Complications and assessments for patient with acute pyelonephritis and T2DM. Help needed!

[Carolfp]

Hello lovely students/RN's.

I am being clinically assessed tomorrow by my clinical educator.

I need to provide the pathophysiology behind a patient's condition, and rationale for 1 or more nursing assessments.

This is only a quick and rough example of what I want to handover to my clinical educator:

Presenting problem: Acute pyelonephritis,

Hx of medical conditions: T2DM

Pathophysiologyof pyelonephritis: (rough explanation)

Pyelonephritis occurs when bacteria (usually E coli) travels from the lower urinary track (which is an UTI when it's the lower urinary track) to the upper renal track reaching the kidneys (renal parenchyma- the functional tissue of the kidneys, consisting of the nephrons which filter blood and makes urine).

Complications: Can progress to sepsis/septic shock, renal failure + multi organ failure.

Pyelonephritis can lead to scarring of the tissue r/t ineffective renal perfusion:

capillaries in the nephrons responsible for oxygenation are damaged/destroyed resulting in decline of renal perfusion. Hypoperfussion affects the kidney's production of erythropropin factor responsible for the production of rbc. Decrease of RBC = Decreased O2 supply to kidney= kidney failure? *please correct me if I'm wrong.

SYMPTOMS:

-Hyperthermia (second line of defence: inflammatory mediators such as neutrophils are activated, and release pyrogens as they die fighting the bacteria= raise in temperature to kill the bacteria.

-Impaired urinary elimination

Bladder wall irritation occurs, contraction of smooth muscle to eradicate pathogens along with urine.

-headache

-vomiting

-weakness

and pain/dysuria/tenderness of bladder are

-Mental status change (This is what I need help with)

Patho behind a mental status change: Accumulated residual uremic +electrolyte imbalance can be toxic to the CNS : can anyone give me more explanation on this? I don't quite understand. I will be doing my assessment on this and I need to explain the rationale for doing a Neuro assessment/Neuro obs (Glasgow coma scale).

Part2: The part I'm super lost in:

I will quickly explain the pathophysiology behind T2DM and the contraindications of this with pyelonephritis to my clinical teacher.

Since the patient has T2DM there will already be complications and indications of renal problems. eg: T2DM produces autonomic bladder neuropathy (nerve damage?)

AND Glucosiruia, neprhosclerosis, microangopathy.

As an example:

T2DM: causes polydispia which is characterized by:

-Excessive thirst

-Glycosuria

-Osmotic effect of glucose draws water into the urine

-Water is being lost from the tissues= Dehydration

"Dehydration causes a decrease in BP leading to increase sodium (in the blood?) and osmolarity (concentration)" Can anyone explain this to me?

Osmoreceptors respond to dry mouth, this stimulates the hypothalamus which signals the pituitary glands and release ADH (antidiuretic hormone)

this results in water reabsorption in kidneys.

R/T: water retention?

HYPONATREMIA -low NA

oedema?

Part 3:

Therefore my following assessments will be:

1) OBS to check if patient is experiencing any septic shock/tempertaure(is this correct)?

2)Fluid intake/Hydration assessment TO check of dehydration/odema as dehydration leads to hypovalemic shock (would I still do this despite the patient being on IV fluids?)

but what I'm not sure of is: does pyelonephritis cause water retention/and dehydration? or is it more the diabetes?

3)Observations of mental status/delerium

4) check for uremia= sign of condition worsening?

Anything else I could be missing?

Thank you all for taking your time in reading this.

I know it's very confusing and maybe doesn't make any sense a all. I just want to know if my assessments are adequate in regards to the patients conditions.

Any advice/opinions help would be of immense help. Thanks!!!