Pyelonephritis is a nursing process. Pyelonephritis - medical history. Evaluation of the work of a medical employee

List of abbreviations

BP - blood pressure

WHO – world organization health

PN – pyelonephritis

PM – medicine

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 features development;

· 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 reasons 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 abnormal urodynamics and infection urinary tract at different age periods in representatives of different sexes.

Pyelonephritis may be independent disease, but more often complicates the course 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 uropathies, against the background of bladder catheterization, as well as in patients with concomitant pathology(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, but focuses on the 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.

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 everything possible methods research such as:

· scientific and theoretical analysis medical literature according to Mon.

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

· empirical observation, additional methods research:

Organizational (comparative, complex) method;

Subjective method clinical examination 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 kidney disease of predominantly bacterial etiology, characterized by damage 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 prednisone, diabetes mellitus, immune defects) Hormonal imbalance(pregnancy, menopause, long-term use 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,

· paranasal sinuses nose

· carious teeth,

· lungs,

· bile ducts,

· purulent lesions skin,

· osteomyelitis.

For women, the main source of kidney infection is the genitals during 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. Initial stage disease is interstitial serous pyelonephritis, which is not accompanied by destruction 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 weakly expressed 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 sharp increase 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 kidney condition 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 old age clinical manifestations

less pronounced

· absent

· or perverted.

A picture of a general infectious disease or sepsis without signs of damage is observed urinary organs, painting acute abdomen, there are signs reminiscent of meningitis, etc. Emphysematous pyelonephritis occurs as 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. The most typical clinical signs his 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 recent years, cases of combined disease with chronic glomerulonephritis and pyelonephritis have been increasingly reported.

May leak under masks.

1. Latent form - 20% of patients. Most often there are no complaints, and if there are, it is weakness, increased fatigue, 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. Peculiarities: intoxication syndrome with an increase in temperature, chills, which can occur even with normal temperature, V clinical analysis blood leukocytosis, 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 increased blood pressure, which may be the first and only urinary syndrome not expressed and unstable. 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 symptom. 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

The most common complications of 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 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

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

Defines increased content protein 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, increase in ESR, increasing protein concentration.

3. Biochemistry of blood

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

Injected into the patient's body radioactive isotopes– substances capable of emitting radioactive rays. When administered, they mix with other substances that accumulate in internal organs, and act as “tags” that make it possible to detect injected drugs in internal organs that 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:

− entry into the body table salt;

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

· 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 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, but the main role is played by non-drug and drug therapy that are prescribed by a doctor.

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:

· control over compliance with bed or floor bed rest V acute period diseases with its gradual expansion;

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

· monitoring clinical manifestations diseases, 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 medicines;

· 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.), rehabilitation 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 in your right hand and insert the needle parallel to the arm 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;

Postpone 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;

Do light massage injection sites without removing the cotton wool (wipes) 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: skin 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 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 any burning pain in the chest and shortness of breath, you urgently need to 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 nursing process is to provide 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 carry out healing procedures, but also to 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 about the organization of the regime, nutrition and talks about the preventive treatment of the patient.

Knowledge and skills acquired while writing coursework - the necessary conditions 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 Toolkit 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 of 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 adherence to the regime motor activity, labor, 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 a horizontal position, pain is reduced, blood supply to the kidneys is improved, and therefore regenerative processes are improved.

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 a possible impairment of renal function.

5. Protect the patient from concomitant infections and colds.

Any additional infection may lead to exacerbation of 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,

The responsibilities of a nurse include:

• - control over compliance with bed or semi-bed rest during the acute period of the disease with its gradual expansion;
• - ensuring sufficient 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;
• - information about ways to prevent exacerbation of pyelonephritis;
• - early detection and treatment of acute infectious diseases (tonsillitis, acute respiratory diseases, etc.), rehabilitation of chronic foci of infection (chronic tonsillitis, carious teeth, etc.).

Caring for patients during exacerbation of the disease

The patient needs bed rest for 2-3 weeks. When a person experiences pain, suffers from fever or weakness, bed rest seems natural to him, but when the symptoms subside or are absent, it is quite difficult to keep a young patient in bed, so it is necessary to have conversations during which it is necessary to explain that it is easier and better for the kidneys to work when horizontal. body position, that the kidneys “love” warmth and that a warm bed is one of the best means treatment.

The patient may experience frequent urge to urinate both day and night, so it is advisable that the ward or room where the patient lies is located near the toilet. The patient should be encouraged to use a bedpan at night to avoid hypothermia.

It is necessary to ventilate the room either in the absence of the patient, or by covering him warmly (in the cold season, you need to cover your head). The room should be warm, and the patient should be dressed warmly enough, always wearing socks. When cooling, especially the legs, the patient urinates more frequently.

Caring for a patient in remission (not exacerbation)

Although the patient does not need constant bed rest, it is still necessary to streamline the work and rest schedule. The patient's sleep should be at least 8 hours. Daytime rest is also important (even if not every day), at least 30 - 40 minutes in a horizontal position. Work in cold rooms, on the street (especially in the cold season), on night shifts, in hot shops, stuffy rooms, heavy physical activity is contraindicated for patients with chronic pyelonephritis. A change of job is sometimes difficult for the patient, but close people must tactfully but persistently convince him of the need. the right choice, because continued work associated with hypothermia or heavy loads will provoke an exacerbation of the disease. When planning your vacation on vacation, holidays or weekends, the patient should remember the risk of hypothermia and large physical activity. Therefore, of course, it is better to avoid kayaking or camping in cold weather! The patient needs to remember (or be reminded) about the need to choose the right clothes: according to the season, especially for young girls and boys who are embarrassed to wear warm underwear and warm shoes. Important preventative measure is a good and timely outflow of urine. Often (especially in sick schoolchildren and students) artificial retention of urination occurs, usually associated with the false shame of visiting the toilet more often or some purely situational problems. A confidential conversation with a loved one can eliminate this problem. Stagnation of urine is a serious risk factor for exacerbations. Once every 6 months, the patient must visit the dentist, must visit an ENT doctor and follow his recommendations for the prevention and treatment of nasopharyngeal diseases. The patient's diet outside of an exacerbation is not so severe, but spicy foods and spices should not be on the patient's table. Fluid intake (except for cases of hypertonic form, as mentioned above) should be quite large (at least 1.5 - 2 liters per day). The kidneys should be “washed” well. During the period of remission (weakening or temporary disappearance of symptoms of the disease), the patient is usually given intermittent maintenance therapy for 3-6 months (as prescribed by a doctor). It is also called anti-relapse. What does it mean? For 10 days of each month, the patient must take one of the prescribed antibacterial drugs, according to the list given by the doctor. A new medicine is taken every month. In the intervals between taking antibacterial drugs, the patient takes herbal decoctions ( lingonberry leaf, Birch buds, horsetail, bearberry, aka bear ears, kidney tea) - 10 days each decoction. For example, from July 1 to July 10, the patient takes nitroxoline ( antibacterial drug), from July 11 to 21 - a decoction of birch buds, from July 22 to 31 - lingonberry leaf, and from August 1 to 10 - nevigramon (an antibacterial drug), etc. Naturally, even in a state of remission, the patient must periodically undergo control urine tests. To ensure proper implementation of prescribed therapy, it is good to keep a self-monitoring diary. Currently, with appropriate therapy, correct behavior in relation to your health, the prognosis of the disease becomes favorable - you can prevent the development of renal failure and create conditions for full life patient.

For all forms and stages of the disease important place therapy involves following a certain diet. It is necessary to exclude spicy foods and spices, coffee, alcoholic beverages, meat and fish broths from the diet. At the same time, food should be fortified and sufficiently high in calories. You can eat almost all fruits and vegetables, especially those containing a lot of potassium, as well as eggs, boiled lean meat and fish, milk and dairy products.

In addition, it is necessary to drink a sufficient amount of fluid (about 1.5 - 2 liters per day) to prevent excessive concentration of urine and to flush the urinary tract. Very healthy to drink cranberry juice, which contains natural antibacterial substances. During an exacerbation of the disease, fluid intake, on the contrary, should be reduced, since the outflow of urine is disrupted. Also, during an exacerbation and in the hypertensive form of pyelonephritis, it is necessary to limit table salt to 2-4 g per day.

In the anemic form of the disease, food includes foods containing a lot of iron and cobalt (strawberries, wild strawberries, pomegranates, apples). Also, for almost all forms of pyelonephritis, it is recommended to eat grapes, watermelon, and melons, which have a diuretic effect.

Treatment control

Treatment is monitored continuously; every 7-10 days the patient undergoes the necessary urine tests prescribed by the attending physician. It is very important to properly prepare for the test. First of all, it is necessary to toilet the external genitalia.

Included complex therapy antibiotics and/or uroseptics, the herbal medicine Canephron® N is used.

The leading problem in care chronic pyelonephritis is the patient’s lack of knowledge about his disease, risk factors for exacerbations, possible adverse outcomes of the disease and measures to prevent it. A common cause of the disease is the negligence of patients, not paying attention to their disease, as a result of which there is no treatment and, consequently, the development of complications. Treatment of pyelonephritis cannot be carried out independently; you should consult a doctor for diagnosis and treatment. Late diagnosis and inadequate treatment of chronic pyelonephritis can lead to various and serious complications up to chronic renal failure. Thus, proper care, nutrition, prevention, timely treatment will help the patient alleviate the disease to the stage of remission.

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.

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 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.

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, 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.

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.

· lower back pain, 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

· chills,

· increase in body temperature to 39-40°,

· profuse sweat

· pain all over 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,

· floor,

· 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

· none

· 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

−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 symptom. 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

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.

.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

· . 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 with 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.)

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.

· 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

· 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.

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

At nursing examination the nurse received the following data: complaints of fever, 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. Skin is clean, subcutaneous fat 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 analysis urine, urine analysis 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 a nursing examination, the nurse received the following data: complaints of sharp pain in the lumbar region on the right, radiating to the 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 position is forced, the skin is 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 of renal colic begins.

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.

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.

Pyelonephritis - pathology infectious nature, involving the parenchyma and pyelocaliceal system of the kidneys in the inflammatory process. Acute form 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.

Development 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 general clinical examination, biochemical research. 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 is an important stage of treatment, including following doctor’s orders, monitoring general condition patient.

The nurse after the patient is admitted to the hospital:

1. Informs about the hospital regime and upcoming procedures.
2. Informs about the need for surrender biological material(blood, urine, feces).
3. Provides and monitors the timely collection and sending of biological material for research to the clinical laboratory.
4. 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.
5. Informs about the need for physical procedures, ensures and controls their completion.
6. Prepares the patient for a study or physical procedure.
7. Monitors compliance with doctor's recommendations regarding nutrition and bed rest.
8. Provides emotional and psychological support to the patient.
9. Provides first aid in case of deterioration of health.
10. Monitors the patient's health problems and informs the attending physician about them.

Nursing care 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 inflammatory pathology urinary organs must strictly observe the drinking regime. The daily volume of liquid consumed (water, mineral water, fruit drinks, compotes, herbal teas and decoctions) during therapy should exceed age norm 2.5 times.

Providing medication treatment

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

The main direction of treatment of infectious and inflammatory kidney disease is the use of antibacterial, uroseptics, painkillers and antispasmodics, the choice of which is carried out 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! Reception and introduction medications carried out strictly by the clock, at regular intervals. When adverse reactions The nurse informs the attending physician about the need to change the medication.

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 studies. 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 carrying out instrumental research(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 ultrasound examination to full bladder Provides fluid to the patient. 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 number of urinations.

With proper treatment and organization of the nursing process, health restoration occurs within the expected time frame. The patient is discharged from the hospital to 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.