Clinical interventions for acute and chronic pyelonephritis management

Interventions for: PYELONEPHRITIS

While most UTIs affect the urethra and bladder, pyelonephritis comes about when there is progression of a urinary tract infection to the upper urinary system. Pyelonephritis, by definition, "is a bacterial infection of the renal pelvis, tubules, and intestinal tissue of one or both kidneys" (Smeltzer, Bare, Hinkle, Cheever, 2010). The infection could be unpleasant and painful and is worse than cystitis. It is important to note, from the onset, that pyelonephritis does not cause serious or long-term harm if promptly treated. However, delays in treatment could bring about permanent kidney damage. In essence, there are two kind of pyelonephritis -- chronic and acute. While acute pyelonephritis has got to do with the unanticipated development of inflammation in the kidney, chronic pyelonephritis is a persistent or perennial infection that refuses to clear. The latter is rare and could result in kidney scarring and failure. Interventions for both will be taken into consideration in this text.

Acute pyelonephritis

It should be noted, from the onset, that with early treatment and further observation, pyelonephritis' prognosis is considered to be good. Unlike is the case with chronic pyelonephritis, permanent extensive damage in the case of acute pyelonephritis is rare. Those diagnosed with acute pyelonephritis are, in most cases, offered outpatient treatment (Smeltzer, Bare, Hinkle, Cheever, 2010). This is more so the case if they do not exhibit sepsis symptoms, vomiting and nausea, or dehydration. In this case, "a 2-week course of antibiotics is recommended because renal parenchymal disease is more difficult to eradicate then mucosal bladder infections" (Smeltzer, Bare, Hinkle, Cheever, 2010 p. 1365).

In essence, antibiotics are effective in the treatment of most kidney infections. It is for this reason that a course of antibiotic tablets will often be prescribed for those diagnosed early enough with pyelonephritis. Recommended antibiotics could include Co-amoxiclav and ciprofloxacin. It should, however, be noted that these may not be appropriate for pregnant women -- and it is advised that they be put on other antibiotics. Further, it is recommended that pregnant women be hospitalized for a number of days (around 3 days) for parenteral antibiotic therapy, and thereafter be put on oral antibiotics once there are clear signs of improvement (Smeltzer, Bare, Hinkle, Cheever, 2010). If relapse occurs, the initial antibiotic regimen could be followed by a 6-week antibiotic therapy. Like is the case with all UTI patients, parenteral fluids are necessary for hydration purposes. This is particularly the case given that hydration in key in the facilitation of the cleaning up of the urinary tract (Smeltzer, Bare, Hinkle, Cheever, 2010).

Ischemic Stroke: Interventions

Stroke, according to the U.S. National Institutes of Health (2016) "occurs when blood flow to the brain stops." In some quarters it is referred to as a "brain attack." In essence, significant or total disruption of the blood supply to the brain could cause the death of brain cells because the brain is in this case cut off from both oxygen and essential nutrients. The death of brain cells could cause lasting damage. Ischemic stroke could be distinguished from the other kind of stroke -- hemorrhagic stroke, in the sense that ischemic stroke "occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot"(National Institutes of Health, 2016). The key focus of therapy as far as the treatment of ischemic stroke is concerned is the preservation of ischemic penumbra tissue. To prevent irreversible damage, there is need to establish revascularization through recanalization strategies -- which could include administering IV recombinant rt-PA.

There are also a number of endovascular and surgical approaches to the treatment of ischemic stroke that could be applied; with some like carotid endarterectomy still being studied to establish their effectiveness. One of the most commonly endovascular procedures in the treatment of ischemic stroke is referred to as mechanical thrombectomy. Here, medical professionals attempt to get rid of blood clots through the insertion of a stent retriever, after which a catheter is inserted via a groin artery. The clot is grabbed once the stent opens -- permitting those performing the procedure to retrieve the clot trapped within the stent. It is important to note that it is recommended that the procedure be performed after the administration of tPA and before six hours elapse since the detection of the condition's symptoms. According to the national institutes of health, after stroke, the goal of treatment is to ensure that the patient recovers "as much function as possible and prevent future strokes" (National Institutes of Health 2016).