Urinary Tract Infection relates to Chapter 44 Nursing

Urinary Tract Infection (relates to Chapter 44, “Nursing Management: Renal and Urologic Problems, ” in the textbook)

Urinary Tract Infection Second most common bacterial disease l Account for more than 8 million office visits per year l Results in >100, 000 people hospitalized annually l

Urinary Tract Infection l >15% patients who develop gramnegative bacteria die – 1/3 of these caused by infections originating in urinary tract

Urinary Tract Infection Bladder and its contents are free of bacteria in majority of healthy patients l Minority of healthy individuals have colonizing bacteria in bladder – Called asymptomatic bacteriuria and does not justify treatment l

Urinary Tract Infection E. coli most common pathogen l Counts of 105 CFU/ml indicate significant UTI l Counts as low as 102 CFU/ml in a person with signs and symptoms are indicative l

Urinary Tract Infection Classification Upper tract involves renal parenchyma, pelvis, and ureters – Typically causes fever, chills, flank pain l Lower tract involves lower urinary tract – No usual systemic manifestations l

Urinary Tract Infection Classification Pyelonephritis is inflammation of renal parenchyma and collecting system l Cystitis is inflammation of bladder wall l Urethritis is inflammation of the urethra l

Urinary Tract Infection Classification l Uncomplicated infection occurs in otherwise normal urinary tract

Urinary Tract Infection Classification l Complicated infections occur with coexisting presence of – Obstruction – Stones – Catheters – Diabetes or neurologic disease – Recurrent infection

Urinary Tract Infection Classification Initial infection l Recurrent UTI l Unresolved bacteriuria l Bacteria persistence l

Urinary Tract Infection Etiology and Pathophysiology Physiologic and mechanical defense mechanisms maintain sterility l Alterations in defense mechanisms increase risk of infection l Organisms causing UTI usually introduced via ascending route from urethra l

Urinary Tract Infection Etiology and Pathophysiology Contributing factor: urologic instrumentation l Sexual intercourse promotes “milking” of bacteria from perineum and vagina l UTIs rarely result from hematogenous route l

Urinary Tract Infection Etiology and Pathophysiology Common source of hospital-acquired UTI is nosocomial infections l Urologic instrumentation common predisposing factor l

Urinary Tract Infection Clinical Manifestations l Symptoms – Dysuria – Frequent urination (>q 2 h) – Urgency – Suprapubic discomfort or pressure

Urinary Tract Infection Clinical Manifestations Urine may contain visible blood or sediment, giving cloudy appearance l Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis) l

Urinary Tract Infection Clinical Manifestations in Older Adult Symptoms often absent l Experience non-localized abdominal discomfort rather than dysuria l May have cognitive impairment l Less likely to have a fever l

Urinary Tract Infection Clinical Manifestations Patients with significant bacteriuria may have no symptoms or nonspecific symptoms like fatigue or anorexia l Patients with bladder tumors or those receiving intravesical chemotherapy or pelvic radiation usually experience frequency, urgency, and dysuria l

Urinary Tract Infection Diagnostic Studies Initially obtain dipstick urinalysis to identify presence of nitrates, WBCs, and leukocyte esterase l Findings confirmed by microscopic urinalysis l Following confirmation of bacteriuria and pyuria, urine culture may be obtained l

Urinary Tract Infection Diagnostic Studies Urine culture indicated in complicated or nosocomial, persistent bacteria, or frequently recurring (>2 episodes annually) l May be cultured if infection is unresponsive to empiric therapy or diagnosis is questionable l

Urinary Tract Infection Diagnostic Studies Clean-catch is preferred l Specimen obtained by catheterization or suprapubic needle aspiration has more accurate results l

Urinary Tract Infection Diagnostic Studies Sensitivity testing determines susceptibility to antibiotics l Imaging studies are indicated in selected cases – IVP or abdominal CT when obstruction suspected l

Urinary Tract Infection Collaborative Care Drug Therapy Antibiotic selected on empiric therapy or results of sensitivity testing l Uncomplicated cystitis treated by shortterm course of antibiotics l Complicated UTIs require long-term treatment l

Urinary Tract Infection Collaborative Care Drug Therapy l Trimethoprim-sulfamethoxazole (TMPSMX) or nitrofurantoin used to treat empiric uncomplicated or initial – Inexpensive – TMP-SMX taken bid

Urinary Tract Infection Collaborative Care Drug Therapy Pyridium is OTC that provides soothing effect on urinary tract mucosa – Stains urine reddish orange that can be mistaken for blood and may stain underclothing l Effective in relieving discomfort l

Urinary Tract Infection Collaborative Care Drug Therapy l Combination agents (e. g. , Urised) used to relieve pain – Preparations with methylene blue tint urine blue or green

Urinary Tract Infection Collaborative Care Drug Therapy Prophylactic or suppressive antibiotics sometimes administered to patients with repeated UTIs l TMP-SMX administered qd to prevent recurrence or single dose prior to events likely to cause UTI l

Urinary Tract Infection Nursing Management Nursing Assessment l Health History-what will you ask? l Subjective Data- what symptoms might the client describe? l Objective Data- what signs might you find?

Urinary Tract Infection Nursing Management Nursing Diagnoses Acute pain l Impaired urinary elimination l

Urinary Tract Infection Nursing Management Planning Patient will have l Relief from lower urinary tract symptoms l Prevention of upper urinary tract involvement l Prevention of recurrence

Urinary Tract Infection Nursing Management Nursing Implementation l Health Promotion – Recognize individuals at risk

Urinary Tract Infection Nursing Management Nursing Implementation l Health Promotion – Emptying bladder regularly and completely – Evacuating bowel regularly – Wiping perineal area front to back – Drinking adequate fluids (15 ml per lb)

Urinary Tract Infection Nursing Management Nursing Implementation l Health Promotion – Daily intake of cranberry juice or cranberry essence may help reduce risk – Avoid unnecessary catheterization and early removal of indwelling catheters l Prevents nosocomial infections

Urinary Tract Infection Nursing Management Nursing Implementation l Health Promotion – Aseptic technique must be followed during instrumentation procedures – Wash hands before and after contact – Wear gloves for care of urinary system

Urinary Tract Infection Nursing Management Nursing Implementation l Health Promotion – Routine and thorough perineal care for all hospitalized patients – Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals

Urinary Tract Infection Nursing Management Nursing Implementation l Acute Intervention – Adequate fluid intake l Patient may think will worsen condition due to discomfort l Dilutes urine, making bladder less irritable l Flushes out bacteria before they can colonize

Urinary Tract Infection Nursing Management Nursing Implementation l Acute Intervention – Avoid caffeine, alcohol, citrus juices, chocolate, and highly-spiced foods l Potential – bladder irritants Application of local heat to suprapubic or lower back may relieve discomfort

Urinary Tract Infection Nursing Management Nursing Implementation l Acute Intervention – Instruct patient about drug therapy and side effects – Emphasize taking full course despite disappearance of symptoms – Second or reduced drug may be ordered after initial course in susceptible patients

Urinary Tract Infection Nursing Management Nursing Implementation l Acute Intervention – Instruct patient to watch urine for changes in color and consistency and decrease in cessation of symptoms – Counsel on persistence of lower tract symptoms beyond treatment or onset of flank pain or fever should be reported immediately

Urinary Tract Infection Nursing Management Nursing Implementation l Ambulatory and Home Care – Emphasize compliance with drug regimen l Take – – – as ordered Maintain adequate fluids Regular voiding Void after intercourse

Urinary Tract Infection Nursing Management Nursing Implementation – – – Temporarily discontinue use of diaphragm Instruct on follow-up care with urine culture Recurrent symptoms typically occur in 12 weeks after therapy

Urinary Tract Infection Nursing Management Evaluation Use of nonanalgesic relief measures l Appropriate use of analgesics l Pass urine without urgency l Urine free of blood l Adequate intake of fluids l