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Medical and Nursing Management of

Acute Pyelonephritis, Hypovolemic


Shock

Medical management
Acute Pyelonephritis
Usually treated as outpatient if they are not dehydrated, not

experiencing nausea and vomiting, and not showing any signs


or symptoms of sepsis.
Other patients, including all pregnant women, may be
hospitalized for at least 2-3 days of parenteral therapy.
For outpatients, a 2 week course of antibiotics is
recommended Commonly prescribed agents include TMP-SMZ,
ciprofloxacin, gentamicin with or without ampicillin, or a thirdgeneration cephalosporin ( Warren et. Al.,1999).
After the initial antibiotic regimen, antibiotic therapy for up to 6
weeks is instituted if chronic or recurring symptomless infection
persist for months or years
Follow-up urine culture is done 2 weeks after completion of
antibiotic therapy

Hypovolemic Shock

Blood component therapy is recommend to optimize cardiac preload,


correct hypotension, and maintain tissue perfusion.
Large -gauge intravenous needles or catheters are inserted to
peripheral veins to emphasize volume replacement.
Central Venous Pressure (CVP) catheter may be inserted in or near
the right atrium to serve as a guide for fluid replacement and serve as a
vehicle for emergency fluid replacement.
Intravenous fluid are infused at rapid rate until systolic blood pressure
or CVP rises to satisfactory level above the baseline measurement or
until there is improvement in patients clinical condition. Infusion of
lactated Ringers solution is useful initially because it approximates
plasma electrolyte composition and osmolality, allows time for blood
typing and screening, restores circulation, and serves as an adjunct to
blood component therapy.
Measures to control hemorrhage are instituted because hemorrhage
compounds the shock state. Serial hematocrit values are obtained if
continued bleeding is suspected

Nursing Management
Acute Pyelonephritis
Fluid intake and output are carefully measured and recorded. Unless contraindicated ,
fluid are encouraged (3-4 l/day) to dilute the urine, decrease burning on urination, and
prevent dehydration.
Assesses the patients temperature every four hours and administers antipyretic and
antibiotic agents as prescribed
Patients teaching focus on prevention of UTIs

Hypovolemic Shock
Ensuring patent airway and maintaining breathing are crucial. Additional ventilatory
assistance is given as required. A rapid physical examination is performed to determine
the cause of shock.
Facilitate rapid fluid and blood replacement as prescribed
Elevate patient feet slightly to improve cerebral circulation and promote venous return
to the heart. However, this position is CONTRAINDICATED for patients with head injury
Instruct patient to avoid unnecessary movement
An indwelling urinary catheter is inserted as prescribed to record urinary output every
hour. Urine volume indicates the adequacy of kidney perfusion
Ongoing nursing surveillance of the total patient is maintained. Vital signs, skin
temperature, color, pulse oximetry, neurologic status, CVP, arterial blood gases ECG
recordings, hematocrit, hemoglobin, coagulation profile,electrolytes, and urinary output
are monitored serially to assess patient response to treatment.
Reassured and comfort the patient
Body temperature is maintained within normal limits to prevent increasing metabolic
demands that the body may be unable to meet.