A 35-year-old non-pregnant woman presents to the emergency department with complaints of fever, chills, and severe flank pain. Which assessment finding would be most indicative of pyelonephritis in this patient?

Costovertebral angle tenderness with high fever is the classic presentation for pyelonephritis, indicating kidney involvement. Other options suggest preeclampsia, lower UTI, or non-specific symptoms.

Pyelonephritis is a serious upper urinary tract infection that affects the renal pelvis and kidney parenchyma, and it poses significant risks during pregnancy. The condition occurs when bacteria ascend from the lower urinary tract to the kidneys, causing inflammation and infection.

The most characteristic and reliable assessment finding for pyelonephritis is costovertebral angle (CVA) tenderness combined with systemic signs of infection such as high fever. CVA tenderness is elicited by gently striking the back at the costovertebral angle (where the 12th rib meets the spine) and indicates kidney involvement. This finding, along with fever above 101°F (38.3°C), chills, and flank pain, forms the classic triad of pyelonephritis symptoms.

During pregnancy, pyelonephritis is particularly concerning because it can lead to serious complications including preterm labor, sepsis, acute respiratory distress syndrome (ARDS), and maternal septic shock. The physiological changes of pregnancy, including ureteral dilation due to progesterone effects and mechanical compression by the growing uterus, predispose pregnant women to urinary stasis and ascending infections.

Early recognition and prompt treatment with appropriate antibiotics are crucial to prevent maternal and fetal complications. The nurse must assess for signs of systemic infection and monitor for complications such as preterm contractions, changes in fetal heart rate patterns, and signs of sepsis. Immediate medical intervention is required when pyelonephritis is suspected in pregnancy.

Sarah, a 28-year-old G2P1 at 24 weeks gestation, arrives at the emergency department accompanied by her husband.
She reports that she woke up this morning with severe pain in her right lower back that radiates to her side.
The pain is constant and described as a deep, aching sensation that worsens with movement.

Sarah's vital signs are: temperature 102.1°F (38.9°C), pulse 110 bpm, respirations 22/min, and blood pressure 128/84 mmHg.
She appears uncomfortable and is frequently shifting positions to find relief from the pain.
She reports having chills and feeling "feverish" since early morning.

During the nursing assessment, Sarah mentions she had a urinary tract infection about 3 weeks ago that was treated with antibiotics.
She states she completed the full course of medication as prescribed.
However, she admits she has been experiencing some urinary frequency over the past few days but thought it was normal for pregnancy.

The nurse prepares to perform a focused assessment to determine if Sarah's symptoms are consistent with pyelonephritis.
Given her presentation of fever, chills, and flank pain during pregnancy, the nurse knows that prompt identification and treatment are crucial to prevent serious maternal and fetal complications.