The role of the nurse in the prevention of pyelonephritis. Providing medication treatment. Treatment of oral diseases

Nursing process in inflammatory kidney diseases in children (pyelonephritis). Information about the disease. Pyelonephritis is bacterial disease kidneys, in which the pyelocaliceal system and interstitial tissue are affected, followed by damage to the entire nephron. Pyelonephritis affects children at any age. Girls get sick 5-6 times more often.
The disease develops when pathogenic microflora penetrates ( coli, Klebsiella, Proteus, bacterial-viral associations, etc.) into the pelvis and parenchyma of the kidneys. The main route of infection is ascending (urogenic) from lower sections urinary tract. The hematogenous route for sepsis and the lymphogenous route for constipation and dysbacteriosis are possible. The main reason retention of microbes in the kidneys is a violation of the outflow of urine. This is facilitated by abnormal development of the kidneys and urinary tract. In most children, these anomalies are detected in the first months of life, but in some they remain undetected for many years. There may also be functional disorders outflow of urine - reflux (reverse flow of urine). Reflux promotes the penetration of microbes into the kidney with the development of chronic pyelonephritis.
An infection that has entered the kidney causes bacterial inflammation of the wall of the renal pelvis, calyces and interstitial tissue; the bacteria multiply rapidly, their toxic waste products enter the blood, causing general intoxication.
At risk for development acute pyelonephritis includes children with congenital anomalies of the kidneys and urinary tract, often suffering from acute respiratory diseases, children with metabolic disorders, constitutional abnormalities, chronic foci of infection. An important role is played by defects in hygienic care, especially for girls at an early age, as well as the factor of hypothermia.
The prognosis of the disease can be:
- Favorable if the child does not have anomalies in the development of the kidneys and urinary tract.
- Unfavorable if chronic pyelonephritis forms, nephrons die and parenchyma is replaced connective tissue, and the kidney shrinks and develops chronic renal failure.
Pyelonephritis is considered chronic after 6 months. from the onset of the disease.
After acute pyelonephritis, the child must be registered with a dispensary for 5 years in order to achieve a complete recovery and prevent the development of chronic process.
Action plan: adherence to diet and regimen; exercise therapy; observation by a nephrologist according to plan; general urine tests in the first month once every 10 days, then once a month, then once every 3 months; Zimnitsky test once every 6-12 months; reorganization foci of infection at the dentist and ophthalmologist once every 6 months. A child is removed from the register if there is stable clinical and laboratory remission.
Children with chronic pyelonephritis are not deregistered and are transferred for observation to an adult clinic.

Stages of the nursing process for pyelonephritis:

Stage 1. Collection of patient information

Subjective examination methods:
Typical complaints: increased body temperature with chills, headache, decreased appetite, weakness, malaise; pain in the lower abdomen, in lumbar region or along the ureters; frequent painful urination; the appearance of cloudy urine with sediment and flakes.
History (anamnesis) of the disease: the onset of the disease is acute and violent, often as a complication after acute respiratory infections, pneumonia and other infections, but it can also be gradual.
Life history (history): an ill child from a risk group.
Objective examination methods:
Examination: the child’s health is disturbed, body temperature rises above 38 °C with chills, pain when tapping the lumbar region: the urine is cloudy with flakes.
results laboratory methods diagnostics ( outpatient card or medical history). In particular, pathological changes in urine tests.

Stage 2. Identifying the problems of a sick child

In a patient with pyelonephritis, the following physiological needs may be disrupted: maintaining body temperature, excreting, eating, sleeping, resting, communicating. Therefore, problems arise that require solutions.
A. Existing problems caused by intoxication:
- increased body temperature with chills, headache, loss of appetite, weakness, malaise; in children early age- vomiting, nausea, loose stool.
B. Existing problems caused by bacterial inflammation renal parenchyma:
- pain in the lower abdomen, in the lumbar region or along the ureters;
- frequent painful urination - dysuria: frequent urge to urinate (to no avail);
- nocturia, enuresis;
- the appearance of cloudy urine with sediment and flakes.
Possible potential problems:
- risk of transition of acute pyelonephritis to chronic;
- the risk of developing acute urinary retention with concomitant cystitis.

3-4 stages. Planning and implementation of nursing care for a patient in a hospital

Purpose of care: promote recovery, prevent the development of complications.

Care plan

1. Ensure organization and control of compliance with bed rest during periods of fever, dysuria, intoxication
Implementation of care:
Independent interventions:
- Conduct a conversation with the patient/parents about the disease and prevention of complications
- Explain to the patient/parents about the need for bed rest
- Place a warm heating pad on the lumbar area or Bladder
- Monitor the presence of a potty (vessel) in the patient’s room
- Warn the patient and/or his parents that the child must urinate in a potty or bedpan. Visiting the toilet is temporarily prohibited.
Motivation:
Protection of the central nervous system from excessive external stimuli. Creating a kidney-sparing regime, ensuring maximum comfort conditions. Reducing pain. Satisfaction physiological need excrete waste products.

2. Leisure organization
Implementation of care:
Recommend parents bring their favorite books and toys.
Motivation:
Creation comfortable conditions to comply with the regime.

3. Creating comfortable conditions in the ward
Implementation of care:
- Monitor the implementation wet cleaning and regular ventilation of the room
- Monitor the regularity of changing bed linen
- Monitor the observance of silence in the ward
Motivation:
Satisfying physiological needs for sleep and rest.

4. Providing assistance in carrying out hygiene measures and eating
Implementation of care:
- Conduct a conversation with the patient and/or parents about the need for personal hygiene
- Recommend that parents bring toothpaste, comb, clean change of underwear
Motivation:
Ensuring sanitary and hygienic measures. The need to be clean.

5. Provide organization and control over diet adherence: dairy-vegetable. a regimen of fluid intake, the volume of which should exceed the age requirement by 2.5 times.
Implementation of care:
Independent interventions:
- Conducting a conversation with the patient and/or parents about dietary habits and the need to follow a diet
- Recommend parents to bring food with high content carbohydrates: fruits, vegetables, cookies; Do not force feed a child if he refuses food
- Recommend parents to bring liquids to drink: slightly alkaline mineral waters, fruit drinks, compotes
- Monitor the fluid you drink; Determine the amount of drink according to the child’s desire, give in small, fractional portions
Motivation:
Satisfying the physiological need for food
Elimination of intoxication.

6. Follow doctor's orders:
- administration of antibiotics intravenously, intramuscularly or orally;
- taking uroseptics by mouth;
- collection of urine for laboratory tests: general analysis, according to Nechiporenko, according to Zimnitsky, Rehberg test, daily urine;
- preparing the patient for special methods studies: ultrasound, excretory urography, tomography
Implementation of care:
Dependent Interventions:
1. Administer antibiotics and give uroseptics in the prescribed dose, at regular intervals
2. Explain to the patient and/or parents about the need to administer antibiotics and take other medications
3.Have a conversation about possible side effects of medications
4.Have a conversation with the patient and/or parents about the need for laboratory research urine; teach the relatives/patient the rules for collecting urine different tests; provide utensils for collecting urine; monitor urine collection and, if necessary, wake up at night.
5.Before each instrumental examination, reassure the child/parents, explain the goals and progress of the examination, teach how the child should behave
6.Before excretory urography, 2-3 days before the excretory urography, make sure that they are excluded from the diet. gas-forming products; warn the patient and/or parents about this; in the evening and in the morning before the examination, give a cleansing enema: in the morning on the day of the examination, make sure that the child does not eat and is sure to urinate; calm the child down and accompany him to the examination.
Motivation:
Etiotropic treatment. Elimination of kidney infection. Prevention of complications. Early detection of side effects. Diagnosis of the disease. Assessment of kidney function. Monitoring the effectiveness of treatment. Psychological support. Diagnosis of the disease, identification of developmental anomalies.

7. Provide dynamic monitoring of the patient's response to treatment
Implementation of care:
Independent interventions:
- Measuring body temperature in the morning and evening
- Control of the frequency and nature of urination
- Control of daily diuresis
- Maintaining a "Urine sheet"
If your general condition worsens, immediately inform your attending physician or doctor on duty.
Motivation:
Monitoring the effectiveness of treatment and care. Early detection and prevention of complications.

Stage 5. Assessing the effectiveness of care

At proper organization nursing care the child's recovery occurs in deadlines, the patient is discharged to satisfactory condition under the supervision of a nephrologist in a children's clinic at the place of residence.
The patient and his parents should be aware of the peculiarities of the regime and diet that the child must follow after discharge from the hospital. about the need for dispensary registration and strict adherence to all recommendations.

It can be unilateral or bilateral, primary or secondary (with ICD, prostate adenoma).

Etiology:

1. Microbial flora– Escherichia coli, staphylococci, Proteus vulgaris, enterococci, streptococci, Mycoplasma Pseudomonas aeruginosa, Klebsiella.

Source of infection– carious teeth, chronic tonsillitis, furunculosis, mastitis, osteomyelitis, cholecystitis, urethritis, cystitis, prostatitis, adnexitis, panaritium. Infection is possible during instrumental studies - bladder catheterization, cystoscopy, retrograde pyelography.

Penetration of an infection into the kidney does not always cause the development of pyelonephritis; for its occurrence it is necessary predisposing factors:

obstacle in profit center ( congenital anomalies development, stones, tumors)

Vesicoureteral reflux

· …
diabetes, tuberculosis, gout, chronic colitis, chronic cystitis, hypopolyvitaminosis

long-term use oral contraceptives

Abuse of drugs that affect renal tissue (analgesics, tetracycline, etc.)

· pregnancy

Cooling of the lower parts of the body

The infection can spread to the kidney:

ascending route - from the bladder, urethra or prostate gland along the wall of the ureter or its lumen

· hematogenously - the infection spreads through the bloodstream, both from distant foci (tonsils, sinuses) and directly from the urinary tract - microbes first enter the renal vessels and then into the interstitial tissue of the kidneys

lymphogenous route - through lymphatic vessels, often from the intestines, with acute appendicitis, cholecystitis – contributes to this close connection lymphatic system of the kidneys and intestines

Pyelonephritis affects women more often, this is facilitated by anatomical abilities and hormonal features women's body - estrogens can disrupt urodynamics (urine movement), which is additional factor spread of infection.

The most dangerous time of development in women is childhood, marriage, and pregnancy.

In men, pyelonephritis occurs in old age due to prostate hypertrophy and urodynamic disturbances, and in at a young age does not arise due to the presence in the secretion of the prostate gland of a substance that has an antimicrobial effect.

The acute process begins unilaterally, often with right side, then the other kidney is also involved; with pyelonephritis, the medulla of the kidneys is affected.

Clinic: usually occurs 2-4 weeks after focal infection and is characterized by three syndromes:

1. Intoxicating(constant or hectic fever, chills, sweating - heavy sweats, headache, myalgia, arthralgia, nausea, vomiting, bacteriological shock may develop: decreased blood pressure, cold sticky sweat, severe weakness, facial features are pointed, pulse is fast and thready).

2. Urinary syndrome : polyuria, dysuria, leukocyturia (pus in the urine), bacteriuria.

3. Pain syndrome– constant dull pain in the lumbar region, caused by stretching of the renal pelvis, tension in the lumbar region, a feeling of cold, Pasternatsky’s symptom is sharply positive.

Patient problems:

a) Physiological: a triad of symptoms is characteristic: fever with chills, dysuria, pain in the lumbar region.

b) Priority: fever with chills, dysuria.

c) Potential: paranephritis, subphrenic abscess, peritonitis, hepatorenal syndrome, bacteriological shock, necrosis of the renal papillae with the development of acute renal failure.

Nursing diagnosis: urinary disorders: fever with chills, dysuria, pain in the lumbar region caused by inflammation renal pelvis.

Nursing interventions:

Dependents: I will strictly follow all doctor's orders.

1. Bed rest .

2. Diet varied:

· exclude: spicy foods, meat broths, canned food, coffee, pepper, mustard, onions, horseradish; alcohol consumption is prohibited

3. B severe cases IV drip of 5% glucose solution, saline. solution, hemodez, rheopolyglucin, etc., on average, the liquid per day administered by drip and taken orally should consist of 2.5-3 liters

4. Antibacterial therapy :

· antibiotics taking into account the sensitivity of the urine microflora - 4-6 weeks, change after 10-14 days + nystatin, levorin, vitamins B, C, antihistamines if antibiotics are used for a long time

Nitrofurans – furadonin, furagin

5. Diuretic herbs: bearberry, lingonberry leaves, cranberries, cornflower flowers, chamomile, horsetail, licorice root, juniper, parsley, celery, dill seeds, carrots, birch leaves, blueberries, watermelons, melon, pumpkin.

Interdependent:

— laboratory: HOW – leukocytosis up to 30 thousand and more, accelerated ESR up to 40-60 mm per hour and more; OAM – pyuria, bacteriuria, urine analysis according to Nechiporenko – predominance of L over red blood cells

— R-logical: excretory urography– an increase in the volume of the affected kidney, deformation of the pyelocaliceal system.

— instrumental: Ultrasound - an increase in the volume of the affected kidney, expansion of the calyces and pelvis.

Prevention:

· reorganization chronic foci infections,

Avoid cooling

· compliance with personal hygiene rules,

Emptying the bladder in a timely manner

· change underwear daily,

· 10 days of each month to carry out general cleaning of the bladder - use diuretic herbs.

Chronic pyelonephritis – inflammatory disease kidneys of a bacterial nature with damage to the pyelocaliceal system (PSS), interstitial tissue of the kidneys with subsequent damage renal glomeruli and renal vessels. Women suffer up to 40 years of age, men after 50 years of age.

Etiology: Microbial flora - Escherichia coli, staphylococci, Proteus vulgaris, enterococci, streptococci, mycoplasma Pseudomonas aeruginosa, Klebsiella.

The exacerbation of the disease and its development are facilitated by:

cooling, urodynamic disturbances, urinary tract stones, uterine fibroids, lesions chronic infection, diabetes mellitus, pregnancy, urological manipulations, hypopolyvitaminosis, decreased immune reactivity, prolonged statistical stress, fatigue, acute pyelonephritis;

· long-term treatment antibiotics that modify bacteria, which promotes the transition acute process into chronic.

Clinic: five clinical forms course of chronic pyelonephritis:

1. Latent– patient problems – high fatigue, loss of appetite, weight loss, sometimes low-grade fever, feeling of heaviness in the lumbar region, tightness clinical manifestations, Pasternatsky's symptom is positive.

- AS (minor anemia, slight acceleration of ESR), OAM (low relative density of urine, slight proteinuria, leukocyturia), Zimnitsky test (polyuria, nocturia). This form of the disease is very insidious, because. For the patient, chronic renal failure, often uremia, proceeds unnoticed.

2. Hypertensive– manifested by symptoms of hypertension, in 1/3 of cases it acquires a malignant course – rapidly progressing with sharp hypertrophy of the left ventricle, angioretinopathy.

Urinary syndrome is not expressed or detected periodically. This renal hypertension must be differentiated from hypertension, against hypertension is evidenced by the younger age of patients, the absence hypertensive crises and atherosclerosis of the aorta, brain and coronary arteries, the presence of leukocyturia and bacteriuria and IV urography ultrasound data of the kidneys.

3. Recurrent– occurs more often than others: characterized by alternating exacerbations and remissions.

Exacerbations are accompanied by increased pain in the lumbar region, dysuria, fever, and symptoms of intoxication.

As the disease progresses, hypertension, anemia, and chronic renal failure develop.

Swelling is not typical and is practically not observed.

The course of chronic pyelonephritis lasts for 10-15 years or more.

Each exacerbation after any infection, often during or after pregnancy, leads to a new outbreak of inflammatory changes in the renal tissue, followed by an increase in sclerotic, cicatricial changes in it, leading to the death of the tubular and glomerular apparatus of the kidneys and the development of chronic renal failure.

4. Anemic– hypochromic anemia, because low production of erythropoietin in the kidneys, decreased or distorted appetite. Urinary syndrome is not pronounced and unstable.

5. Hematuric– microhematuria, clinical symptoms poor (decreased performance, feeling of heaviness in the lumbar region, sometimes low-grade fever)

Exacerbation of chronic pyelonephritis may resemble acute pyelonephritis.

Objectively: puffy face, pasty eyelids in the morning, sallow skin color and dryness, polyuria, nocturia, Pasternatsky’s symptom is positive.

Patient problems:

a) Physiological: periodic causeless increase in body temperature, sweating at night, general weakness, fatigue, taste perversion, headaches, discomfort in the lumbar region, dysuria.

b) Potential: purulent process in the kidney, inflammation of the perinephric tissue, kidney stone formation, chronic renal failure.

Nursing diagnosis: urinary disorders: symptoms of chronic pyelonephritis caused by inflammation of the renal pelvis, interstitial tissue, damage to the renal glomeruli and renal vessels.

Nursing interventions:

Dependents: during exacerbation:

1. Bed rest for 2-3 weeks.

2. Diet No. 7: limit salt to 4g, protein - with high blood pressure, edema, chronic renal failure, exclusion of spicy dishes, smoked foods, spices, seasonings, if there are no these symptoms - then a dairy-vegetable diet, meat, boiled fish, dishes from vegetables and fruits, limiting salt to 5-8g - for anemia - foods rich in Fe.

For all forms and any stage of pyelonephritis, watermelons, melons, and pumpkins are recommended - they have a diuretic effect and promote cleansing urinary tract from germs, mucus, small stones.

3. Antibacterial therapy:

· antibiotics taking into account the sensitivity of the urine microflora: penicillins, cephalosparins, macrolides, fluoroquinolones;

· nitrofurans – furadonin, furagin;

· nitroxaline. Use a combination of these groups with a change every 7-10 days. The effect is positive in the absence of clinical manifestations, bacteriuria or leukacyturia.

4. Vitamins.

5. Immunomodulators.

6. Drugs that improve renal hemodynamics (trental, pentaxiphylline).

7. Diuretic herbs: bearberry, lingonberry leaves, cranberries, cornflower flowers, chamomile, horsetail, licorice root, juniper, parsley, celery, dill seeds, carrots, birch leaves, blueberries, watermelons, melon, pumpkin.

8. For hypertension - antihypertensive drugs.

Prevention: sanitization of chronic foci of infection, avoid cooling, adherence to personal hygiene rules, emptying the bladder in a timely manner, change underwear daily, carry out a general cleaning of the bladder 10 days of each month - use diuretic herbs; lifelong dispensary observation, sanatorium-resort treatment.

A 30-year-old patient was admitted to the nephrology department with a diagnosis of exacerbation of chronic pyelonephritis.

During the nursing examination, the nurse received the following data: complaints of increased temperature, nagging pain in the lumbar region, frequent and painful urination, general weakness, headache, lack of appetite. The patient has a history of chronic pyelonephritis for 6 years. The patient is restless, worried about his condition, and doubts the success of treatment.

1Objectively:

temperature 37.8°C. Moderate condition. Consciousness is clear. Facial hyperemia. The skin is clean, subcutaneous fat is poorly developed. Pulse 98 beats/min., tense, blood pressure 150/95 mm Hg. Art. The tongue is dry, covered with a white coating. The abdomen is soft, painless, Pasternatsky's sign is positive on both sides.

2The patient was prescribed:

1. Bed rest, diet No. 7.

2. General blood test, general urine test, urine test according to Nechiporenko.

3. Oxacillin 1 g – 4 times a day IM

4. Vitamin therapy: B 1 (6%-1.0), B 6 (5%-1.0) s.c.

5. Uroantiseptics of plant origin (bearberry, corn silk, Dill seeds).

Tasks

1. Identify needs whose satisfaction has been disrupted; formulate and justify the patient’s problems.

2. Define goals and plan nursing interventions with motivation.

3. Explain to the patient how to correctly collect urine for general analysis and according to Nechiporenko.

4. Teach the patient how to prepare for excretory urography.

5. Demonstrate on a dummy the technique of bladder catheterization in men.

Sample answers

(1) The patient's needs are violated:

eat, drink, excrete, maintain temperature, communicate, work, be healthy.

(2) Patient problems:

è real ones:

nagging pain in the lower back, dysuria, fever, general weakness, headache, lack of appetite, uncertainty about a favorable outcome of the disease, anxiety about one’s condition;

è potential:

deterioration of the patient's condition associated with the development of complications.

From these problems

è priority is frequent, painful urination (dysuria).

(3) Short term goal:

the patient notes a decrease in frequency and pain when urinating by the end of the week.

(4) Long term goal:

disappearance of dysuric phenomena by the time the patient is discharged and demonstration by the patient of knowledge of risk factors leading to exacerbation of the disease.

(5) NURSING INTERVENTIONS:

(6) Performance evaluation:

The patient notes a significant improvement in his condition, pain in the lumbar region has disappeared, and there are no dysuric symptoms. The goal has been achieved.

3. The student explains to the patient the rules for collecting urine for general analysis and according to Nechiporenko.

4. The student teaches the patient the procedure for preparing for excretory urography.

5. The student demonstrates on a dummy the technique of bladder catheterization in men in accordance with the generally accepted algorithm.

Task No. 17 (renal stone disease.)

A 45-year-old patient is admitted to the nephrology department with a diagnosis of renal stone disease.

During the nursing examination, the nurse received the following data: complaints about sharp pains in the lumbar region on the right with irradiation to groin area, genitals, frequent, painful urination, small portions, single vomiting.

Considers himself sick for 3 years. The attacks recur periodically.

1Objectively:

Moderate condition. Consciousness is clear. He orients himself adequately in the surrounding space, is anxious, and tosses about in bed. The situation is forced, skin pale, covered with cold, sticky sweat. Body temperature 36.7 0 C. Respiratory rate 18 per minute. Pulse 100 beats/min., rhythmic. Blood pressure 120/80 mm Hg. Art. Stomach correct form, participates in the act of breathing. Pasternatsky's sign is sharply positive on the right.

Urinalysis shows hematuria.

2The patient was prescribed:

- bed rest;

- heating pads, hot baths;

- panoramic photo of the kidneys;

- repeat urine test.

- Ultrasound of the urinary system;

- no-spa solution 2% -2 ml i.m.

- baralgin 5 ml i.v.

Tasks

1. Formulate the violated needs and identify the patient’s problems.

2. Create a motivational nursing intervention plan.

3. Explain to the patient how to prepare for plain radiograph abdominal organs.

4. Teach the patient how to provide self-help when an attack begins renal colic.

5. Demonstrate the technique of performing a cleansing enema on a phantom.

Sample answers1

(1) The patient’s needs are violated:

- highlight;

- to be healthy;

- communicate;

- work;

- sleep;

- rest.

(2) Patient problems

è real ones:

- attack of lower back pain;

- urinary disturbance;

- vomit;

- anxiety;

è potential:

- hydronephrosis;

- secondary pyelonephritis;

- chronic renal failure;

è priority: - attack of lower back pain;

(3) Short term goal:

relieve pain within a few hours.

(4) Long term goal:

teach the patient self-help techniques when an attack of renal colic begins.

(5) NURSING INTERVENTIONS

(6) Performance evaluation:

the goal was achieved, the pain disappeared, the patient calmed down. By the time of discharge, attacks of renal colic had not recurred.

3. The student demonstrates the correct level of communication with the patient, the ability to clearly explain how to prepare for a survey x-ray of the abdominal organs.

4. The student demonstrates teaching a patient how to provide self-help during an incipient attack of renal colic.

5. The student demonstrates the cleansing enema technique on a model.

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 survey 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 of psychological comfort in the ward, constantly provide him with support, introduce the child to 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 the condition and laboratory parameters.

5. Monitor vitally important functions(Body volume, 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. Must be included in the complex breathing exercises and relaxation exercises.

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

8. Prepare your child in advance for laboratory and instrumental methods research 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, and 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

· Sharp pallor 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 symptom Pasternatsky.

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, big amount hyaline and granular cylinders, blood pressure is never 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. Mixed form manifested by edema, increased blood pressure, high proteinuria, gross hematuria, 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 conducting targeted therapeutic measures)

Forecast.

The period of complete clinical and laboratory remission occurs after approximately 2-4 months, sometimes even later. Full recovery taking into account morphological changes in the kidneys, it 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 meals), 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. Medications:

· 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.

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 for 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 analysis blood, general analysis urine 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.

The inflammatory process in the kidneys is called pyelonephritis.

This disease is widespread, affecting 2/3 of all patients hospitalized in the nephrology department.

The disease has an extensive classification and many causes.

During hospitalization, the patient needs professional care, consider the stages and effectiveness nursing process with pyelonephritis.

General information about the disease

This disease is common and is diagnosed in both adults and adults. Most often it affects:

• people with a weakened immune system;
• aged people;
• young patients 6–7 years old;
• women during pregnancy.

Inflammation can be a complication bacterial infection, it does not matter where exactly the “center” of inflammation is located (in the bronchi, lungs or oral cavity).

Pyelonephritis is often caused by the presence of stones in the urinary system. irritate the kidney, causing inflammation. With a prolonged course, the process becomes chronic and leads to changes in the structure of tissues.

The disease (in its chronic form) is considered a pathology; it leads to irreversible changes and can cause necrotic processes.

Against the background of pyelonephritis, it often develops, in difficult cases. If there is a significant disturbance in the outflow of urine, the kidney changes, resembles a “center” of infection, its cavities are filled with urine and pus.

Despite the widespread and easy diagnostics The disease often becomes chronic and is caused by exacerbations. But even at these moments the patient may not pay attention to characteristic symptoms because it is weakly expressed.

Dulling the vigilance of patients, the chronic form of pyelonephritis leads to complications, against the background of which renal failure develops.

In the acute form of the disease, inflammation develops rapidly and vivid and specific symptoms occur. If not docked pathological processes in the kidneys, then they will arise various complications that can lead to death.

In the chronic form, the disease proceeds latently, without pronounced symptoms. Symptoms are disturbing only during periods of exacerbation.

Causes:

• infection by pathogenic microorganisms;
• systemic hypothermia;
• disruption of the outflow of urine from the pelvis;
• stones.

A number of studies will help diagnose the disease:

• analysis of biological secretions for biochemistry;
• and sensitivity to antibiotics.

To identify the presence of stones in organs, structural changes, and foci of infection, CT or MRI may be recommended.

Stages of the nursing process for pyelonephritis

Therapy is carried out in a hospital, and a large part of it falls on the shoulders of nurses, their responsibilities include:

• care for the patient, provide him with plenty of fluids;
• control body temperature;
• monitor compliance with the regimen and doctor’s recommendations.

If we're talking about about an elderly person or child, the nurse should provide the patient with access to a bedpan or potty.

The staff monitors the progress of the disease and follows the doctor’s recommendations. Participates in setting up IVs or administering injections. The nurse should inform the doctor about any deterioration in the patient’s well-being, keep a temperature chart, and collect tests.

Effective work nurse is divided into several stages. Based on the completion of all the work, you can evaluate overall efficiency patient care.

Collection of patient information

After the diagnosis is completed, the doctor prescribes treatment for the patient. The nurse should familiarize herself in detail with the patient’s chart, the type and classification of pyelonephritis, for further care.

It is necessary to ask the patient about what exactly is bothering him, the symptoms and side effects of the disease:

• changes in urine;
• past illnesses;
• possible allergies and intolerances;
• interview relatives to find out details.

If necessary, you need to assign additional tests, for a clearer picture.

It is important to clarify with relatives and the patient who to keep informed of what is happening during treatment. The patient himself or his relatives can make wishes and requests as therapy progresses.

Troubleshooting

With pyelonephritis, problems may arise in some physical disorders, because of this, the patient needs help, namely in measuring temperature, help with eating, urinating, or simply in spending leisure time.

Possible associated symptoms caused by intoxication or inflammation:

• nausea and vomiting;
• chills and;
• severe headache and fatigue;
• lack of appetite;
• pain in the lower back, abdomen or urethral area;

It is especially important for the nurse to monitor all the patient’s symptoms, since pyelonephritis with complications can go from form to form to and end.

Care plan and implementation

The main goal of the nurse is to promote quick recovery the person who asked for help and prevent complications.

It is imperative to ensure that the patient does not get out of bed during a fever. If this is a child, clear instructions must be given to parents.

The patient may need a bedpan, or a heating pad placed on the back or stomach can be used to relieve symptoms.

After diagnosing and collecting all the information, the nurse should indicate procedures, appointments proper food and monitor compliance with all instructions.

Leisure organization

Leisure in inpatient treatment very important because good mood also has a very positive effect on a person’s recovery, especially if it is a child.

A good book or a child’s favorite toy will help on a subconscious level to shorten the hospital stay.

But it is better to refuse computer or mobile equipment.

Creating comfortable conditions

A person who is in a hospital needs comfort, it is important that the nurse takes into account the wishes of an additional pillow or blanket, or, if possible, a bed near the window. Also in the room there should be a bedside table and a closet for personal belongings.

Mandatory conditions are:

• control over regular ventilation and cleaning of the ward;
• frequent change of bed linen;
• peace and quiet.

Sleep and rest one more time important aspect Get well soon.

Providing assistance in carrying out hygiene measures

Children or older people often need help when taking a bath; when determining the patient’s needs, the nurse should immediately know who and when to come to the rescue.

Provide organization and control over diet and food intake

It is prescribed for both acute and chronic pyelonephritis. It involves avoiding the following products:

• spicy and salty foods;
• carbonated drinks;
• alcohol and caffeinated drinks;
• smoked and fried food.

In the acute type of the disease, protein intake is also limited. On initial stage recommend light food, which is quickly absorbed.

In case of chronic pyelonephritis, reduce the amount of salt consumed; it may be recommended to follow drinking regime. With limitation daily consumption liquid up to 1.5–2 liters.

The nurse must ensure that the kitchen in the hospital takes into account the needs or if food is brought by relatives, then the menu must comply with the requirements.

Follow doctor's orders

The doctor usually visits patients only once a day, in the morning. At the same time, he gives instructions to the nurse, which she in turn applies to help the patient, namely:

• regularly in time;
• in the prescribed dose;
• passing all tests;
• preparation for ultrasound, x-ray or other diagnostic methods.

It is imperative to have a conversation about possible side effects of medications.

Provide dynamic monitoring of response to therapy

To avoid worsening the condition or side effects during treatment, you need to monitor:

• measure temperature 2 times a day;
• control the nature and frequency of urination;
• keep track of ;
• keep the so-called “urinary sheet”.

If the patient's condition worsens, it is necessary to urgently stop the medications and inform the attending physician. At effective care complications can be avoided and prevented negative reaction body for treatment.

Evaluation of the work of a medical employee

If all points of the plan were followed during nursing care, then recovery occurs within the specified time frame. The patient is discharged in better condition and placed under observation at the clinic according to registration.

It is necessary to follow the diet and other recommendations. Regular examination and testing will have a beneficial effect on further recovery.

Conclusion

If you contact medical institution on time, the prognosis is favorable. With a long and uncompensated course of the disease, in the event of complications developing, there is a high risk of encountering certain consequences.

Pyelonephritis is common, but dangerous disease, leading to . The disease should be treated in a timely manner, otherwise it will become chronic and cause complications.

The participation of nurses in treatment helps ensure patient comfort. Care helps to easily cope with the disease and avoid serious complications.