Urinary Assessment
What is the medical term for painful or burning urination?
Dysuria
Which organs are primarily affected by acute pyelonephritis?
Kidneys
Based on Maria's fever, dysuria, right flank pain, and positive CVA tenderness, what is the most likely working diagnosis?
Acute pyelonephritis
Maria reports a sulfa antibiotic allergy that caused a rash and facial swelling. Which commonly prescribed UTI antibiotic should be avoided?
Trimethoprim-sulfamethoxazole (TMP-SMX/Bactrim)
Maria reports taking phenazopyridine (Pyridium) at home. What noticeable change in urine color can this medication cause?
Orange or reddish-orange urine color.
Maria has a temperature of 100.6°F and right-sided flank pain. What physical assessment finding further supports a kidney infection?
Right sided CVA tenderness
What is the most common route by which bacteria reach the kidneys and cause pyelonephritis?
Enter through the lower urinary tract and ascend upwards
Which diagnostic test identifies the bacteria responsible for Maria's infection and helps determine the most appropriate antibiotic?
Urine culture and antimicrobial susceptibility testing.
Why is nitrofurantoin (Macrobid) inappropriate for Maria's suspected pyelonephritis?
Nitrofurantoin does not achieve adequate concentrations in kidney tissue to effectively treat pyelonephritis.
Maria has had poor oral intake. What two assessments are important when evaluating her hydration status?
Assess mucous membrane moisture and fluid intake/output.
Maria's urinalysis is positive for nitrites and leukocyte esterase. What do these findings indicate?
Bacterial UTI
Why does Maria's poorly controlled type 2 diabetes increase her risk of developing a urinary tract infection?
Hyperglycemia can impair immune defenses and increase susceptibility to bacterial infections.
Maria's WBC count is 12.8 with neutrophil predominance. What does this result suggest?
Leukocytosis, supporting an infectious or inflammatory process.
Maria's previous urine culture showed E. coli susceptible to cefpodoxime. Why should a new urine culture still be obtained?
The causative organism and antibiotic susceptibility may have changed since the previous infection.
Maria lives alone, has transportation difficulties, and occasionally struggles with medication costs. What interventions could help improve adherence to her treatment plan?
Assess medication affordability, involve social work or case management as needed, identify transportation resources, and arrange follow-up phone calls.
During the abdominal assessment, which two techniques help evaluate Maria's suprapubic discomfort and right-sided flank pain?
Abdominal palpation and percussion over the CVA.
Maria has CKD stage 3a with an estimated GFR of approximately 48. Why is this important when selecting medications?
Reduced kidney function can decrease medication clearance, increasing the risk of drug accumulation and adverse effects.
Why is uncomplicated cystitis less likely than pyelonephritis in Maria's case?
Maria has fever, chills, flank pain, and CVA tenderness in addition to lower urinary symptoms.
If the provider chooses an oral antibiotic for outpatient treatment and resistance concerns make the regimen less reliable, what initial parenteral medication might be considered?
Ceftriaxone
Maria is receiving outpatient treatment for pyelonephritis. What symptoms should prompt immediate medical attention?
Worsening flank pain, persistent vomiting, inability to maintain hydration or take medications, confusion, fainting, or other signs of serious illness.
Maria has fever, right flank pain radiating to her groin, and tachycardia. What potentially dangerous condition should the nurse recognize and promptly report?
Possible obstructing ureteral stone with infection
How could untreated pyelonephritis worsen Maria's existing chronic kidney disease?
Severe kidney infection may cause dehydration, systemic inflammation, sepsis, or acute kidney injury, potentially leading toworsening renal function.
Maria's right flank pain radiates toward her groin. What imaging study is commonly used to identify a suspected ureteral stone?
Noncontrast CT of the abdomen and pelvis.
Maria has CKD stage 3a, takes metformin and lisinopril, and has reduced oral intake. What three medication safety considerations should the nurse discuss with the provider?
Evaluate renal function and medication dosing; monitor for dehydration or acute kidney injury; and assess whether metformin or lisinopril should be temporarily held.
A nurse is completing a SOAP note in Maria's electronic health record. In which section should the nurse document her temperature of 100.6°F, positive urinalysis, and right CVA tenderness?
Objective