The effectiveness of inpatient treatment depends not only on the work of a qualified doctor, as is commonly believed, but also on the correct nursing care provided to the patient. 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 treatment of serious diseases, especially such as, for example, pyelonephritis. The implementation of a competent nursing process for 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 occurs with Escherichia coli or other bacterial-viral compounds. Infection usually occurs through the urinary tract or hematogenously - through infected blood that has entered the kidneys.
Children are more likely to develop pyelonephritisup to 7 years old. Moreover, girls get sick several times more often than boys, which is associated with the anatomy and developmental features of the body. The disease also occurs in adults: in women between 18 and 30 years old (especially during pregnancy) and in men suffering from prostatitis. There is also the concept of senile pyelonephritis, the risk of 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
According to the nature of the disease in medicine, two types of pyelonephritis are distinguished: acute and chronic. In primary pyelonephritis, the symptoms of the disease are mild: there is a feverish state. It is caused by fever, chills, general fatigue and lethargy, nausea.
In secondary pyelonephritis, which is characterized by a significant violation of the outflow of urine, patients experience severe pain in the lower back against the background of a general deterioration in well-being and high temperature (up to 40 ° C). Pain may disappear over time, the temperature may drop to subfebrile levels, which, however, does not indicate recovery - the symptoms appear again.
Chronic pyelonephritis develops even if the prescribed treatment was noteffective or not at all. It usually takes six months for the disease to become chronic. In chronic pyelonephritis, the nursing process, medical care and hospital are mandatory. Quite often, a kidney disease that has passed into a chronic form makes itself felt not only by high fever and malaise, but also by the appearance of hematuria and hypertension. The combination of these symptoms leads to inevitable kidney failure, and later can lead to death.
Diagnosis of disease
Before starting the nursing process for pyelonephritis, it is necessary to take an anamnesis. A nephrologist asks the patient (in the case of treating a child, his parents) regarding the course of the disease and disturbing symptoms. If pyelonephritis is suspected, the patient must pass tests such as:
- general and biochemical blood tests;
- Ultrasound of the urinary system;
- urography;
- urinalysis for bacteriology.
After the necessary information has been collected, the doctor draws up a treatment plan. If the patient or his family members have questions, the doctor must answer them. He also conducts consultations regarding the timing of therapy, its main points. After the patient is admitted to the hospital, the work of nurses begins.
Starting nursing care
The first step in the nursing process for pyelonephritis is a conversation with a new patient about 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 a conversation with a new patient regarding his well-being and main complaints, the nurse draws up a written plan of care. Identification of key issues and assessment of future prospects allows the nurse to competently create a care plan that also contains 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 more types of important tasks: short-term and long-term. Usually, short-term goals are met during the period of time that 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, so they are not always given priority.
Third and fourth stage
In the third step, after diagnosing the patient and setting goals, a care plan is drawn up. It, in fact, is not only a written guide that helps the nurse to coordinate their actions and save time, but also a kind of report to control the patient's condition and material costs forhis treatment.
The fourth stage implies the direct implementation of nursing care and support. Nursing for pyelonephritis in children and adults includes helping with daily activities and needs. So, for example, a nurse should help the patient get dressed, wash or brush their teeth, go to the toilet.
Its task is also to create conditions under which treatment will be most effective. Various preventive measures, preventing the development of complications, performing procedures (droppers, injections, enemas) - carrying out all these manipulations also lies on the shoulders of nurses. A particularly important point in the treatment of pyelonephritis - kidney disease - is the maintenance of a "urinary sheet", 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 process for acute pyelonephritis
Already directly at the fourth stage, the implementation of nursing care begins. The nurse, in addition to conducting conversations with the patient and his relatives, provides the necessary care. The first days in the hospital, the patient must maintain strict bed rest. The transition to half-bed rest is possible only with the weakening of the symptoms of the disease, the improvement of the general condition.
In acute pyelonephritis, even going to the toilet is prohibited. Therefore, the nurse is obliged to serve the pot (vessel) in time and dispose of the waste in a timely manner. One of the moments of nursingprocess for pyelonephritis in adults is the use of warm heating pads to be applied to the lower back or on the bladder area 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's recovery. Wet cleaning of the ward, change of bed linen should be carried out regularly. The room should be quiet and calm, as sleep is an important moment of recovery. Thus, any nursing 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 extremely important for a nurse to monitor the patient's compliance with the principles of proper 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 table s alt (up to 6 grams) and protein (up to 70 grams) daily entering the body. The daily volume of fluids drunk is also limited - the amount of fluid received should be equal to the amount allocated.
Nursing process for acute pyelonephritis in children, as well as in adults, is to provide patients with fractional meals 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 in large volumess alt-containing products: various pickles, smoked meats, canned food, sauces and seasonings. It is advisable to minimize the amount of fat used in meals, and you should also give preference to lean meat and fish.
Features of caring for the elderly and children
The nursing process for pyelonephritis in the elderly has its key features. Elderly patients are not always able to eat on their own, perform hygiene procedures, go to the toilet. Therefore, if the patient has certain problems with the implementation of motor processes, the nurse should provide all kinds of support. This can be spoon-feeding, wiping the face with a damp cloth, helping with washing and washing when half-bed.
Also, when caring for elderly patients, the nurse should pay special attention 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 dissatisfied, be in a depressed state, which will negatively affect the productivity of treatment. Therefore, the nurse should have a conversation with the child's parents, ask them to bring their favorite toys, books, coloring books - everything that can entertain him andcheer up.
Performing medication
After the attending physician has made all the necessary instructions and prescribed the required drugs, one of the most important tasks of the nurse is to provide medical treatment to the patient. Also, its tasks include collecting tests (general blood collection and blood collection for biochemistry), warning the patient about upcoming examinations, including informing them about their correct passage (do not eat for 8 hours, use cleansing enemas, etc.).
Pyelonephritis is treated with antibacterial drugs and uroseptics, which stop inflammation in the kidneys. In the presence of pain, painkillers and antispasmodics can also be used. The nursing process for glomerulonephritis and pyelonephritis is to provide patients with drugs. Every day, the nurse dispenses the required amount of prescribed drugs, and also regularly makes intravenous and intramuscular injections of antibacterial and other drugs. Among other things, the nurse should warn the patient about possible side effects from taking medications and immediately inform the doctor if they really occur.
Nursing care assessment
After the completion of the treatment period, the last, fifth stage of the nursing process for chronic pyelonephritis and its acute variety begins - the final assessment of the care provided by the nurse in the hospital. To provide an objective assessment of care, it is necessary to compare the desired outcomes at discharge withavailable, where the patient's response itself 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, the short-term goals set by the nursing staff are considered met. The patient is discharged in satisfactory or good condition. The end of the nursing process in chronic pyelonephritis is accompanied by the preparation of a discharge epicrisis. It describes in detail the patient's problems before treatment, appeared during treatment and took place 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 the fulfillment of long-term goals - rehabilitation, relapse prevention, etc.
General conclusion
Pyelonephritis is a serious infectious disease of the kidneys, which in most cases requires hospitalization and treatment in a hospital setting. Its acute variety is dangerous in that there is a possibility of its transformation into a chronic one, which, however, rarely happens with proper treatment and care. Everyone is susceptible to the disease: children, adults, and the elderly. Often, pyelonephritis develops against the background of difficulty passing urine, which is associated with kidney stones and prostatitis, as well as against the background of infection in the urinary tract.
In pyelonephritis, the nursing process is an extremely important condition for treatment in a hospital. It consists of five stages, the first two of which area comprehensive examination and diagnosis of the patient, as well as conversations with him and his relatives regarding future treatment. The next two stages are directly nursing care, which manifests itself 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 on the basis of 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.
