A pregnant client at 28 weeks gestation is diagnosed with acute pyelonephritis. Which nursing intervention should be the priority?

Priority Assessment: The primary nursing focus is continuous monitoring for signs of preterm labor, including regular uterine contractions, low back pain, pelvic pressure, or changes in vaginal discharge. Any indication of labor must be reported immediately for tocolytic intervention if appropriate.

Fetal Surveillance: Initiate continuous electronic fetal monitoring to assess fetal heart rate patterns and uterine activity. A nonreassuring fetal status may indicate maternal sepsis or fetal intolerance to the infectious process, necessitating urgent escalation of care.

Antibiotic Administration: Administer intravenous antibiotics as prescribed without delay, typically a cephalosporin or ampicillin-gentamicin combination. Ensure blood and urine cultures are obtained prior to the first dose to guide targeted therapy.

Maternal Monitoring: Closely track vital signs, particularly temperature and heart rate, to evaluate the response to treatment. Monitor for signs of sepsis such as hypotension, altered mental status, or tachypnea. Strict intake and output monitoring is essential to ensure adequate renal function and hydration status.

Comfort and Positioning: Position the client in a left lateral recumbent position to optimize uterine perfusion and renal blood flow. Administer antipyretics as ordered for fever management, as hyperthermia is detrimental to the fetus. Apply heat packs to the flank only after the immediate risk of preterm labor has been ruled out or stabilized.