A nurse is providing discharge teaching to a client who has a permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices:

• Antibiotic therapy: The client’s symptoms (flank pain, painful urination, reddish-brown urine), elevated white blood cell count (15,000/mm³), positive nitrites, leukocyte esterase, and blood in the urine suggest a urinary tract infection (UTI) or pyelonephritis. Antibiotics are needed to treat this infection.
• Urinary tract infection: The urinalysis findings of turbid, dark red urine with blood, positive nitrites, and leukocyte esterase, along with symptoms like painful urination, flank pain, and fever, strongly point to a UTI, possibly involving the kidneys.

Rationale for Incorrect Choices:

• Lithotripsy: Lithotripsy is used for kidney stones, but the client’s symptoms don’t suggest kidney stones, as there is no sharp, colicky pain. The symptoms are more aligned with a UTI.
• Indwelling urinary catheter: An indwelling catheter is not needed for this UTI unless there’s urinary retention. The client's main issue is a UTI, and there is no mention of retention or obstruction requiring a catheter.
• Kidney failure: Although BUN and creatinine are elevated, the primary issue is a UTI, not kidney failure. Kidney failure would be characterized by more severe, prolonged renal dysfunction.
• Pneumonia: The symptoms do not suggest pneumonia. The primary symptoms of pneumonia include cough and difficulty breathing, which are not present here. Crackles are more likely due to fluid overload.

Rationale:

• Blood pressure: In glomerulonephritis, blood pressure elevation is commonly seen due to fluid retention and impaired kidney function, which leads to increased vascular resistance. This is more pronounced than in pyelonephritis, where blood pressure changes may be less severe.
• Respiratory rate: Both pyelonephritis and glomerulonephritis can cause an elevated respiratory rate. In pyelonephritis, it may be due to systemic infection or respiratory distress caused by fluid accumulation or sepsis. In glomerulonephritis, respiratory rate can increase due to fluid retention, leading to pulmonary congestion or difficulty breathing.
• Urinary output amount: Both conditions can cause decreased urinary output. In pyelonephritis, this may occur due to kidney inflammation or infection affecting kidney function. In glomerulonephritis, decreased output is due to glomerular damage that impairs filtration, leading to oliguria or anuria.
• Edema: Edema, particularly periorbital and in the extremities, is a hallmark of glomerulonephritis. The glomerular filtration barrier is damaged, causing protein loss in the urine and subsequent fluid retention. In contrast, edema is less common in pyelonephritis and usually occurs only in severe or advanced cases.
• Pain location: Flank pain is a key feature of pyelonephritis due to kidney infection or inflammation. The pain is usually localized to the back or side, in the area where the kidneys are located. Glomerulonephritis typically does not cause significant flank pain; it is more associated with systemic symptoms like edema, hematuria, and hypertension.