Page 1857 - Saunders Comprehensive Review For NCLEX-RN

3. Chronic pyelonephritis most commonly occurs
following chronic urinary flow obstruction with
reflux.
4. E. coli is the most common causative bacterial
organism.
B. Acute pyelonephritis
1. Acute pyelonephritis occurs as a new infection or
recurs as a relapse of a previous infection.
2. It can progress to bacteremia or chronic
pyelonephritis.
3. Assessment
a. Fever and chills
b. Tachycardia and tachypnea
c. Nausea
d. Flank pain on the affected side
e. Costovertebral angle tenderness
f. Headache
g. Dysuria
h. Frequency and urgency
i. Cloudy, bloody, or foul-smelling urine
j. Increased WBCs in the urine
C. Chronic pyelonephritis
1. A slow, progressive disease usually associated with
recurrent acute attacks
2. Causes contraction of the kidney and dysfunction of
the nephrons, which are replaced by scar tissue
3. Causes the ureter to become fibrotic and narrowed by
strictures
4. Can lead to AKI or CKD
5. Assessment
a. Frequently diagnosed incidentally
when a client is being evaluated for
hypertension
b. Inability to conserve sodium
c. Poor urine-concentrating ability
d. Pyuria
e. Azotemia
f. Proteinuria
D. Interventions
1. Monitor vital signs, especially for elevated
temperature.
2. Encourage fluid intake up to 3000 mL/day to reduce
fever and prevent dehydration.
3. Monitor intake and output (ensure that output is a
minimum of 1500 mL in 24 hours).
4. Monitor weight.
5. Encourage adequate rest.
6. Instruct the client about a high-calorie, low-protein

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