# A nurse is caring for a client with acute pyelonephritis. Which nursing intervention should be the highest priority to prevent complications? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541463 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client with acute pyelonephritis. Which nursing intervention should be the highest priority to prevent complications? A 28-year-old female client is admitted to the medical unit with acute pyelonephritis. She presents with fever of 102.8°F (39.3°C), chills, flank pain, and dysuria. Laboratory results show elevated white blood cell count and positive urine culture for E. coli. ## 보기 1. Encourage increased fluid intake to 3-4 liters per day 2. Administer prescribed antibiotics on schedule 3. Monitor vital signs every 4 hours 4. Assess for signs of sepsis and urosepsis **✔ 정답** **정답: 4** ## 해설 Assessing for signs of sepsis and urosepsis is the highest priority because pyelonephritis can rapidly progress to life-threatening complications. Other interventions are important but secondary to early sepsis recognition. ## 심화 해설 Clinical Scenario Analysis The client presents with classic manifestations of acute pyelonephritis: flank pain, fever (101.8°F / 38.8°C), chills, nausea, and dysuria. Laboratory findings of leukocytosis and bacteriuria confirm an active upper urinary tract infection. This infection carries a significant risk of progressing to urosepsis, a systemic and potentially life-threatening response to infection. Priority Intervention: Early Detection of Sepsis The correct answer is **Option 2**. While all listed interventions are important components of care for acute pyelonephritis, the nurse's immediate priority is to monitor for and detect early signs of systemic decompensation. The rationale is rooted in the concept of early risk stratification and the time-critical nature of sepsis intervention. Research on acute pyelonephritis has validated the use of structured assessment tools to predict clinical deterioration. A prospective study comparing scoring systems in non-emphysematous acute pyelonephritis found that tools like the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score 2 (NEWS2) are relevant for guiding ICU admission and anticipating in-hospital mortality in this specific urological infection [2]. By systematically monitoring vital signs and mental status, the nurse can calculate these scores and identify a patient who is transitioning from a localized infection to a systemic illness with organ dysfunction. The assessment of vital signs and signs of sepsis directly informs the most critical clinical decisions. A change in respiratory rate, a drop in blood pressure, or an altered level of consciousness are early indicators of systemic involvement that necessitate immediate escalation of care. A multicenter cohort study on acute pyelonephritis management highlights that even in monitored settings, the focus remains on tracking the severity of illness (SOI) and risk of mortality (ROM) to prevent pyelonephritis-related complications [1]. The nurse's ongoing assessment at the bedside is the primary mechanism for capturing this data in real time. The other options, while valid, are secondary to this initial and continuous safety assessment. Administering analgesics (Option 1) addresses comfort, encouraging fluids (Option 3) supports the medical plan to flush bacteria, and providing education (Option 4) promotes long-term adherence. However, none of these actions will detect a life-threatening deterioration. A patient who is becoming septic cannot be effectively treated if the warning signs are missed because the nurse was prioritizing a non-urgent task. The foundational nursing process step of assessment must come first to ensure the safety and appropriateness of all subsequent interventions. References (research sources) - [1]Patient Characteristics and Clinical Outcomes of Acute Pyelonephritis Treated in Mayo Clinic's Hospital-at-Home Program.Research articleGomez-Cabello CA, Dumic I, Maniaci MJ, Paulson MR, Shiari A, Webster LW, McGrew J, Genovese A, Collaco B, Trabilsy M, Forte AJ, Bosch W. (2026) · DOI: 10.1093/ofid/ofaf748 - [2]Dual-score framework: National Early Warning Score 2 and quick Sequential Organ Failure Assessment scores in acute pyelonephritis.Research articleJain PR, Aravind S, K PR, Shekar M, Palaniyandi V, Sekar H, Krishnamoorthy S. (2026) · DOI: 10.5527/wjn.v15.i1.114165 ## 임상 시나리오 Clinical Priority: Early Sepsis Detection in Pyelonephritis A client with acute pyelonephritis and systemic signs (fever, chills, tachycardia) is at high risk for urosepsis. The highest nursing priority is continuous assessment for clinical deterioration, as early recognition of sepsis is the most critical factor in preventing mortality. Use a systematic approach to detect the transition from localized infection to systemic illness. Key Sepsis Assessment Components - **Mental Status:** Monitor for new onset confusion, agitation, or decreased responsiveness (indicates cerebral hypoperfusion). - **Hemodynamics:** Track trends in blood pressure (sustained hypotension despite fluids suggests septic shock) and heart rate (persistent tachycardia >90 bpm). - **Respiratory Status:** Assess for tachypnea (>20 breaths/min) and increased work of breathing (compensatory response to metabolic acidosis). - **Perfusion Markers:** Evaluate capillary refill (>3 seconds), skin mottling, and decreased urine output (2 mmol/L) indicates tissue hypoperfusion and guides resuscitation. - **Blood Cultures:** Obtain two sets of blood cultures before antibiotic escalation, as bacteremia confirms urosepsis and directs targeted therapy. - **Fluid Resuscitation Readiness:** Ensure IV access is patent and prepare for rapid administration of 30 mL/kg crystalloid fluids per sepsis protocols if hypotension develops. - **Documentation:** Clearly document assessment findings, time of recognition, and communication with the provider to support timely intervention and quality metrics. **Clinical Pearl:** A common pitfall is attributing tachycardia and tachypnea solely to fever. Always consider these as potential early signs of systemic inflammatory response and impending sepsis, especially in gram-negative infections like E. coli pyelonephritis. ## 핵심 개념 - **Urosepsis** — Sepsis caused by a urinary tract infection that has spread into the bloodstream, leading to systemic inflammatory response and potential organ dysfunction. - **Pyelonephritis** — A bacterial infection of the renal pelvis and kidney parenchyma, commonly caused by ascending E. coli, presenting with fever, flank pain, and dysuria. - **Surviving Sepsis Campaign** — An international initiative that provides evidence-based guidelines emphasizing early identification and aggressive management of sepsis to reduce mortality. ## 같은 주제 문제 - [A nurse is assessing a 45-year-old female client who presents to the emergency department …](https://mymerci.kr/pages/nclex_q.php?qn_id=541456) - [A 45-year-old female patient is admitted to the medical unit with suspected acute pyelonep…](https://mymerci.kr/pages/nclex_q.php?qn_id=541457) - [A nurse is caring for a client diagnosed with acute pyelonephritis. 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