Pyelonephritis — NCLEX Cheat Sheet
Kidney infection + flank painAlso known as: kidney infection · upper UTI · infected kidney · flank infection
Use this quick-reference guide to spot, treat, and prevent Pyelonephritis on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
📌 Mech
- UTI ascended to kidney
- E. coli, reflux, obstruction
🩺 Signs
- FLANK pain, CVA tenderness
- HIGH fever, chills, N/V
- dysuria, frequency, cloudy urine
🚩 Report
- sepsis: ↑HR, ↓BP, ↑lactate
- chronic → scarring, CKD
✅ Do
- IV antibiotics, then oral
- ↑fluids, antipyretics, rest
- culture first, monitor I&O
📚 Pyelonephritis — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Hallmark signs are costovertebral angle (flank) tenderness, high fever, and chills.
- Patients also have classic UTI symptoms: dysuria, frequency, urgency, and cloudy/foul urine.
- Nausea, vomiting, and malaise commonly accompany the infection.
- Urinalysis shows WBC casts, pyuria, bacteria, and possibly hematuria.
- Obstruction (stones, BPH) and vesicoureteral reflux predispose to ascending infection.
- Untreated infection can progress to bacteremia and septic shock.
Nursing priorities
What to do, in order- Obtain urine and blood cultures before initiating antibiotics.
- Administer IV antibiotics, antipyretics, and IV fluids as ordered.
- Encourage oral fluid intake (up to 3 L/day) to flush the urinary tract unless contraindicated.
- Monitor temperature, vital signs, intake/output, and pain.
- Assess for and relieve any urinary obstruction contributing to the infection.
Red flags — report now
Escalate immediately- Hypotension, tachycardia, and high fever - signs of urosepsis/septic shock; escalate immediately.
- Decreasing urine output or worsening flank pain - possible obstruction or kidney damage; report.
- Persistent high fever despite antibiotics may indicate abscess - notify provider.
- Confusion or altered mental status, especially in older adults - report.
Labs & values
Numbers to know- Urinalysis: WBC casts, pyuria, bacteria, nitrites
- Urine and blood cultures: identify organism
- WBC: normal 5,000-10,000/mm3 (elevated with left shift)
Patient teaching
What patients must know- Complete the full course of antibiotics even after symptoms resolve.
- Drink plenty of fluids and empty the bladder regularly and completely.
- Treat lower UTIs promptly and report flank pain or fever right away.
❓ Pyelonephritis: NCLEX FAQs
What are the priority nursing interventions for Pyelonephritis?
Obtain urine and blood cultures before initiating antibiotics. Administer IV antibiotics, antipyretics, and IV fluids as ordered. Encourage oral fluid intake (up to 3 L/day) to flush the urinary tract unless contraindicated. Monitor temperature, vital signs, intake/output, and pain.
What are the warning signs of Pyelonephritis a nurse must report?
Hypotension, tachycardia, and high fever - signs of urosepsis/septic shock; escalate immediately. Decreasing urine output or worsening flank pain - possible obstruction or kidney damage; report. Persistent high fever despite antibiotics may indicate abscess - notify provider. Confusion or altered mental status, especially in older adults - report.
What do I need to know about Pyelonephritis for the NCLEX?
Hallmark signs are costovertebral angle (flank) tenderness, high fever, and chills. Patients also have classic UTI symptoms: dysuria, frequency, urgency, and cloudy/foul urine. Nausea, vomiting, and malaise commonly accompany the infection. Urinalysis shows WBC casts, pyuria, bacteria, and possibly hematuria.
What patient teaching is important for Pyelonephritis?
Complete the full course of antibiotics even after symptoms resolve. Drink plenty of fluids and empty the bladder regularly and completely. Treat lower UTIs promptly and report flank pain or fever right away.
Quick Tip
Hallmark signs are costovertebral angle (flank) tenderness, high fever, and chills.
📖 Related Topics
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