The effectiveness of inpatient treatment depends not only on the work of a qualified doctor, as is commonly believed, but also on the nursing care provided to the patient correctly. Nurses monitor the condition of patients and strive to make the treatment process as productive and comfortable as possible. It is impossible to do without their participation in the case of treatment of serious diseases, especially such as, for example, pyelonephritis. The implementation of a competent nursing process with pyelonephritis is one of the most important components of effective treatment.
What is pyelonephritis?
Pyelonephritis is a serious kidney disease caused by a bacterial infection in the body. In most cases, infection of the pelvis and parenchyma with Escherichia coli or other bacterial-viral compounds occurs. Infection usually occurs through the urinary tract or through the hematogenous route through infected blood that has got into the kidneys.
The development of pyelonephritis is more likely to affect children under 7 years of age. Moreover, girls get sick several times more often than boys, which is associated with the anatomy and developmental characteristics of the body. The disease occurs in adults: in women from 18 to 30 years (especially during pregnancy) and in men suffering from prostatitis. There is also the concept of senile pyelonephritis, the risk of developing which in the elderly increases with each passing decade.
A fairly common cause of the development of the disease is urolithiasis. Violation of the outflow of urine leads to the formation of pathogenic microflora in the urinary tract and subsequent inflammation of the kidneys. The waste products of pathogenic bacteria subsequently enter the bloodstream, which leads to general intoxication of the body.
Types and symptoms of pyelonephritis
By the nature of the disease in medicine, two types of pyelonephritis are distinguished: acute and chronic. With primary pyelonephritis, the symptomatology of the disease is weakly expressed: there is a febrile state. It is caused by fever, chills, general tiredness and lethargy, nausea.
In secondary pyelonephritis, which is characterized by a significant violation of the outflow of urine, patients experience severe lower back pain amid a general deterioration in well-being and high temperature (up to 40 ° C). Pain over time can disappear, the temperature can drop to subfebrile indicators, which, however, does not mean recovery - the symptoms appear again.
Chronic pyelonephritis also develops if the prescribed treatment was not effective or failed at all. It usually takes six months to go into a chronic form. In chronic pyelonephritis, a nursing process, medical care and a hospital are mandatory. Quite often, a kidney disease that has turned into a chronic form makes itself felt not only with high fever and malaise, but also with the appearance of hematuria and hypertension. The combination of these symptoms leads to inevitable renal failure, and subsequently can lead to death.
Diagnosis of the disease
Before starting the nursing process with pyelonephritis, it is necessary to collect an anamnesis. The nephrologist interviews the patient (in the case of treatment of the child - his parents) regarding the course of the disease and disturbing symptoms. If there is a suspicion of pyelonephritis, the patient should pass such tests as:
- general and biochemical blood analysis;
- Ultrasound of the urinary system;
- urography;
- urinalysis for bacterial culture.
After the necessary information has been collected, the doctor draws up a treatment plan. If the patient or members of his family have questions, the doctor should answer them. He also consults on the timing of therapy, its main points. After the patient enters the hospital, the work of nurses begins.
Start Nursing
The first stage of the nursing process in pyelonephritis is a conversation with a new patient regarding the daily routine and upcoming procedures, tests. The second stage is a secondary diagnosis of the patient. It consists in identifying factors that can negatively or positively affect the treatment process. The nurse also answers the patient's possible questions and takes into account his wishes.
Based on the testimony of the attending physician and conversations with the newcomer patient regarding his health and basic complaints, the nurse draws up a written care plan. Identification of key problems and assessment of future prospects allows the nurse to correctly draw up a care plan that will also contain specific goals. The main goal of the nursing process in pyelonephritis, as in any other disease, is to achieve positive results in the case of nursing intervention.
In addition to the main goal, the nurse must take into account and consider the implementation of two other types of important tasks: short-term and long-term. Usually short-term goals are fulfilled during the period of time during which the patient is in the hospital. Long-term goals are fulfilled by the patient himself after discharge from the hospital. They are aimed more at rehabilitation, therefore they are not always given priority.
The third and fourth stage
In the third stage, after diagnosing the patient and setting goals, a care plan is drawn up. In fact, it is not only a written guide that helps the nurse coordinate their actions and save time, but also a form of report to monitor the patient’s condition and material costs for his treatment.
The fourth stage involves directly the implementation of nursing care and support. The nursing process for pyelonephritis in children and adults includes providing assistance in everyday activities and needs. So, for example, a nurse should help the patient get dressed, wash or brush her teeth, and go to the toilet.
Its task is also the formation of conditions under which treatment will occur as efficiently as possible. Various preventive measures, preventing the development of complications, performing procedures (droppers, injections, enemas) - all these manipulations also lie on the shoulders of nurses. A particularly important point in the treatment of pyelonephritis - kidney disease - is the management of the "urinary leaf", which indicates all the necessary information to control the course of the disease: the amount of sugar and protein in the urine, the presence of red blood cells, epithelium, and so on.
Nursing in acute pyelonephritis
Already directly at the fourth stage, the implementation of nursing care begins. The nurse, in addition to conducting interviews with the patient and his relatives, provides the necessary care. The first days in the hospital, the patient must maintain a strict bed rest. The transition to a half-bed mode is possible only with the weakening of the symptoms of the disease, an improvement in the general condition.
In acute pyelonephritis, even a toilet is prohibited. Therefore, the nurse must deliver the pot (vessel) on time and dispose of the waste in a timely manner. One of the moments of the nursing process in pyelonephritis in adults is the use of warm heating pads to be applied to the lower back or to the bladder during pain attacks.
The main task of a nurse in caring for a patient with acute pyelonephritis is to provide the most comfortable conditions for the patient to recover. Wet cleaning of the room, bed linen should be carried out regularly. The room should be quiet and calm, since sleep is an important moment of recovery. Thus, any sister processes in pyelonephritis and their principles are concentrated not only around minimizing the negative impact of external stimuli, but also around ensuring maximum comfort.
Nursing and diet
It is imperative for the nurse to monitor patient compliance with the principles of good nutrition. In acute and chronic pyelonephritis, the patient is prescribed a special diet - table No. 7 (7a, 7b), which consists in reducing the amount of sodium chloride (up to 6 grams) and protein (up to 70 grams) daily ingested. The daily volume of fluid consumed is also limited - the amount of fluid received should be equal to the amount of fluid released.
The nursing process in acute pyelonephritis in children, as in adults, is to provide patients with fractional nutrition in the hospital (4-6 times a day). The nurse should pay special attention to the dishes and products that the patient consumes. With pyelonephritis, it is forbidden to consume salt-containing products in large volumes: various pickles, smoked meats, canned foods, sauces and seasonings. It is advisable to minimize the amount of fat used in dishes, you should also give preference to lean meat and fish.
Features of caring for the elderly and children
The nursing process with pyelonephritis in the elderly has its own key features. Elderly patients are not always able to eat on their own, perform hygiene procedures, and go to the toilet. Therefore, the nurse in the event that the patient has certain problems with the implementation of motor processes should provide all possible support. This can be feeding from a spoon, wiping the face with a damp cloth, helping to wash and wash in half-bed mode.
Also, when nursing elderly patients, special attention should be paid to the regular measurement of vital signs: body temperature, pulse rate, and especially blood pressure. For a patient, being in a state of hypertension - high blood pressure - in conjunction with hematuria, may result in the development of renal failure.
The nursing process for pyelonephritis in children also has its own characteristics. An important role here is played by the competent organization of leisure, without which a small patient may feel unsatisfied, be depressed, which will negatively affect the productivity of treatment. Therefore, the nurse should have a conversation with the parents of the child, ask them to bring their favorite toys, books, coloring books - all that can amuse and cheer him up.
The implementation of drug treatment
After the attending physician made all the necessary instructions and prescribed the required drugs, one of the most important tasks of a nurse is to carry out drug treatment of the patient. Her tasks also include collecting tests (general blood collection and blood collection for biochemistry), warning the patient about upcoming examinations, including informing about their correct passage (do not eat for 8 hours, use cleansing enemas, etc.).
Treatment of pyelonephritis is carried out with the help of antibacterial drugs and uroseptics, which stop the inflammation in the kidneys. In the presence of pain, painkillers and antispasmodics may also be used. The nursing process for glomerulonephritis and pyelonephritis is to provide patients with drugs. Every day, the nurse gives the right amount of prescribed drugs, and also regularly makes intravenous and intramuscular injections of antibacterial and other drugs. Among other things, the nurse must warn the patient about possible side effects from taking the medicine and urgently inform the doctor if they really have arisen.
Nursing Assessment
After the treatment period is over, the last, fifth stage of the nursing process occurs in chronic pyelonephritis and in its acute form - the final assessment of the care provided by the nurse in the hospital. To set an objective assessment of care, it is necessary to compare the desired results at discharge with the available results, where the patient’s reaction plays an important role. His behavior, words spoken about the effectiveness of the treatment, and the results of control tests are used as evaluation criteria.
Usually, on the day of discharge from the hospital, short-term goals set by nursing staff are considered fulfilled. The patient is discharged in satisfactory or good condition. The end of the implementation of the nursing process in chronic pyelonephritis is accompanied by the registration of an epicrisis. It describes in detail the problems of the patient before treatment that appeared during treatment and which occurred after the assistance provided. After discharge from the hospital, the patient is observed for some time by the district nurse and nephrologist who are engaged in fulfilling long-term goals - rehabilitation, preventing relapse, etc.
General conclusion
Pyelonephritis is a serious infectious kidney disease, which in most cases requires hospitalization and treatment in a hospital setting. Its acute variety is dangerous in that it is likely to transform into a chronic one, which, however, rarely happens with proper treatment and care. Everyone is affected by the disease: children, adults and the elderly. Pyelonephritis often develops against the background of obstructed discharge of urine, which is associated with kidney stones and prostatitis, as well as against infection in the urinary tract.
With pyelonephritis, the nursing process is an extremely important condition for treatment in a hospital. It consists of five stages, the first two of which are a comprehensive examination and diagnosis of the patient, as well as conversations with him and his relatives regarding the future treatment. The next two stages are directly nursing care, which is manifested in informing the patient about future tests and examinations, injections and various procedures, including hygiene. The last, fifth stage is the stage of the final assessment of nursing care, which is set based on the patient's response to treatment and the results of control tests and examinations. After discharge from the hospital, the patient is observed by a nephrologist.