# A nurse is caring for a client diagnosed with acute pyelonephritis. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541460 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client diagnosed with acute pyelonephritis. Which nursing intervention should be the priority? A 65-year-old female client presents to the emergency department with complaints of severe flank pain, fever of 102.4°F (39.1°C), chills, and nausea. Laboratory results show elevated white blood cell count and positive nitrites in urine. The physician diagnoses acute pyelonephritis and orders IV antibiotics. ## 보기 1. Encourage increased fluid intake to 3-4 liters per day unless contraindicated **✔ 정답** 2. Apply heat to the flank area to reduce pain and promote comfort 3. Restrict fluid intake to prevent further kidney irritation 4. Encourage the client to hold urine to allow antibiotics to concentrate in the bladder **정답: 1** ## 해설 Increased fluid intake is the priority to flush bacteria from the urinary tract and prevent dehydration from fever. Other options like restricting fluids or holding urine are incorrect and can worsen the condition. ## 심화 해설 Understanding Acute Pyelonephritis and the Priority Intervention The correct answer is Encourage increased fluid intake to 3-4 liters per day unless contraindicated. This intervention directly addresses the underlying pathophysiology of acute pyelonephritis and helps prevent serious complications. Pathophysiology and Rationale for Fluid Intake Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. The infection triggers an inflammatory response, leading to edema and potential temporary impairment of kidney function. The primary mechanisms by which increased fluid intake helps are: 1. Mechanical Flushing of Bacteria: A high urine flow physically washes bacteria out of the renal pelvis, ureters, and bladder. This reduces the bacterial load and prevents the organisms from adhering to and ascending further into the urinary tract. The rationale is rooted in combating urinary stasis, a key risk factor for infection. As noted in the literature, conditions that promote urinary stasis directly encourage bacterial growth [1]. Increasing fluid intake is the most direct nursing measure to counteract this. 2. Prevention of Dehydration and Renal Protection: The client presents with a high fever of 102.4°F (39.1°C), which increases insensible water loss and the risk of dehydration. Dehydration reduces renal perfusion and the glomerular filtration rate, which can exacerbate kidney injury and reduce the delivery of antibiotics to the infected tissue. Maintaining a high urine output helps preserve renal function during the acute infection. 3. Dilution of Irritating Solutes: Concentrated urine is highly acidic and can further irritate the inflamed renal tissues and bladder mucosa, worsening the client's discomfort and nausea. Diluting the urine provides a soothing effect on the inflamed urinary tract. Why Other Options Are Incorrect or Lower Priority - Option 2: Apply heat to the flank area to reduce pain and promote comfort. While pain management is an important nursing intervention, it is not the priority over a measure that directly combats the infection's progression and prevents renal damage. Applying heat is a comfort measure that can be performed after initiating the intervention that addresses the physiological cause of the problem. Using the nursing process, treating the infection (the etiology of the pain) takes precedence. - Option 3: Restrict fluid intake to prevent further kidney irritation. This is contraindicated and based on a flawed understanding of renal physiology. Fluid restriction would lead to concentrated urine, which is more irritating to the inflamed mucosa and promotes urinary stasis. The goal is to dilute the urine and flush out bacteria, making this intervention harmful for a client with pyelonephritis. - Option 4: Encourage the client to hold urine to allow antibiotics to concentrate in the bladder. This is also contraindicated. Pyelonephritis is an infection of the kidney, not just the bladder. Holding urine would increase the risk of vesicoureteral reflux, where infected urine travels back up the ureters to the kidneys, potentially worsening the infection. Furthermore, it promotes the exact urinary stasis that must be avoided [1]. The goal of antibiotic therapy is to achieve adequate tissue levels in the renal parenchyma through blood circulation, not by concentrating it in a static pool of urine. Appropriate antibiotic management, such as ensuring correct selection and timely administration as highlighted in antimicrobial stewardship studies, is the physician’s and pharmacist's role, while the nurse facilitates this by maintaining hydration for effective drug distribution and excretion .References (research sources) - [1]Recurrent Pyelonephritis in Quadriplegia: Rethinking Oral Cefdinir in the Presence of Nephrolithiasis.Research articleJafri M, Khan Z, Lambroussis CG. (2026) · DOI: 10.7759/cureus.102477 ## 임상 시나리오 Acute Pyelonephritis: Fluid Management PriorityWhy flushing the system is the first-line nursing action The priority for acute pyelonephritis is increased fluid intake to 3-4 L/day unless contraindicated. This mechanically flushes bacteria from the renal pelvis and ureters, directly reducing the infectious load and combating urinary stasis. With a fever of 102.4°F (39.1°C), the client has increased insensible water loss. Adequate hydration prevents dehydration, maintains renal perfusion and GFR, ensuring IV antibiotics reach the infected tissue effectively. CautionFluid intake must be verified as safe for clients with contraindications like heart failure or oliguric renal failure. Always assess for fluid overload signs such as crackles or edema when pushing fluids. ## 핵심 개념 - **Acute Pyelonephritis** — Acute pyelonephritis. A bacterial infection of the upper urinary tract involving the renal pelvis and renal parenchyma. Characterized by fever, chills, flank pain, and nausea/vomiting. - **Flank Pain** — Flank pain. A typical symptom of kidney-related diseases (such as pyelonephritis, kidney stones, etc.). It is accompanied by tenderness at the costovertebral angle (CVA), where the kidneys are located. - **Nitrites (in urine)** — Urine nitrite. When positive (+) on a urine dipstick test, it indicates that gram-negative bacteria (such as E. coli) in the urinary tract have reduced nitrate to nitrite, serving as an indirect marker of bacteriuria. - **Hydration Therapy** — Fluid therapy. A key supportive treatment for infectious diseases, especially urinary tract infections. The goal is to flush bacteria and inflammatory byproducts from the urinary tract, prevent dehydration, and maintain kidney perfusion. - **Sepsis** — Sepsis. A life-threatening condition in which an untreated or severe infection (e.g., advanced pyelonephritis) spreads into the bloodstream, triggering a systemic inflammatory response. 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