Kidney Kwame — UTI & Pyelonephritis
Burning and frequency stay in the bladder — flank pain, fever and chills mean it's climbed to the kidney
Kwame has had burning with urination and a constant urge to go for two days, but tonight he spikes a fever, starts shaking with chills, and develops a deep ache in his right flank. When the nurse taps gently over his back, he winces sharply.
Kwame's lower urinary tract infection causes dysuria, urgency, frequency and cloudy, foul-smelling urine. Left untreated or with an ascending infection, bacteria can travel up the ureters to the kidney, causing pyelonephritis with fever, chills, flank pain and costovertebral angle tenderness. Untreated pyelonephritis risks urosepsis and permanent renal scarring, so recognizing the shift from lower to upper tract symptoms is a critical nursing skill.
Read Kidney Kwame's full story →The story arc
The setup
Kwame develops dysuria, urinary frequency, urgency and cloudy urine that he initially treats with cranberry juice at home.
The turn
Two days later, Kwame develops fever, chills, nausea and a new dull ache in his right flank that wasn't there before.
The crisis
Kwame's temperature spikes to 39.5°C, his WBC count is 18,000/mcL, and he has marked right costovertebral angle tenderness with tachycardia and hypotension.
The save
The nurse obtains a urine culture before starting the prescribed IV antibiotics, ensures adequate hydration, monitors vital signs and urine output closely, and watches for signs of sepsis requiring escalation.
NCLEX study section — UTI & Pyelonephritis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.