A nurse is performing discharge teaching to a client who was admitted for pyelonephritis. Which of the following instructions related to the prevention of pyelonephritis should the nurse include in the teaching? Select all that apply.

Choice A rationale Using douches is generally discouraged for routine vaginal cleansing because they can disrupt the normal flora, primarily Lactobacillus, which helps maintain an acidic vaginal pH (3.8 to 4.5). This disruption allows for the overgrowth of pathogenic bacteria, which may then ascend the urinary tract, increasing the risk of both cystitis and subsequent pyelonephritis (infection of the kidney parenchyma and renal pelvis). Choice B rationale Consuming adequate fluid intake, typically 2.5 to 3 liters daily, is a crucial preventative measure against urinary tract infections, including pyelonephritis. Increased fluid intake promotes frequent voiding, which mechanically flushes bacteria, such as Escherichia coli, out of the bladder and urethra before they can colonize and ascend to the kidneys, thus reducing the bacterial load. Choice C rationale Wiping the perineal area from front to back after voiding prevents the transfer of enteric bacteria, particularly Escherichia coli, from the perirectal area into the urethra. E. coli is the most common causative organism for lower urinary tract infections, and this simple hygienic practice significantly decreases the risk of ascending infection leading to pyelonephritis. Choice D rationale Completing the entire course of antibiotics as prescribed, even if symptoms resolve early, ensures the complete eradication of the pathogenic bacteria responsible for the infection. Stopping antibiotics prematurely allows the most resistant organisms to survive and multiply, potentially leading to a relapse of the infection or the development of antibiotic-resistant pyelonephritis, which is harder to treat. Choice E rationale While good hygiene is important, bathing twice a day itself does not specifically prevent pyelonephritis. Excessive bathing or using bubble baths can sometimes irritate the urethra or introduce bacteria. The key preventative measures relate more to proper voiding habits and perineal hygiene to prevent ascending bacterial migration from the urethra to the bladder and then to the kidneys.