malbin cells are doubtful, but if there are more than 40% of them, then it is characteristic of pyelonephritis. Active leukocytes are rarely detected. True bacteriuria *****> 10 5 bacteria in 1 ml.

To prove it, 30 g of prednisolone IV and evaluate the indicators (increase in leukocytes by 2 or more times, active leukocytes may appear).

2. Recurrent almost 80%. Alternation of exacerbations and remissions. Features: intoxication syndrome with fever, chills, which can occur even at normal temperature, leukocytosis in a clinical blood test, increased ESR, shift to the left, C-reactive protein. Pain in the lumbar region, usually 2-sided, in some like renal colic: the pain is asymmetrical! Dysuric and hematuric syndromes. Hematuria syndrome now occurs more often, there may be micro- and macrohematuria. Increased blood pressure. The most unfavorable combination of syndromes: hematuria + hypertension - > after 2-4 years, chronic renal failure.

3. Hypertensive form: the leading syndrome is an increase in blood pressure, which may be the first and only one, the urinary syndrome is not pronounced and is not constant. It is dangerous to do a provocation, as there may be an increase in blood pressure.

4. Rarely anemic. Persistent hypochromic anemia, may be the only sign. Associated with a violation of erythropoietin production, urinary syndrome is not expressed and is not constant.

5. Hematuric: recurrence of macrohematuria.

6. Tubular: uncontrolled urinary losses of Na + and K + (salt - losing kidney). Acidosis. Hypovolemia, hypotension, decreased glomerular filtration, may be acute renal failure.

7. Azotemic: appears for the first time already. honor disadvantage

1.4 Complication and prognosis

Most frequent complications pyelonephritis are associated with the spread of infection through the kidney and into surrounding tissues. So acute pyelonephritis can be complicated

· paranephritis,

· formation of pustules in the kidney (apostematous pyelonephritis),

carbuncle

kidney abscess,

· necrosis of the renal papillae, which is an indication for surgical intervention.

Pyonephrosis is terminal stage purulent-destructive pyelonephritis. The pyonephrotic kidney is an organ that has undergone purulent melting, consisting of separate cavities filled with pus, urine and tissue decay products.

A two-way process, affecting the excretory function of the kidneys, can lead to the development of renal failure.

1.5 Diagnostics

1. Urine tests (General, according to Nechiporenko, according to Zimnitsky)

Determines increased protein content in the urine and the presence of a large number of red blood cells (hematuria).

2. General blood test

Allows you to identify signs of inflammation: leukocytosis, increased ESR, increased protein concentration.

3. Blood biochemistry

Establishes an increase in the concentration of urea and creatinine in the blood.

4. Daily blood pressure measurement

5. Ultrasound of the kidneys

Determines an increase in kidney size in acute PYELONEPHRITIS or shrinkage in chronic forms of the disease or renal failure.

6. Radioisotope angiorenography

Radioactive isotopes - substances capable of emitting radioactive rays - are introduced into the patient's body. When administered, they are mixed with other substances that accumulate in the internal organs and act as “tags” that make it possible to detect injected drugs in the internal organs, which can indicate changes, neoplasms, etc. etc.

8. Kidney biopsy

Allows you to clarify the form of pyelonephritis, its activity, and exclude kidney diseases with similar symptoms.

1.6 Treatment

1 Patients are subject to hospitalization with exacerbation of chronic renal failure or acute renal failure.

2 Strict bed rest at the beginning of the disease for 2-3 weeks, then when the condition improves, blood pressure normalizes, and swelling disappears, the patient is transferred to semi-bed rest

3 Prescribe a diet (No. 7, 7a, 7b) in which the following is limited:

− intake of table salt into the body;

− protein intake;

− water inflows.

The amount of water you drink should correspond to the amount of fluid excreted.

4 Drug therapy.

− antibiotics

· . Prescribe drugs from the penicillin group (benzylpenicillin 1,000,000-2,000,000 units/day, oxacillin orally or intramuscularly 2-3 g/day, ampicillin orally up to 6-10 g/day, ampicillin sodium salt intramuscularly or intramuscularly). /at least 2-3 g/day, etc.) symptomatic therapy antihypertensive drugs, diuretics

(papaverine, capoten, furosemide (Lasix), veroshpiron, hypothiazide,).

antiplatelet drugs

(heparin, hepalpan, methinzol)

non-steroidal anti-inflammatory drugs

(Voltaren, Brufen)

· antihistamines

(tavegil, suprastin, etc.)

5 Elimination of foci of infection

6 Treatment of chronic pyelonephritis

should be carried out over a long period of time (years). Treatment should begin with the appointment of nitrofurans (furadonin, furadantin, etc.), nalidixic acid (negram, nevigramon), 5-NOK, sulfonamides (urosulfan, atazole, etc.), alternating them. At the same time, it is advisable to treat with cranberry extract. If these drugs are ineffective or the disease worsens, antibiotics are used wide range actions. The prescription of an antibiotic should each time be preceded by determining the sensitivity of the microflora to it. For most patients, monthly 10-day courses of treatment are sufficient. However, in some patients with such therapeutic tactics, virulent microflora continues to be sown from the urine. In such cases, long-term continuous antibiotic therapy is recommended, changing drugs every 5-7 days.

1.7 Prevention

Prevention for acute renal failure and chronic renal failure comes down to:

· Early diagnosis.

· Antibacterial treatment(penicillin, macrolides, semisynthetic penicillins). The course must be at least 10 days.

· Mandatory urine analysis in the middle - end of the 2nd week of illness for scarlet fever, sore throat and other diseases of streptococcal etiology contributes to early detection and hence a smoother course of pyelonephritis

· Hygiene measures in order to prevent streptoderma. Carrying out these activities helps reduce the incidence of pyelonephritis.

· Observation by a nephrologist, periodic urine tests and blood pressure measurements.

2. Nursing process for pyelonephritis

Immediately before nursing interventions, it is necessary

· ask the patient or his relatives,

· conduct an objective study - this will allow the nurse to assess the physical and mental patient's condition,

· as well as identify his problems and suspect kidney disease, including pyelonephritis,

· create a care plan. When interviewing a patient (or his relatives)

· It is necessary to ask questions about past illnesses, the presence of edema, increased blood pressure, pain in the lumbar region, changes in urine.

Analysis of the data obtained helps to identify the patient’s problems – nursing diagnosis. The most significant are:

§ headache;

§ pain in the lumbar region;

§ general weakness, increased fatigue;

§ nausea, vomiting;

§ the need of the patient and his family members for information about the disease, methods of its prevention and treatment.

Nursing care is of considerable importance in solving these problems, however main role non-drug and drug therapy, which are prescribed by a doctor, plays a role.

The nurse informs the patient and his family members about the essence of the disease, the principles of treatment and prevention, explains the course of certain instrumental and laboratory research and preparation for them.

Nursing care for patients with PN includes:

· monitoring compliance with bed or semi-bed rest during the acute period of the disease with its gradual expansion;

Ensuring adequate rest and sleep; restriction of physical activity; these measures help reduce blood pressure, the severity of general weakness, and fatigue;

· monitoring the clinical manifestations of the disease, primarily edema and hypertension: daily measurement of pulse, blood pressure, amount of fluid drunk and excreted;

· identifying signs of complications - the development of renal failure, informing the doctor about this;

· monitoring compliance with the diet and treatment prescribed by the doctor, as well as identifying side effects of medications;

· training the patient or his parents in the skills of monitoring the general condition of the patient, including determining pulse, blood pressure, and urine output;

· informing about ways to prevent exacerbation of PN;

· early detection and treatment of acute infectious diseases (sore throat, acute respiratory diseases, etc.), sanitation of chronic foci of infection ( chronic tonsillitis, carious teeth, etc.).

Manipulations performed by a nurse

1. Blood sampling for biochemical analysis.

− Before the manipulation, the nurse informs the patient about the upcoming procedure and obtains his consent.

− Wash your hands under running water and dry them.

− Check the sterilization date and sterility indicators, as well as the integrity of the packaging of trays, cotton balls, tweezers and syringes

− Attach the needle, check its patency without removing the cap.

− Place the assembled syringe and 4-5 pcs. cotton balls soaked in alcohol in a sterile tray.

− Carry out hand hygiene and wear gloves.

− Sit the patient down and place a cushion under the elbow.

− Apply a tourniquet to the protected surface of the arm above the elbow.

− Ask the patient to clench and unclench his fist several times.

− Palpate the most accessible vein and ask the patient to clench his fist.

− Treat the injection site with 2 cotton balls soaked in alcohol.

− Fix the vein by stretching the skin of the elbow.

− Take the syringe into right hand and parallel to the arm, insert the needle into the vein.

− Pull the piston towards you, make sure that the needle is in the vein and draw 5-10 ml for the study

− Invite the patient to unclench his fist

− Remove the harness

− Lightly press a cotton ball to the puncture site and remove the needle.

− Ask the patient to bend his arm at the elbow for 5 minutes

− Carefully pour the blood from the syringe into the test tube

− Attach the patient code number to the tube, place the direction in a plastic bag

− Place the blood tubes together with the rack in a container and close tightly.

− Place the used material in a disinfectant solution.

− Container with directions to transport to the laboratory.

Performing intramuscular injections.

Technique:

Wash and dry your hands;

Check the name and expiration date of the medicine;

Remove sterile trays and tweezers from the packaging;

Assemble the disposable syringe;

Prepare 4 cotton balls (wipes), moisten them with skin antiseptic in the tray;

File the ampoule with the medicine using a special file;

Wipe the ampoule with one cotton ball and open it;

Discard the used cotton ball with the end of the ampoule into the waste tray;

Draw the medicine from the ampoule into the syringe, change the needle;

Help the patient take a position comfortable for this injection (on his stomach or side);

Determine the injection site;

Wear gloves;

Treat the skin at the injection site twice with cotton balls (napkins) moistened with a skin antiseptic (first a large area, then the injection site itself);

Displace the air from the syringe without removing the cap, remove the cap from the needle;

Insert the needle into the muscle at an angle of 90°, leaving 2 - 3 mm of the needle above the skin;

Place your left hand on the piston and inject the medicine;

Remove the needle by pressing a cotton ball (napkin);

Place the used syringe in the waste tray;

Perform a light massage of the injection site without removing the cotton wool (napkins) from the skin;

Place a cotton ball (napkin) in the waste tray;

Help the patient take a position that is comfortable for him;

Disinfect used equipment in separate containers for the duration of exposure;

Remove gloves, with the working surface facing inward, and throw them into a container for used seals;

Wash and dry your hands.

Determination of water balance.

Technique:

The patient receives normal normal nutrition. The amount of liquid you drink is strictly limited to 1 liter per day. From 8 pm to 8 am the patient is on bed rest. In this case, two 12-hour portions of urine are collected - from 8 pm to 8 am and from 8 am to 8 pm - and its quantity is measured.

3. Practical part

3.1 Observation 1

Patient **** years old, was admitted to the nephrology department with a diagnosis of acute pyelonephritis

Carrying out the first stage of the nursing process - nursing examination, the initial assessment sheet was filled out (Appendix 1).

Complaints: Headache, mainly in the parieto-occipital region, moderate. Pain in the lumbar region, aching in nature, without connection with movement. Frequent urination in small portions, with pain. Weakness.

Objectively: the skin is dry, swollen, pale, blood pressure 120/85, respiratory rate 28, PS 80 per minute, body temperature 37.4, Pasternatsky’s symptom is positive.

The second stage of the nursing process is identifying disrupted needs, identifying real, priority, and potential problems.

Present problems: headache, mainly in the parieto-occipital region, moderate. Pain in the lumbar region, aching in nature, without connection with movement. Frequent urination in small portions, with pain Weakness.

Potential problems: risk of complications - chronic renal failure, hypertensive crisis, risk of developing bedsores.

The third stage is planning nursing interventions.

The fourth stage is characterized by the implementation of nursing care (Appendix No. 2)

At the fifth stage, the results of nursing interventions are assessed: The patient notes less pronounced polyuric phenomena.

The goal has been achieved.

3.2 Observation 2

Patient ******., 69 years old, applied to the nephrology department with a diagnosis of chronic pyelonephritis. Upon admission, he complained of: severe chest pain due to physical and emotional stress, weakness, increased blood pressure.

Objectively: pale skin, weakness, anxiety, fear of death

BP 170/115, PS -79 per minute. arrhythmic due to exacerbation myocardial infarction developed

First aid for myocardial infarction.

1. Call a doctor.

2. Measure blood pressure.

3. Place the patient in bed with the head of the bed raised, ensuring him complete mental and physical rest;

4. Provide inflow fresh air, unbutton tight clothing.

5. Nitroglycerin 1 tablet. under the tongue, and if it is intolerant - Validol 1 tablet. under the tongue, Acetylsalicylic acid - tab. under the tongue, Paracetamol (Analgin) 1 tablet.

6. If burning pain in the chest and shortness of breath occur, you should immediately put a nitroglycerin tablet under your tongue. If pain persists within 5 minutes, you can take another tablet (maximum 3 tablets).

7. Monitor the patient’s condition, pulse, blood pressure.

Having analyzed cases of pyelonephritis, we can draw conclusions: knowledge of the etiology, clinical picture, diagnostic features, methods of examination and treatment of the disease, prevention of complications, as well as knowledge of manipulations will help the nurse carry out all stages of the nursing process.

In the first situation, the implementation of the nursing process is carried out by identifying the patient's problems and drawing up a care plan for the identified problems. In the second case, the nursing process consists of providing emergency first aid due to the deterioration of the patient's condition. In the provision of primary medical care, forecasts are different, which allow one to confirm or refute one or another provision contained in the purpose of the study.

Conclusion

Having studied in depth the “Nursing process for pyelonephritis” and analyzed two cases from practice, it was concluded that the goal of the work was achieved. The work shows that the use of all stages of the nursing process, namely:

Stage 1: assessment of the patient’s condition (examination);

Stage 2: interpretation of the data obtained (identification of the patient’s problems);

Stage 3: planning the upcoming work;

Stage 4: implementation of the drawn up plan (nursing interventions);

Stage 5: evaluation of the results of the listed stages

Allows you to improve the quality of nursing care.

A nurse, whose responsibilities include caring for patients, must not only know all the rules of care and skillfully perform medical procedures, but also clearly understand what effect medications or procedures have on the patient’s body. Treatment of the disease mainly depends on careful proper care, adherence to regimen and diet. In this regard, the role of the nurse in the effectiveness of the treatment is increasing. Prevention of the disease is also very important: the nurse teaches family members how to organize a regimen, nutrition and talks about preventive treatment patient.

The knowledge and skills acquired in the course of writing coursework are necessary conditions for providing nursing care.

Having written this course work, I learned better about the disease pyelonephritis and learned to apply my knowledge in practice

Literature

1. K.E. Davlitsarova, S.N. Mironova - Manipulation technique; M.: – Infra Forum 2005. – 480 s.

2. V. G. Lychev, V. K. Karmanov - Guide to conducting practical classes on the subject “Nursing in therapy with a course of primary medical care”: – educational manual M.: – Infra Forum, 2010. – 384 p.

3. V. G. Lychev, V. K. Karmanov - Fundamentals of nursing in therapy - Rostov n/d Phoenix 2006 - 512 p.

4. V.I. Makolkin, S.I. Ovcharenko, N.N. Semenkov - Nursing in therapy - M.: - Medical Information Agency LLC, 2008. – 544 p.

5. S.A. Mukhina, I.I. Tarnovskaya – Theoretical foundations of nursing - 2nd ed., rev. and additional - M.: - GEOTAR - Media, 2010. - 368 p.

6. S.A. Mukhina, I.I. Tarnovskaya - Practical guide to the subject “Fundamentals of Nursing”; 2nd edition in Spanish add. M.: – GEOTAR - Media 2009. – 512 p.

7. T.P. Obukhovets, T.A. Sklyarov, O.V. Chernova - Fundamentals of Nursing - ed. 13th add. reworked Rostov n/a Phoenix – 2009 – 552s

Annex 1

Table 1. Primary nursing assessment sheet for the inpatient chart.

Patient's name.

Residence address:

Attending doctor.

Diagnosis: Acute pyelonephritis,

Date of receipt _20.03.12_time__11:30__

primary repeated

Entered

by ambulance yourself

direction of the clinic translation

Method of transportation to the department

on a gurney on a chair on foot

Consciousness

clear contact oriented

disoriented

confusion stupor stupor

Need for breathing

free difficult

Respiratory rate 28/min

Pulse rate 80 per minute

rhythmic arrhythmic

Blood pressure 120/85 mm Hg.

Is a smoker

Number of cigarettes smoked __15___

yes dry with phlegm no

Need for adequate nutrition and hydration

Body weight 80 kg height 185 cm

Takes food and drink

independently needs help

normal reduced

elevated absent

Do you have diabetes?

If yes, then how does it regulate the disease?

insulin glucose-lowering tablets

complies

allergy

Dyspeptic disorders

nausea, vomiting

heaviness, discomfort in the abdominal area

No teeth preserved

partially preserved

Are there removable dentures?

yes from above from below no

Takes liquid

limited quite a lot

Ability to dress, undress, choose clothing, personal hygiene

independent dependent completely partially

Dressing, undressing

on one's own

with outside help

Is there a choice of clothes yes no

Does he care about his appearance?

neat sloppy

doesn't show interest

Can I do it on my own?

· to wash hands

· wash your face

· brush your teeth

· take care of

dentures

· to shave

· carry out hygiene

crotch

· comb your hair

· take a bath, shower

· wash your hair

· cut nails

Oral health

sanitized unsanitized

Skin condition

dry normal oily

swelling, scratching

ulcers rash

Ability to maintain normal body temperature

Body temperature at the time of examination was 38.7°C

decreased normal increased

sweating chills feeling hot

Physiological functions

Urination

normal in frequency rapid

rare painful

nightly (how many times)

incontinence presence of catheter

Bowel function

Character of the chair

usually consistency

liquid solid

incontinence

Need for movement

independent

fully

partially

Walking

on one's own

with outside help

use of additional devices

Can I do it on my own?

partially cannot independently

· walk up the stairs

· sit on the chair

· go to the toilet

· move to

contractures

Risk of falling yes no

Risk of developing bedsores yes no

Number of points on the Waterlow scale

no risk - 1 - 9 points

there is a risk - 10 points

high risk - 15 points

very high risk - 20 points

Need for sleep

uses sleeping pills

sleeps well

Sleep habits

Factors that disrupt sleep

The need to work and rest

works

does not work

pensioner

student

disability

hobbies

Is there an opportunity to realize your hobbies?

Possibility of communication

Spoken language Russian

Difficulties in communication

normal

hearing loss right left

hearing aid

normal

contact lenses right left

complete blindness from right to left

ocular prosthesis right left

Ability to maintain a safe environment

Maintaining Security

on one's own

with outside help

Motor and sensory abnormalities

dizziness

unsteadiness of gait

decreased sensitivity

(signature)

Nurse

(signature)

Table 2. Plan of care

Patient problems

Goals of nursing interventions

Nursing interventions

Real problems: headache, pain in the lumbar region, aching in nature, without connection with movement. Frequent urination in small portions, with pain

Potential problems: chronic renal failure,

hypertensive crisis, development of bedsores

Priority problem: polyuria

Short-term goal: the patient will notice a decrease in polyuric symptoms

Long-term goal: the patient will report absence of polyuric symptoms by the time of discharge

1. Provide a therapeutic and protective regime, diet No. 7.

2. Observance of strict bed rest

3. Monitoring the patient’s hemodynamics (respiratory rate, blood pressure, pulse). (For early diagnosis possible complications).

4. Control of daily diuresis. (To control water and electrolyte balance).

5. Monitoring the appearance and condition of the patient. (For early diagnosis and timely provision emergency care in case of complications).

6. Conduct a conversation with relatives about providing the patient with nutrition in accordance with diet No. 7.

7. Conduct conversations: about the importance of observing the regime of physical activity, work, rest, nutrition; about the need to systematically take medications; about the importance of preventive examination and treatment. (For effective treatment and prevention of rheumatism).

8. Timely implementation of doctor's orders. (For effective treatment).

9. Providing preparation for additional research. (For correct execution research).

Ensuring the patient's personal hygiene. (To create patient comfort and prevent secondary infection).

Appendix 2

Table 1. Treatment tables

general characteristics

Diet

A diet with restriction of proteins, fats and carbohydrates within the physiological norm. Salt-free hyposodium diet (food is prepared without salt, salt-free bread is specially baked). The sodium content of the products is 400 mg, which is 1 g of table salt. Culinary processing of products - without mechanical sparing. Vegetables, fruits, berries in sufficient quantities, often raw. All dishes are prepared without salt; meat and fish are boiled, possibly followed by baking or frying.

Eating 5 times a day.

Food is given 5-6 times a day.

A salt-free diet in terms of the range of products and the nature of culinary processing, similar to diets No. 7a and 7b, but the amount of proteins is increased to 80 g by adding boiled meat or fish, as well as cottage cheese.

Eating 4 – 5 times a day.

Appendix 3

Table 1.

Nursing intervention plan

Rationale

1. Informing the patient and his relatives about the disease.

The patient's right to information is ensured.

The patient and his relatives understand the appropriateness of all care measures.

2. Organize table No. 7 with a limit on spicy, salty dishes, spices, and liquids.

The irritation of the kidney parenchyma is reduced, and therefore the pain syndrome is reduced.

Fluid retention in the body increases edema and increases blood pressure.

3. During the acute period of the disease, arrange for the patient to stay in bed, followed by its extension.

IN horizontal position pain syndrome decreases, blood supply to the kidneys improves, therefore, regenerative processes improve.

4. Clearly record urine output.

A decrease in diuresis indicates fluid retention in the body.

Impaired diuresis, as well as a violation of the ratio of daytime and nighttime diuresis indicates possible violation kidney function.

5. Protect the patient from concomitant infections and colds.

Any additional infection may worsen the disease.

6. Limit the physical and emotional stress on the patient when organizing work and rest.

Loads provoke an increase in blood pressure and increased pain.

7. Organize strict hygiene of the genital organs.

Possible ascending route of infection

8. Protect the patient from hypothermia.

When cooling, immunity decreases - exacerbation of the process.

9. Carry out regular blood pressure monitoring,

List of abbreviations

BP - blood pressure

WHO - world health organization

PN - pyelonephritis

medicinal product

AKI - acute pyelonephritis

ESR - erythrocyte sedimentation rate

Ultrasound - ultrasound examination

CRF - chronic pyelonephritis

CNS - central nervous system

Respiratory rate - respiratory rate

HR - heart rate

ECG - electrocardiogram

Introduction

Pyelonephritis is inflammation of the kidney tissue. Pyelonephritis can affect a person of any age, but more often it affects:

· children under 7 years of age whose disease is associated with anatomical developmental features;

· girls and women aged 18-30 years, in whom the appearance of pyelonephritis is associated with the onset of sexual activity, pregnancy or childbirth;

· elderly men suffering from prostate adenoma.

In addition to the above, one of the most common causes of pyelonephritis is urolithiasis and frequent attacks of renal colic.

With all these diseases and conditions, the outflow of urine from the kidney is disrupted, which allows microorganisms to multiply in it. Factors such as decreased general immunity of the body, diabetes mellitus, and chronic inflammatory diseases also contribute to the development of pyelonephritis. In its course, pyelonephritis can be acute and chronic.

Pyelonephritis is the most common kidney disease in all age groups. There are differences in the incidence of pyelonephritis in men and women at different age periods. In general, women predominate among patients with pyelonephritis.

Pyelonephritis can be an independent disease, but more often it complicates the course of various diseases (urolithiasis, prostate adenoma, diseases of the female genital organs, tumors of the genitourinary system, diabetes mellitus) or occurs as a postoperative complication.

Uncomplicated kidney infections occur in the absence of structural changes in patients without serious concomitant diseases; they are usually observed in outpatient practice.

Complicated infections occur in patients with various obstructive uropathy, against the background of bladder catheterization, as well as in patients with concomitant pathologies (diabetes mellitus, congestive heart failure, immunosuppressive therapy, etc.). In elderly patients, complicated infections are common.

This work did not aim to discuss in detail all aspects of this disease, but focused on the issues of antibacterial therapy for pyelonephritis. However, it is advisable to briefly dwell on the differential diagnosis of urinary tract infections, since the timeliness of diagnosis largely determines the prognosis of treatment.

Subject of study.

Nursing process for pyelonephritis

Object of study.

Nursing process.

Purpose of the study.

Study of nursing process in pyelonephritis

To achieve this research goal it is necessary to study:

· etiology and contributing factors for the occurrence of PN;

· clinical picture and diagnostic features of this disease;

· examination methods and preparation for them;

· principles of treatment and prevention of PN;

· complications;

manipulations performed by a nurse;

features of the nursing process in this pathology.

To achieve this research goal it is necessary to analyze:

· two cases describing the nurse’s tactics when implementing the nursing process for a patient with this disease;

· the main results of examination and treatment of patients with PN, necessary to fill out the sheet of nursing interventions.

To achieve this goal, it is necessary to use all possible research methods, such as:

· scientific and theoretical analysis of medical literature on PN.

· biographical (analysis of anamnestic information, study of medical documentation).

· empirical observation, additional research methods:

-organizational (comparative, complex) method;

-subjective method of clinical examination of the patient (history collection);

-objective methods of examining the patient (physical, instrumental, laboratory);

· biographical (analysis of anamnestic information, study of medical documentation);

· psychodiagnostic (conversation).

Practical significance:

A detailed disclosure of material on the topic of the course work “Nursing process for pyelonephritis” will improve the quality of nursing care

1. Pyelonephritis

Pyelonephritis - inflammatory<#"justify">1.1.Etiology

The cause of pyelonephritis is always an infection. Factors contributing to the development of an infectious process in the kidney:

Disorders of urine flow

narrowing of the ureter,

kidney development abnormalities

hydronephrosis,

Pre-existing kidney diseases, especially interstitial nephritis Immunodeficiency conditions (treatment with cytostatics and/or prednisone, diabetes mellitus, immune defects) Hormonal imbalance (pregnancy, menopause, long-term use of contraceptives)

1.2.Pathogenesis

Local foci of infection play a leading role in the occurrence of pyelonephritis during the antibacterial period. They may be

· tonsils,

· carious teeth,

· lungs,

· bile ducts,

· purulent skin lesions,

· osteomyelitis.

1.3 Clinic and classification

The disease begins suddenly, the temperature rises sharply to 39-40 ° C, and

· weakness,

· headache,

· profuse sweating,

· nausea and vomiting.

· lower back pain, usually on one side.

According to the course, acute or chronic pyelonephritis is distinguished

Acute pyelonephritis

· apostematous,

· carbuncle

· kidney abscess.

· general weakness

· chills,

· increase in body temperature to 39-40°,

· profuse sweat

· pain all over the body,

· nausea, sometimes vomiting,

· dry tongue,

· Tachycardia

· body condition

· age,

· floor,

· previous condition of the kidneys and urinary tract.

· less pronounced

· none

· or perverted.

−persistent feverish woman,

−stomach ache,

−nausea, vomiting

−urine examination showed pyuria.

Chronic pyelonephritis

Chronic pyelonephritis can be a consequence of untreated acute pyelonephritis (more often) or primary chronic, that is, it can occur without acute phenomena from the onset of the disease. In most patients, chronic pyelonephritis occurs in childhood, especially in girls. In 1/3 of patients, a routine examination fails to identify undoubted signs of pyelonephritis. Often, only periods of unexplained fever indicate an exacerbation of the disease. In recent years, cases of combined disease with chronic glomerulonephritis and pyelonephritis have been increasingly reported.

May leak under masks.

Latent form - 20% of patients. Most often there are no complaints, and if there are, then weakness, increased fatigue, and less often low-grade fever. Women may experience toxicosis during pregnancy. A functional study reveals nothing, except for a rare unmotivated increase in blood pressure and mild pain when tapping the lower back. Laboratory diagnosis. Repeated tests are of decisive importance: leukocyturia, moderate, no more than 1 - 3 g/l proteinuria + Nechiporenko test. Stengheimer-Malbin cells are doubtful, but if there are more than 40% of them, then it is characteristic of pyelonephritis. Active leukocytes are rarely detected. True bacteriuria *****> 10 5 bacteria in 1 ml.

To prove it, 30 g of prednisolone IV and evaluate the indicators (increase in leukocytes by 2 or more times, active leukocytes may appear).

Recurrent almost 80%. Alternation of exacerbations and remissions. Features: intoxication syndrome with fever, chills, which can occur even at normal temperature, leukocytosis in a clinical blood test, increased ESR, shift to the left, C-reactive protein. Pain in the lumbar region, usually 2-sided, in some like renal colic: the pain is asymmetrical! Dysuric and hematuric syndromes. Hematuria syndrome now occurs more often, there may be micro- and macrohematuria. Increased blood pressure. The most unfavorable combination of syndromes: hematuria + hypertension - > after 2-4 years, chronic renal failure.

Hypertensive form: the leading syndrome is an increase in blood pressure, which may be the first and only one, the urinary syndrome is not pronounced and is not constant. It is dangerous to do a provocation, as there may be an increase in blood pressure.

Anemic rarely. Persistent hypochromic anemia may be the only sign. Associated with a violation of erythropoietin production, urinary syndrome is not expressed and is not constant.

Hematuric: recurrence of macrohematuria.

Tubular: uncontrolled urinary losses of Na + and K + (salt - losing kidney). Acidosis. Hypovolemia, hypotension, decreased glomerular filtration, may be acute renal failure.

Azotemic: appears for the first time already hr. honor disadvantage

1.4 Complication and prognosis

The most common complications of pyelonephritis<#"justify">· paranephritis,

· formation of pustules in the kidney (apostematous pyelonephritis),

· carbuncle

· kidney abscess,

· necrosis of the renal papillae, which is an indication for surgical intervention.

Pyonephrosis - is the terminal stage of purulent-destructive pyelonephritis . The pyonephrotic kidney is an organ that has undergone purulent melting, consisting of separate cavities filled with pus, urine and tissue decay products.

A two-way process, affecting the excretory function of the kidneys, can lead to the development of renal failure.

1.5 Diagnostics

.Urine tests (General, according to Nechiporenko, according to Zimnitsky)

Determines increased protein content in the urine and the presence of a large number of red blood cells (hematuria).

.General blood analysis

Allows you to identify signs of inflammation: leukocytosis, increased ESR, increased protein concentration.

.Blood biochemistry

Establishes an increase in the concentration of urea and creatinine in the blood.

.Daily blood pressure measurement

.Kidney ultrasound

.Radioisotope angiorenography

.ECG

.Kidney biopsy

Allows you to clarify the form of pyelonephritis, its activity, and exclude kidney diseases with similar symptoms.

1.6 Treatment

1Patients are subject to hospitalization with exacerbation of chronic renal failure or acute renal failure.

2Strict bed rest at the beginning of the disease for 2-3 weeks, then when the condition improves, blood pressure normalizes, and swelling disappears, the patient is transferred to semi-bed rest

A diet is prescribed (No. 7, 7a, 7b) in which the following is limited:

−intake of table salt into the body;

−protein intake;

−water inflow.

The amount of water you drink should correspond to the amount of fluid excreted.

4Drug therapy.

−antibiotics

(papaverine, capoten, furosemide (Lasix), veroshpiron, hypothiazide,).

· antiplatelet drugs

(heparin, hepalpan, methinzol)

· non-steroidal anti-inflammatory drugs

(Voltaren, Brufen)

· antihistamines

(tavegil, suprastin, etc.)

5Elimination of foci of infection

6Treatment of chronic pyelonephritis

should be carried out over a long period of time (years). Treatment should begin with the appointment of nitrofurans (furadonin, furadantin, etc.), nalidixic acid (negram, nevigramon), 5-NOK, sulfonamides (urosulfan, atazole, etc.), alternating them. At the same time, it is advisable to treat with cranberry extract. In case of ineffectiveness of these drugs or exacerbations of the disease, broad-spectrum antibiotics are used. The prescription of an antibiotic should each time be preceded by determining the sensitivity of the microflora to it. For most patients, monthly 10-day courses of treatment are sufficient. However, in some patients with such therapeutic tactics, virulent microflora continues to be sown from the urine. In such cases, long-term continuous antibiotic therapy is recommended, changing drugs every 5-7 days.

1.7 Prevention

Prevention for acute renal failure and chronic renal failure comes down to:

· Early diagnosis.

· Antibacterial treatment (penicillin, macrolides, semisynthetic penicillins). The course must be at least 10 days.

· Hygienic measures to prevent streptoderma. Carrying out these activities helps reduce the incidence of pyelonephritis.

· Observation by a nephrologist, periodic urine tests and blood pressure measurements.

2. Nursing process for pyelonephritis

Immediately before nursing interventions, it is necessary

· ask the patient or his relatives,

· conduct an objective study - this will allow the nurse to assess the patient’s physical and mental condition,

· as well as identify his problems and suspect kidney disease, including pyelonephritis,

· create a care plan. When interviewing a patient (or his relatives)

· it is necessary to ask questions about previous diseases, the presence of edema, increased blood pressure, pain in the lumbar region, changes in urine.

Analysis of the data obtained helps to identify the patient's problems - nursing diagnosis. The most significant are:

§ swelling;

§ headache;

§ pain in the lumbar region;

§ general weakness, increased fatigue;

§ nausea, vomiting;

§ the need of the patient and his family members for information about the disease, methods of its prevention and treatment.

Nursing care is of considerable importance in solving these problems, but the main role is played by non-drug and drug therapies prescribed by the doctor.

The nurse informs the patient and his family members about the essence of the disease, the principles of treatment and prevention, explains the progress of certain instrumental and laboratory tests and preparation for them.

Nursing care for patients with PN includes:

· control over compliance with bed or semi-bed rest during the acute period of the disease with its gradual expansion;

· ensuring adequate rest and sleep; restriction of physical activity; these measures help reduce blood pressure, the severity of general weakness, and fatigue;

· monitoring the clinical manifestations of the disease, primarily edema and hypertension: daily measurement of pulse, blood pressure, amount of fluid drunk and excreted;

· identifying signs of complications - the development of renal failure, informing the doctor about this;

· monitoring compliance with diet and treatment prescribed by a doctor, as well as identifying side effects of medications;

· training the patient or his parents in the skills of monitoring the general condition of the patient, including determining pulse, blood pressure, and urine output;

· informing about ways to prevent exacerbation of PN;

· early detection and treatment of acute infectious diseases (tonsillitis, acute respiratory diseases, etc.), rehabilitation of chronic foci of infection (chronic tonsillitis, carious teeth, etc.).

Manipulations performed by a nurse

.Blood sampling for biochemical analysis.

−Before the manipulation, the nurse informs the patient about the upcoming procedure and obtains his consent.

−Wash your hands under running water and dry them.

−Check the sterilization date and sterility indicators, as well as the integrity of the packaging of trays, cotton balls, tweezers and syringes

−Attach the needle, check its patency without removing the cap.

−Place the assembled syringe and 4-5 pcs. cotton balls soaked in alcohol in a sterile tray.

−Carry out hand hygiene and wear gloves.

−Sit the patient down and place a cushion under the elbow.

−Apply a tourniquet to the protected surface of the arm above the elbow.

−Ask the patient to clench and unclench his fist several times.

−Palpate the most accessible vein and ask the patient to clench his fist.

−Fix the vein by stretching the skin of the elbow.

−Take the syringe in your right hand and insert the needle into the vein parallel to your hand.

−Pull the plunger towards you, make sure that the needle is in the vein and draw 5-10 ml for the study

−Invite the patient to unclench his fist

−Remove the tourniquet

−Lightly press a cotton ball to the puncture site and remove the needle.

−Ask the patient to bend his arm at the elbow for 5 minutes

−Carefully pour the blood from the syringe into a test tube

−Attach the patient's code number to the tube, place the directions in a plastic bag

−Place the blood tubes along with the rack in a container and close tightly.

−Place the used material in a disinfectant solution.

1. Inform parents about the causes of the disease, clinical manifestations, features of the course, principles of treatment and possible prognosis.

2. Convince the parents and the child (if his age allows) of the need for hospitalization in the nephrology department of the hospital for comprehensive examination and providing adequate treatment. Provide assistance in hospitalization.

3. Provide the child with bed rest during the period of exacerbation of the disease. Create an atmosphere in the room psychological comfort, constantly provide him with support, introduce the child to his peers in the ward, and timely satisfy his physical and psychological needs.

4. Gradually expand the regimen after normalization of body temperature under the control of condition and laboratory parameters.

5. Monitor vital functions (body temperature, heart rate, respiratory rate, blood pressure, daily diuresis, weight curve).

6. As the regime expands, gradually introduce exercise therapy: at first, the exercises are light and familiar, you can lie or sit in bed, then more complex ones in a standing position. Gradually increase the duration of exercises, perform them slowly with incomplete amplitude. Be sure to include breathing exercises and relaxation exercises in the complex.

7. Involve parents and the child in planning and implementing care: teach proper hand washing, toileting of the external genitalia, explain the technique of collecting urine on different kinds research.

8. Prepare the child in advance for laboratory and instrumental research methods using therapeutic play.

9. Familiarize parents with the basic principles of diet therapy: drinking plenty of fluids especially in the first days (up to 1.5-2 liters of liquid per day), following a dairy-vegetable diet with limited salt and protein in the acute period, then table No. 5. Gradually you can switch to a zigzag diet: alternate foods every 7-10 days , changing the pH of urine to the acidic or alkaline side, then conditions for reproduction are not created pathogenic flora and stone formation.

10. Advise parents to continue herbal medicine at home and select herbs that have anti-inflammatory and diuretic effects, teach them how to prepare decoctions. The collection usually includes lingonberries, cornflower, St. John's wort, corn silk, elecampane, nettle, birch leaves, bear ears, horsetail, chamomile, rose hips, blueberries, rowan.

11. Constantly maintain a positive emotional mood in the child, give tasks appropriate to his age, correct behavior, keep him busy with reading books, quiet games, diversify his leisure time, and encourage cognitive activity.

12. Convince parents, after discharge from the hospital, to continue dynamic monitoring of the child by a pediatrician and nephrologist at the children's clinic for 5 years with monitoring of urine tests, examination by a dentist and otolaryngologist 2 times a year.

13. If there is vesicoureteral reflux or other anomaly of the urinary tract, recommend that the parents re-hospitalize the child after 1.5 years to decide on surgical correction.

Complete the task:

Task No. 1

Complete the offer

1. Acute pyelonephritis is __________________________________________________________

2. Predisposing factors for the development of acute pyelonephritis___________________________

3. In what ways does the infection penetrate the kidneys?___________________________________________

4. Dysuric symptoms in pyelonephritis___________________________________________

5. What changes are observed in urine tests in acute pyelonephritis?_________________

__________________________________________________________________________________

6. What are the features of the clinical manifestations of the disease in newborns and infants?

___________________________________________________________________________________

7. What are the features of diet therapy for acute pyelonephritis?___________________________

_________________________________________________________________________________

8. What measures need to be taken to prevent relapse of the disease?___

_________________________________________________________________________________

9. What is the duration of clinical observation for convalescent acute pyelonephritis?

_________________________________________________________________________________

Lecture No. 19. Acute glomerulonephritis.

Acute glomerulonephritis – This is an infectious-allergic disease with diffuse inflammation of the glomerular apparatus, subsequent involvement in the process of the remaining structures of both kidneys and a progressive course. Among kidney diseases, it is the most severe in terms of course and outcome. Glomerulonephritis is observed mainly in the younger school age, boys get sick 2 times more often than girls. There are from 6 to 20 cases per 10,000 children per year.

Etiology: the main role in the development of the disease belongs to nephritogenic strains IN- group A hemolytic streptococcus.

Risk factors for developing the disease:

Hereditary predisposition to nephritogenic streptococcus

· Previous infections (tonsillitis, scarlet fever, chronic tonsillitis, ARVI)

Hypothermia

Chronic foci of infection

Sensitization of the body

· Immunological features organisms that predispose to disease.

Mechanism of the pathological process:

Streptococcus antigens enter the blood and cause the production of antibodies; the formation of immune complexes begins in the blood or kidneys. Due to the commonality of streptococcal antigens and glomerular basement membrane cells, the body produces antibodies not only to streptococcal antigens, but also to basement membrane cells. Autoantibodies and immune complexes destroy the basement membrane, causing immunopathological inflammation of the glomerular apparatus with subsequent involvement of tubules, arterioles and parenchyma in the process.

Clinical picture.

The disease begins acutely, usually 2-3 weeks after the infection.

Symptoms of intoxication:

Fever

· Malaise

Lethargy, weakness, drowsiness

· Headache, nausea

· Severe pallor of the skin

Edema syndrome:

· First in the morning, pasty eyelids, then - swelling of the face, later - swelling on the legs and sacrum. The swelling is dense and cold.

Arterial hypertension:

· Headache

· Nausea, vomiting

· Increased blood pressure, both systolic and diastolic (on average by 30-50 mmHg)

Expansion of the boundaries of the heart during percussion

Deafness of heart sounds, systolic murmur, bradycardia - on auscultation

Urinary syndrome:

· Proteinuria

Hematuria

· Cylinruria

Microleukocyturia

High relative density of urine

Urine the color of “meat slop”

Oliguria, sometimes anuria

Pain symptom:

Pain in the lower back or stomach

· Positive Pasternatsky symptom.

There are three main forms of glomerulonephritis depending on the severity of clinical symptoms:

1. The nephrotic form is manifested by widespread edema, high proteinuria, a large number of hyaline and granular casts, blood pressure is not high and persistent.

2. The hematuric form is characterized by moderately expressed pastosity and increased blood pressure, persistent gross hematuria in combination with proteinuria.

3. The mixed form is manifested by edema, increased blood pressure, high proteinuria, gross hematuria, and cylindruria. This is the most severe and prognostically unfavorable form.

Complications:

· Changes in the vessels of the fundus, hemorrhages leading to visual impairment

· Acute renal failure.

· Eclampsia.

· Acute heart failure.

Diagnostic methods:

· Clinical blood test (neutrophilic leukocytosis, eosinophilia, anemia, accelerated ESR)

Biochemical blood test (hyperasotemia, hypoproteinemia, dysproteinemia)

General urine analysis (proteinuria, hematuria, cylindruria, microleukocyturia)

· Urinalysis according to Nechiporenko (red blood cells more than 1,000 per 1 ml.)

· Urinalysis according to Addis-Kakovsky (red blood cells more than 1*10 6 per day)

· Urine culture for flora and sensitivity to antibiotics

Determination of antistreptococcal antibody titer and complement level in blood serum

Zimnitsky test

Ultrasound of the kidneys

· Intravenous urography

Renoscintigraphy

· Kidney biopsy (for timely assessment of the nature of damage to the renal parenchyma and carrying out targeted therapeutic measures)

Forecast.

The period of complete clinical and laboratory remission occurs after approximately 2-4 months, sometimes even later. Complete recovery, taking into account morphological changes in the kidneys, occurs no earlier than after 1-2 years. If individual clinical symptoms persist for more than 6 months, they speak of protracted current disease, and a duration of more than one year indicates its transition to a chronic form.

Basic principles of treatment acute glomerulonephritis:

During the acute period of the disease, hospitalization of the child in the nephrology department of the hospital is mandatory.

1. Bed rest for 2-3 weeks (until edema decreases, diuresis increases, laboratory parameters improve), then semi-bed rest (after blood pressure normalizes, edema disappears, diuresis is restored, urine tests improve), from 5-6 weeks - ward rest.

2. Diet therapy (table No. 7), dosed fluid intake (based on yesterday’s diuresis). In the acute period, food is prepared without salt, protein is limited for 7-10 days (table No. 7A). When swelling decreases and diuresis increases, food can be slightly salted (0.5 g of salt per day is added to ready-made dishes), and the amount of liquid increases. The amount of protein gradually increases; from 3-4 weeks, the protein load should correspond to the age norm.

3. Medicines:

· Diuretics: hypothiazide, furosemide, lasix.

· Hypotensive: papaverine with dibazole, raunatin, dopegit.

· Antihistamines, for prolonged and severe course hormones (prednisolone).

· Penicillin antibiotics (penicillin or its semi-synthetic analogues) for 7-10 days.

· Improving renal blood flow: trental, chimes.

· Antiplatelet agents: chimes, methindol, heparin.

· Anti-inflammatory: voltaren.

· Vitamins: ascorutin, A, E, group B.

· Cytostatics (for severe cases): cyclophosphamide for 8 weeks.

· Biological products (after a course of antibacterial therapy).

4. If there is no effect from conservative treatment, hemodialysis is performed.

5. Herbal medicine

6. Physiotherapy.

7. Sanitation of foci of chronic infection.

8. Sanatorium-resort treatment.

Prevention.

1. Timely and adequate treatment of streptococcal diseases.

2. Sanitation of foci of chronic infection 2 times a year.

3. Balanced nutrition.

4. Hardening, sports and physical education.

5. Conducting urine tests after any infectious disease.

6. Dispensary observation for convalescents.

Dispensary observation carried out by a pediatrician and nephrologist at a children's clinic for 5 years from the beginning of clinical and laboratory remission in order to monitor the condition, prevent relapses of the disease, monitor kidney function, urine tests, dietary nutrition and physical activity.

Activity:

· Examination by a pediatrician or nephrologist in the first 3 months - once every 2 weeks, then monthly during the first year, quarterly for 2-3 years, once every six months for 4-5 years.

· Courses of anti-relapse treatment in the 1st year - once every 2-3 months, then in spring and autumn (herbal medicine, vitamin therapy).

· Examination by a dentist and otolaryngologist in spring and autumn, and, if necessary, sanitation of foci of chronic infection.

· Control clinical analysis blood once every six months, biochemical blood test, general urine test and Zimnitsky test - at every doctor’s examination (the first 3 months - once every 2 weeks) and after any intercurrent inflammatory disease.

· Monitor blood pressure at every doctor's visit.

Pyelonephritis is an inflammatory kidney disease that requires treatment in a hospital. This measure is due constant control patient's condition and monitoring dynamics. These functions are included in the nursing process for pyelonephritis.

What is pyelonephritis

Pyelonephritis is a pathology of an infectious nature, involving inflammatory process parenchyma and pyelocaliceal system of the kidneys. The acute form of the disease develops acutely with a sharp increase in body temperature, difficulty urinating, and sharp pain in the lumbar region. Chronic pyelonephritis is characterized by a long course. Changes in urine levels are observed throughout the year.

Attention! The cause of pyelonephritis is infectious agents (staphylococcus, E. coli). The infection penetrates the kidneys through the bloodstream, lymph, and through the lower urinary organs.

The development of pathogenic microorganisms occurs against the background of unfavorable factors:

stress, depression, emotional stress;
decreased immunity;
chronic diseases;
poor nutrition;
sedentary lifestyle;
diseases of the urinary organs (urolithiasis, narrowing of the lumen of the ureter, anomalies in the structure of the valves, tumor neoplasms).

Diagnostics

To make a diagnosis of pyelonephritis, a urologist-nephrologist interviews the patient and refers him for tests and instrumental examination.

During the interview, the doctor determines the symptoms, their duration and the presence of other chronic diseases and pathologies of the urinary organs.

The patient donates blood for a general clinical and biochemical study. The results allow us to determine the patient’s condition and the presence of an inflammatory process. General clinical and bacteriological analysis of urine helps to diagnose the inflammatory process in the urinary organs. If protein, salt, or urea levels change, the doctor suggests urolithiasis, other pathologies of the urinary system that precede pyelonephritis.

To confirm the diagnosis, the patient undergoes an ultrasound examination of the kidneys with Dopplerography, MRI, X-ray diagnostics, and secretory urography. Based on the data obtained, the doctor determines a plan of treatment and nursing care for the patient.

Principles of nursing care

Nursing care for pyelonephritis - important stage treatment, including following doctor’s orders, monitoring general condition patient.

The nurse after the patient is admitted to the hospital:

Informs about the hospital regime and upcoming procedures.
Informs about the need for surrender biological material(blood, urine, feces).
Provides and monitors the timely collection and sending of biological material for research to the clinical laboratory.
Informs about the need, as well as the methodology for undergoing instrumental studies of the kidney, which are carried out to monitor the state of health, as well as the dynamics of recovery.
Informs about the need for physical procedures, ensures and controls their completion.
Prepares the patient for a study or physical procedure.
Monitors compliance with doctor's recommendations regarding nutrition and bed rest.
Provides emotional and psychological support to the patient.
Provides first aid in case of deterioration of health.
Monitors the patient's health problems and informs the attending physician about them.

Nursing assistance for pyelonephritis includes following the doctor’s recommendations regarding nutrition and drug treatment. The nurse conducts a conversation with the patient or his parents (if the patient is a minor) regarding the need and features of the recommended diet.

In case of acute pyelonephritis, the patient must follow a dairy-vegetable diet, eat fruits and vegetables that are rich in carbohydrates. If a child has no appetite and refuses to eat, the sister asks the parents not to force feed him.

During treatment of inflammatory pathology of the urinary organs, it is necessary to strictly observe drinking regime. Daily volume of liquid consumed (water, mineral water, fruit drinks, compotes, herbal teas and decoctions) during therapy should exceed the age norm by 2.5 times.

Providing medication treatment

The nursing process for chronic and acute inflammatory processes in the kidneys includes providing patients necessary medications, monitoring their intake, collecting tests and preparing for instrumental research.

The main direction of treatment of infectious-inflammatory kidney disease is the use of antibacterial, uroseptics, painkillers and antispasmodics, the choice of which is made by the attending physician based on data obtained during diagnostic procedures.

On nurse assigned responsibilities for:

providing patients with necessary medications;
intramuscular or intravenous administration of antibacterial, antispasmodic, painkillers;
control oral administration drugs;
conducting a conversation with the patient or his parents about the need to use prescribed medications and their effectiveness;
reporting information about possible contraindications and adverse reactions that may occur as a result of taking medications.

Attention! The intake and administration of medications is carried out strictly by the clock, at regular intervals. If adverse reactions occur, the nurse informs the attending physician about the need to change the drug.

Collection of analyzes and preparation for research

To monitor the patient’s condition and assess the effectiveness of the prescribed treatment, the nursing process for pyelonephritis in children includes the preparation and collection of biological material for clinical trials. The nurse conducts a conversation with the patient and his parents about the need for such manipulations and reports the results of the studies. In adult patients, she draws blood, accepts and monitors the timeliness of urine delivery for laboratory tests.

In case of pyelonephritis, the nursing process is the notification and preparation of the patient for instrumental studies. 2-3 days in advance, the nurse notifies the patient about the need and method of conducting instrumental examination (ultrasound, X-ray diagnostics, MRI).

If necessary excretory urography, the nurse makes sure that the patient does not consume gas-forming products for 3 days. The night before the test he gives a cleansing enema. On the day of instrumental examination, the patient should not eat or drink until the end of the examination.

If necessary, an ultrasound examination of a full bladder provides the patient with fluid. If necessary, ultrasound on an empty bladder informs the patient about the need to visit the toilet immediately before the examination.

Monitoring and assessing the effectiveness of care

In chronic pyelonephritis, it is necessary to monitor the patient's condition and response to the prescribed treatment. For this purpose, the nurse measures body temperature three times a day, and more often if necessary, and controls daily diuresis and the number of urinations.

At proper treatment and the organization of the nursing process, health restoration occurs within the expected time frame. The patient is discharged from the hospital in good condition. After discharge, specialist supervision is required in the clinic at the place of residence.

Before discharge, the nurse informs the patient about the need to continue medication treatment and diet at home. During the conversation, she tells you what medications need to be taken, as well as the duration and frequency of administration.

Pyelonephritis is an inflammatory disease that requires hospital treatment. Monitoring the implementation of the doctor’s recommendations regarding nutrition, taking medications, as well as monitoring the dynamics and condition of the patient is assigned to the nurse and is included in the nursing process.

What antibiotics are prescribed for kidney pyelonephritis?

Very a large number of people were faced with the question: what antibiotics to take for pyelonephritis? This disease is very common in all segments of the population and affects both adults and children. What kind of illness is this, how is it treated and what drugs help overcome the disease?

Inflammatory processes in the kidneys

Kidneys are one of the most important organs and, as shown medical practice, most often susceptible to illnesses varying degrees gravity. Kidney diseases appear due to impaired metabolic processes, autoimmune failures or the development of inflammation. The latter type includes pyelonephritis, which affects the area of the kidneys responsible for the function of collecting and excreting urine.

The most vulnerable to the disease are children 7-8 years old (due to anatomical features body), as well as women capable of childbearing.

There are two types of pathology development:

when pathogenic bacteria enter the kidneys from the bladder;
the infection is transferred to the organ through the general circulatory system.

Once in the kidney, the microorganism actively produces hostile molecules - antigens, thereby provoking a reaction from the immune system. Having received a signal of danger, it sends neutrophils - white blood cells, whose job is to destroy pathogenic bacteria. But in this situation, they strike not only the products of metabolic processes of bacteria, but also the cells of the organ. This occurs because the immune system perceives damaged tissue as atypical.

This whole process leads to the development of inflammation with corresponding symptoms and consequences.

The main signs of pyelonephritis include:

high temperature (up to 39 °C);
rapid heartbeat (tachycardia);
discomfort when breathing (shortness of breath);
superficial spasms blood vessels(chills);
sharp pain in the lumbar region;
headache;
attacks of nausea.

In addition, among the first signs of pyelonephritis, a change in the color of urine can be noted; from yellow it can become red or green. A general analysis of urine will show an increased level of leukocytes - more than 18 units (the result is influenced by neutrophils excreted in the urine).

Examination of urine under a microscope reveals the presence of microorganisms and an increased number of neutrophil cells (neutrophilia).

This pathology is of two types: acute and chronic (it develops from an acute process due to sufficient elimination of the causative agent of the disease).

As with other diseases caused by pathogenic bacteria, treatment of pyelonephritis with antibiotics is mandatory. They are prescribed in all cases, except for violation of the outflow processes of urine.

Antibiotics for the treatment of pyelonephritis

Before prescribing a course of treatment, the doctor conducts a thorough diagnosis, which is aimed at recognizing the type of bacteria and subsequently confirming the existing disease.

For these purposes, biomaterial is usually taken to inoculate bacteria to determine their type and sensitivity to antibiotic drugs. The latter is associated with the selection of the most effective medicine.

Before the culture result is obtained, the doctor will prescribe broad-spectrum antibiotics suitable for the treatment of kidney inflammation:

Penicillins, more precisely from the category of piperacillins, are modern drugs belonging to the fifth generation. Their activity is manifested against both gram-positive and gram-negative bacteria. In the pharmacy you can find drugs in this group with the following names: Piperacillin sodium salt, Isipen, Piprax, Picillin, Pipracil. It is used in the form of intramuscular and intravenous injections.
Semi-synthetic drugs from the group of penicillin antibiotics are effectively used. Available in the form of injection solution and tablets under the following trade names: Ampicillin, Zetsil, Ampicillin sodium salt, Pentrexil, Penodil, etc.
Cephalosporins are derivatives of 7-amylocephalosporic acid. There are several generations of these drugs, the most modern of which are the fourth generation. They are distinguished from their predecessors by more wide circle actions. 4th generation cephalosporin antibiotics include the following drugs: Cefanorm, Ladef, Cefepime, Cefomax, Tsepim, etc. Available only in the form of an injection solution.
Drugs belonging to the group of fluoroquinolones are also effectively used to treat inflammation of the kidneys and bladder. These are third generation drugs (Sparfloxacin, Levofloxacin) and more modern medicine fourth generation - Moxifloxacin. Despite its fairly wide spectrum of action, it is highly toxic, so the course of treatment should not exceed 7 days.
Minoglycoside aminocyclitols are antibiotics of natural and semi-synthetic origin. Act on a narrow range of microorganisms. If we take into account the drugs of the latest (3rd and 4th generations), then these are Tobramycin, Sizomycin, Izepamycin. Most often prescribed for purulent pyelonephritis.
Antibiotics belonging to the group of beta-lactams and called carbapenems. They are highly effective and cope with many aerobic and anaerobic microorganisms. The drugs are administered intravenously. These include the following: Jenem, Meropenem (the most common among this group), Doriprex, Invasin.
Another large group of antibiotics with active substance chloramphenicol. It is used, among other cases, for the treatment of kidneys. Its action is due to the destruction of bacterial protein synthesis. Among the drugs in this class you can find Nolicin, Leukomecin, Marmacetin, Otomycin, Paraxin, Stamycetan, Treomycin, Chlorbiotic, Chlorotsid and others.

As soon as the culture result is obtained, the doctor selects a new dosage of the drug, depending on the type of microorganism. Until the sensitivity test is ready, treatment is carried out with narrow-spectrum agents that act only on a certain group of bacteria.

If sensitivity to any antibiotic is determined, then all other medications are discontinued. Treatment suitable drug is carried out until the causative agent of inflammation is completely eliminated from the organ.

Remedies for acute forms of the disease

Remedies for acute pyelonephritis are selected as follows:

for E. coli these are drugs from the groups of aminoglycosides, cephalosporins or fluoroquinolones (usually a 14-day course is prescribed);
To get rid of the Proteus bacterium, antibiotics from the category of gentamicins, nitrofurans, aminoglycosides and ampicillins are taken;
for enterococcus, combinations of drugs are effective: Ampicillin + Gentamicin; Levomycetin + Vancomycin.

Almost all antibiotics, especially in hospital settings, are used in the form of injections, most often into a vein. Thus, active substances The entire medication reaches the kidneys through the bloodstream, which means that patients with pyelonephritis will experience a faster recovery.

Requirements for drug therapy

As is known, broad-spectrum antibiotics are not particularly selective and affect the entire microflora of the body. That is why they are prescribed with caution and only in case of urgent need. What properties should the most safe drugs from the group of antibiotics:

They should not have a detrimental effect on damaged kidney tissue - the disease already puts a strain on this important organ, so additional damage will lead to dysfunction, and then to kidney failure.
The antibiotic should be excreted from the body in urine, since its sufficient concentration in the urine indicates effective treatment.
In the case of pyelonephritis, the effect will be from those drugs that have not bacteriostatic, but bactericidal properties. In the first case, the processes in the pathogenic bacterium will be disrupted, but the decay products will not leave the body. This means there is a high risk of relapse. Antibacterial drugs are removed pests fully.

If we evaluate the positive dynamics of treatment with antibiotic therapy, then early and late criteria are taken into account.

The first includes the following:

decreased body temperature;
eliminating signs of intoxication;
improvement of general condition;
normalization of the cleansing and excretory activity of the kidneys;
improvement of external indicators (color, transparency) of urine.

If these signs are present during the first two days, we can speak of a successful choice of drugs and their positive effect on kidney tissue.

Late criteria, which are assessed after 14-28 days, include the following indicators:

cessation of appearance high temperature and chills;
tests a week after the end of treatment show the absence of pathogenic bacteria in the kidneys.

If this result is obtained, it means that the antibiotic has completely removed bacteria from the kidneys and bladder. And the very last criterion is that after three months there is no re-infection.

In the absence of positive dynamics, when the antibiotic does not cope with the task, it is worth replacing the product or supplementing with antimicrobial drugs.

Possible complications

Antibiotics for pyelonephritis, as for any other disease, should only be prescribed by a doctor upon direct consultation.

There is a risk of nephrotoxicity, that is, negative changes in kidney tissue. It is especially dangerous for children, the elderly, and for patients with diabetes and renal failure. In this case, the doctor must be very careful in choosing the dosage and the drug itself.

While broad-spectrum antibiotics have a standard dosage, narrow-acting drugs require a more careful approach and dose selection. This is due to the fact that the amount of the drug less than necessary will allow the microorganism to adapt to its use. A large dose will damage not only the kidneys, but also the liver.

When taking a course of antibiotics, you can get intestinal upset; this happens with large doses of medication and long-term treatment. If you insert the syringe needle incorrectly when injecting, there is a risk of developing an abscess.

Do not forget about individual intolerance to drugs, which manifests itself in the form of an allergic reaction. And this threatens with itching, fever, and rash. In severe cases, this can lead to anaphylactic shock or angioedema.

Any medical procedure, including the administration of antibiotics, requires sterility, because microorganisms and infections can be transferred from the external environment.

An overdose of these drugs contributes to the development of toxic (metabolic) hepatitis, pancreatitis or leads to impaired renal function - renal failure.

In case of correct selection of the drug and dosage, the risk of complications is minimal, the maximum may occur side effects, which all medicines without exception have.

No matter what drugs are used to treat pyelonephritis, the main thing is that the recovery is effective, completely eliminates the causative agents of the disease and does not put unnecessary strain on the kidneys.

Selecting the necessary therapy for the treatment of pyelonephritis is very difficult, so only a specialist in this field should do this. Self-medication is strictly prohibited, as it can lead to serious complications and consequences.

Temperature with pyelonephritis

Temperature with pyelonephritis is one of the main symptoms. It accompanies this disease in both acute and chronic forms. It is believed that pyelonephritis does not occur without fever. Only very in rare cases the absence of this symptom can be observed. This can happen when the patient's immune system is very weakened and cannot adequately respond to the development of the disease. Features of increased temperature during pyelonephritis will be discussed below.

Features of symptoms in different forms of the disease

Pyelonephritis is an inflammation of the kidneys caused by a bacterial infection. Pathogenic microorganisms are affected renal pelvis and parenchyma. Their activity causes an increase in temperature. This symptom is the immune system's response to an invasion of foreign organisms.

But an increase in temperature can be a sign not only of pyelonephritis, but also of many other diseases. Therefore, in order to correctly make a diagnosis, it is necessary to know what other symptoms may accompany it during the development of pyelonephritis.

Usually, along with temperature, the following are observed:

the appearance of pain in the lumbar region;
problems with urination - an increase or decrease in its frequency, burning and pain during the process itself.

In addition to these specific signs, symptoms may be observed general intoxication body:

muscle and headaches;
feeling of weakness throughout the body;
nausea and vomiting;
diarrhea.

This is what causes various complications with pyelonephritis.

Features of symptoms in different forms of the disease

How long the temperature lasts during pyelonephritis and how much it rises may depend on several factors. The individual characteristics of the patient play a role in this. In adults and children, the course of the disease also has its own characteristics. But most of all, the degree and duration of this symptom depends on the form of the disease.

Therefore, the features of changes in body temperature during pyelonephritis can be divided into two groups:

In the acute form of the disease. In this situation, the body temperature rises sharply and quickly reaches a level of 39-40 degrees. It is usually accompanied by pain in the lumbar region, vomiting and aches throughout the body. Characteristic feature This form of the disease is characterized by abrupt changes in temperature. During the day it usually drops to low-grade levels, and in the evening it returns to the critical level again. If treatment is not started, this temperature may persist for several days.
In the chronic form of the disease. A distinctive feature is that the inflammatory process in the kidneys is sluggish. Therefore, the temperature does not go beyond subfebrile values. This can be very exhausting for the patient, but often with chronic pyelonephritis he does not even realize that he has the disease. A person constantly feels weak throughout the body, gets tired quickly, loses appetite and sleep. Back pain may also appear, but, compared to the acute form of the disease, it is nagging in nature. In addition, with this form of the disease, swelling may occur. The temperature in chronic pyelonephritis can remain constant and the patient even gets used to this condition and stops noticing it.

Typically, their disease is more severe than in adults.

A high temperature with pyelonephritis indicates that the body is fighting an infection. In this way, it creates unfavorable conditions for life pathogens, which leads to their death. But at the same time, pyelonephritis is a serious disease and it would be wrong to rely only on the internal reserves of the body. Therefore, doctors recommend lowering the temperature after it exceeds 38 degrees. Its higher values, especially more than 40 degrees, not only do not help in the fight against infection, but can also pose a danger to human life.

The patient cannot independently decide which means to reduce the temperature during pyelonephritis. The course of treatment can only be prescribed by the attending physician. Antibiotics are usually prescribed for pyelonephritis. Under their influence pathogenic bacteria begin to die and the temperature gradually decreases. In cases where the temperature is kept at a high level for too long, antipyretics are used in parallel with antibiotics.

Depending on the patient’s condition and his individual characteristics, medications can be prescribed in the form of:

tablets;
injections;
rectal suppositories.

It should be noted that if a patient develops purulent pyelonephritis, drug therapy may not lead to the desired result. The temperature in this case remains high.

It must also be remembered that improvement in condition after taking prescribed medications, including a decrease in temperature to normal levels, is not a reason to stop treatment. If you do not follow the prescribed course to the end, the disease may become chronic, which will be much more difficult to cure.