Chapter 45 Urinary Tract Infection Urinary Tract Infections
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Chapter 45 Urinary Tract Infection
Urinary Tract Infections • The second most common reason persons seek health care • Lower UTI – Cystitis – Prostatitis – Urethritis • Upper UTI – Pyelonephritis: acute and chronic – Interstitial nephritis – Renal abscess and perirenal abscess
Assessment • Pain – burning upon urination – Suprapubic, pelvic, or back pain • Increase frequency (voiding more than every 3 hours) • Nocturia; incontinence; hematuria; and change in urine or urinary pattern • About half are asymptomatic • Assess voiding patterns, association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene • Elderly patients often lack the typical symptoms of UTI and sepsis.
Diagnostics • Urine culture – Identify the underlying microorganism • Cellular studies – Microscopic hematuria is present in about half of patients with an acute UTI – Pyuria (greater than 4 WBCs) occurs in all patients with UTI; however, it is not specific for bacterial infection. • Ultrasound and CT scan
Nursing Diagnosis • Acute pain • Deficient knowledge
Collaborative Problems/Potential • Sepsis Complications • Renal failure
Interventions • Prevention – avoid indwelling catheters, care of catheters • Personal hygiene • Medications as prescribed: antibiotics, analgesics • Application of heat to the perineum to relieve pain and spasm • Increased fluid intake • Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol • Frequent voiding • Patient education
Upper Urinary Tract Infections • Pyelonephritis is a bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys
Causes • upward spread of bacteria from the bladder • spread from systemic sources reaching the kidney via the bloodstream.
Acute Pyelonephritis • Enlarged kidneys with interstitial infiltrations of inflammatory cells. • Abscesses within the renal capsule and at the corticomedullary junction. • Eventually, atrophy and destruction of tubules and the glomeruli may result.
Chronic Pyelonephritis • When pyelonephritis becomes chronic, the kidneys become scarred, contracted, and nonfunctioning.
Nursing management: Acute and Chronic • I&O • Unless contraindicated, 3 to 4 L of fluids per day is encouraged to – Dilute the urine – Decrease burning on urination – Prevent dehydration. • Temperature every 4 hours • Administers antipyretic and antibiotic agents as prescribed. • Symptomatic patients are often more comfortable on bed rest.
Nursing management: Acute and Chronic • Patient teaching – prevention of further infection – by consuming adequate fluids – emptying the bladder regularly – performing recommended perineal hygiene.
Urolithiasis and Nephrolithiasis • Calculi (stones) in the urinary tract (Urolithiasis) or kidney (Nephrolithiasis) • Pathophysiology – Supersaturation of calcium or uric acid • Causes; may be unknown • Manifestations – Depend upon location and presence of obstruction or infection – Pain and hematuria – Pyuria – The patient has a desire to void, but little urine is passed
Diagnosis • • X-ray (KUB) Ultrasound blood chemistries stone analysis; strain all urine and save stones – Determine the composition of the stone
Medical Management • Opioid analgesic agents are administered to prevent shock and syncope • NSAIDs – inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone. • Hot baths or moist heat to the flank areas may also be helpful. • Unless contraindicated (E. G. heart failure) fluids are encouraged – ten 8 -ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute – A urine output exceeding 2 L/day is advisable.
Medical management • Thiazide diuretics – Reduce calcium loss in the urine • Protein restriction to minimize uric acid
Potential Sites of Urinary Calculi
Methods of Treating Renal Stones
Methods of Treating Renal Stones
Methods of Treating Renal Stones
Nursing interventions • Administering opoiods and NSAIDs • Increased fluid intake is encouraged to prevent dehydration and promote passage of the stone. • If the patient cannot take adequate fluids orally, IV fluids are prescribed • Ambulation is encouraged as a means of moving the stone through the urinary tract
Patient Teaching • • • Signs and symptoms to report Urine p. H monitoring Measures to prevent recurrent stones Importance of fluid intake Dietary teaching Medication teaching as needed
Questions?
- Urinary tract infection
- Complicated urinary tract infection
- Urinary tract infection in pregnancy ppt
- Nursing management for urinary tract infection
- Bladder infection
- Classification of upper respiratory tract infection
- Lrti
- Sexually transmitted diseases
- Histological structure of kidney
- Urinary bladder
- Tumor in the urinary tract
- A bacterial std that usually affects mucous membranes
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- Rubrospinal tract
- Opportunistic infections
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- Understanding the mirai botnet
- Storch infections
- Storch infections
- Bone and joint infections
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- Postpartum infections
- Retroviruses and opportunistic infections