The 4 th international Scientific Nursing Conference 2012 , innovations in .Nursing Researches. Education & Practice 1 Effect of Pyelonephritis During Pregnancy on Mother's Quality of Life Ass, Prof, Dr. Aida abd El-Razek 1 , Dr. Heba Aly 2 , Dr. Aziza A 3 , Dr. Abear Y 4 1- Maternal and Newborn Health Nursing Faculty of Nursing, Menoufia University 2- Med Surgical Health of Nursing Faculty of Nursing Banha University 3- Maternal and Newborn Health Nursing Faculty of Nursing, Banha University 4- Med Surgical Health of Nursing Faculty of Nursing Banha University Abstract Background: Renal parenchymal infection or Pyelonephritis, constituted 1% to 4% among pregnancies. It is a condition in which the renal tubules become inflamed and their ability to reabsorb sodium is greatly affected. Aim of study; the aim of study was to study the effect of Pyelonephritis during pregnancy on mother's quality of Life. Methods: Study design: descriptive study. Setting: The study was conducted at outpatient of obstetric department Menoufia University and second setting was Ministry of health Teaching hospital. Subjects: The subjects of this study were 120 pregnant mothers medically diagnosed with pyelonephritis chosen according to the inclusion criteria. Pregnant mothers without any complications rather than pyelonephritis. Type of sample: A convenient sample was utilized from both study setting. Results: The study had revealed that mothers had lack of somatic fitness there for they were unable to give care for their families. It is also observed that the majority of the mothers had improper social fitness; they received social support from their family's members. Additionally, there were unhappy with their life changes. More than half among the sample studies was psychological upset because they have almost felt sad and afraid of the deterioration and complications of the pyelonephritis. Conclusions: there was a significant relation was observed between quality of life (QOL) and general characteristics; p values are 0.001, 0.032, 0.022, o.o4 and o.028 respectively. On the other hand, the score percent of sexual fitness shows insignificant difference p value=0.54. Housewives score means significantly higher than the women working as regard somatic fitness percent, social fitness, psychological fitness, job fitness and sexual fitness, p values are 0.01, 0.01, 0.001, 0.04 and 0.03 respectively. Study recommended; that outreach program must be designed and implemented to improve QOL among pregnant mother with pyelonephritis, psychological follow up programs among pregnant mother with pyelonephritis to improvement of their QOL, and further studies in the area of this study are needed with increase sample size to generalized results. Keywords: Pyelonephritis, Pregnancy, Quality of life.
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The 4th international Scientific Nursing Conference 2012 , innovations in .Nursing
Researches. Education & Practice
1
Effect of Pyelonephritis During Pregnancy on Mother's Quality of Life
Ass, Prof, Dr. Aida abd El-Razek1
, Dr. Heba Aly2
, Dr. Aziza A3
, Dr. Abear Y4
1- Maternal and Newborn Health Nursing Faculty of Nursing, Menoufia University
2- Med Surgical Health of Nursing Faculty of Nursing Banha University
3- Maternal and Newborn Health Nursing Faculty of Nursing, Banha University
4- Med Surgical Health of Nursing Faculty of Nursing Banha University
Abstract
Background: Renal parenchymal infection or Pyelonephritis, constituted 1%
to 4% among pregnancies. It is a condition in which the renal tubules become
inflamed and their ability to reabsorb sodium is greatly affected.
Aim of study; the aim of study was to study the effect of Pyelonephritis during
pregnancy on mother's quality of Life.
Methods: Study design: descriptive study. Setting: The study was conducted at
outpatient of obstetric department Menoufia University and second setting was
Ministry of health Teaching hospital. Subjects: The subjects of this study were
120 pregnant mothers medically diagnosed with pyelonephritis chosen
according to the inclusion criteria. Pregnant mothers without any complications
rather than pyelonephritis. Type of sample: A convenient sample was utilized
from both study setting.
Results: The study had revealed that mothers had lack of somatic fitness there
for they were unable to give care for their families. It is also observed that the
majority of the mothers had improper social fitness; they received social
support from their family's members. Additionally, there were unhappy with
their life changes. More than half among the sample studies was psychological
upset because they have almost felt sad and afraid of the deterioration and
complications of the pyelonephritis.
Conclusions: there was a significant relation was observed between quality of
life (QOL) and general characteristics; p values are 0.001, 0.032, 0.022, o.o4
and o.028 respectively. On the other hand, the score percent of sexual fitness
shows insignificant difference p value=0.54. Housewives score means
significantly higher than the women working as regard somatic fitness percent,
social fitness, psychological fitness, job fitness and sexual fitness, p values are
0.01, 0.01, 0.001, 0.04 and 0.03 respectively.
Study recommended; that outreach program must be designed and
implemented to improve QOL among pregnant mother with pyelonephritis,
psychological follow up programs among pregnant mother with pyelonephritis
to improvement of their QOL, and further studies in the area of this study are
needed with increase sample size to generalized results.
Keywords: Pyelonephritis, Pregnancy, Quality of life.
The 4th international Scientific Nursing Conference 2012 , innovations in .Nursing
Researches. Education & Practice
2
Introduction
Renal parenchymal infection or Pyelonephritis, constituted 1% to 4% among
pregnancies. It is a condition in which the renal tubules become inflamed and their ability to
reabsorb sodium is greatly affected. The incidence of higher during pregnancy was found
when the patient's history contained some indication of an earlier renal disease. Pregnancy
associated with chronic nephritis has to be interrupted in the first trimester as the particular
conditions of pregnancy predispose to pyelonephritis (1).
The basic factor predisposing to urinary tract infection during the prenatal period is
the relative stasis of urine caused by pregnancy-induced changes. Hydroureter is common
during the last half of pregnancy. Progesterone causes the ureters to dilate, while the
enlarging uterus leads
to mechanical compression. In addition, changes in a pregnant woman's immune system
may make her more susceptible to infection. The patients at highest risk are those in whom
acute pyelonephritis develops, with associated premature labor and advanced cervical
dilation(4)
.
Pyelonephritis is rising globally, particularly in developing countries where the
major underlying causes, diabetes and hypertension, are also on the rise. Thus, detecting
kidney disease early and managing the underlying causes are key to saving lives (5)
. Mothers
who have a pyelonephritis are at high risk for pregnancy complications, including
miscarriage, stillbirth, preterm birth, and preeclampsia (6)
. The risks of complications of
pyelonephritis in pregnancy, especially preterm labor and delivery, as well as the need to
prevent recurrences and permanent renal damage, have dictated this aggressive approach (7)
.
The prevalence of symptomatic bacteriuria during pregnancy is 2% to 14%. Factors
associated with a higher risk include advanced age, higher parity, and a lower
socioeconomic status. In approximately 20% to 40% of untreated women with
asymptomatic bacteriuria, a symptomatic urinary tract infection, such as cystitis or
pyelonephritis, will subsequently develop during the course of pregnancy or immediately
postpartum. Conversely, acute pyelonephritis will develop in less than 5 % of patients with
asymptomatic bacteriuria who have been appropriately treated with antibiotics (3).
Provided pregnancy pyelonephritis is diagnosed and treated early enough the
incidence of intrauterine fetal death, premature, birth and perinatal fetal loss will not be
higher than the average, but developmental retardation has a slightly higher incidence. The
degree of renal disturbance not only increases the probability of pyelonephritis but also the
damage suffered by the mother and fetus. The prevention of inflammatory renal and
appropriate treatment of inflammatory renal diseases and the constant control of the patient
is the task of prenatal and nephrological care, so as to avoid early and late complications (1,2).
Quality of life refers to that which makes life worth living and connotes the caring
aspect of nursing, because nursing is concerned not only with survival and decreased
morbidity, but also with the whole patient. In providing care to mother's with pyelonephritis,
nurse help mothers to manage the side effects of therapy and focusing nursing intervention
on decreasing symptoms or improving the mother's ability to deal with them, improving
functional abilities, decreasing limitation and identifying issues that affect general health
perception could increase a mother's overall(11)
.
The concept of health-related quality of life (HRQOL) takes into account patient
well-being as expressed by both the physical and psychological domains of health. HRQOL
may be affected by several factors, including the clinical manifestations of diseases, the side
effects of treatment, and the quality of the relationships of the patient with family members
and health care providers (12)
. .
The 4th international Scientific Nursing Conference 2012 , innovations in .Nursing
Researches. Education & Practice
3
Quality of life is terms of how it is negatively affected, on an individual level, by
disease. QOL refers to the degree to which a person enjoys the important possibilities of his
or her life. Their quality of life Model is based on the categories "being", "belonging", and
"becoming", respectively who one is, how one is connected to one's environment, and
whether one achieves one's personal goals, hopes, and aspirations(8)
.
Quality of life (QOL) is used in healthcare to refer to an individual's emotional, social and
physical wellbeing, including their ability to function in the ordinary tasks of living (5)
.
The role of maternity nurses during physical examination must be focused on the
vital signs, the abdomen, and the costovertebral angle (CVA). Careful measurement of
temperature is important, since fever with UTI strongly suggests pyelonephritis. An
increased respiratory rate can indicate respiratory compensation for metabolic acidosis. The
abdomen should be examined especially for adnexal tenderness, which may suggest that the
correct diagnosis is actually pelvic inflammatory disease. CVA tenderness is the classic
physical finding in pyelonephritis (9,10)
Laboratory testing and 24 hours urine collection should be started. Awareness of
symptoms of anemia and fetal monitoring through non-stress test and fetal movement counts
also is mandatory. Ultrasound imaging of the kidney may be required and monitoring of
electrolyte level is important. The mothers should be asked about fetal movement,
contraction, burning or difficulty during urination, more frequent urination, particularly at
night, passage of bloody appearing urine, puffiness around the eyes, swelling of hands or
feet (6)
Nurses can take a central role in working with pregnant mother to promote better
(QOL) among mothers with pyelonephritis consequently it were reflect on better pregnancy
outcomes. Urine culture should be obtained at the first prenatal visit. Dipstick methods are
insufficiently sensitive for screening for bacteriuria in pregnancy (8)
.
Significant of the study:
It was reported that pregnancy markedly predisposes to pyelonephritis, which can
harm both the mother and the fetus. Bacteriuria during pregnancy is associated with
prematurity and low birth weight, although a cause-and-effect relationship is unclear. There
were no previous studies in Menufyia University faculty of nursing Maternal and Neonatal
Nursing Department regarding to the previous mention study title. Incidence of acute
pyelonephritis during pregnancy is less than 5 % and the rate of live birth to mothers of all
races and ages with a history of renal disease was 7/1000 (8)
.This study help to identify
mothers/fetus needs and to plan care to motivate these mothers to develop positive coping
pattern.
The Aim of the study was study effect of pyelonephritis during pregnancy on mother's
quality of life.
Research questions
1. Are pregnant mothers having correct knowledge regarding pyelonephritis and it is related
changes of quality of life?
2. What are factors influencing quality of life among pregnant mothers with pyelonephritis?