Chapter 31: Urinary Tract Infection (UTI) (Children) Flashcards
Urinary Tract Infection (UTI)
an acquired infection of the urinary system caused by a bacterium, virus, or fungus
- are usually ascending and start distally, at the urethral area, causing urethritis or cystitis
- if they start in the upper tract, they cause ureteritis and pyelitis, or pyelonephritis
What Contributes to UTI Infections?
- gender
- age
- race
- renal tissue
- poor hygiene
- constipation
- nutritional status
- adaptive resistant qualities of the causative agents
- structural abnormalities
- catheterization
- urinary tract instrumentation
- sexual activity
Constipation and UTIs
constipation results in incomplete bladder emptying, resulting in residual urine in the bladder, which reduces the innate defense of the child
Who has a higher incidence of UTIs
- newborns born prematurely
- infants with a low birth weight
- in girls, peaks during infancy and toilet training
- boys, if uncircumcised
Risk Factor for UTIs
presence of a urinary tract abnormality that causes urinary stasis, obstruction , reflux, or dysfunctional voiding, as in vesicoureteral reflux (VUR)
- Pyelonephritis (infection in the renal pelvis) contributes to UTI and causes renal scarring with repeated infections
- alterations that interfere with elimination (constipation)
- conditions associated with chronic perineal irritation (e.g. poor hygiene, nylon or spandex undergarments’, masturbation, pinworms, diaper rash, sexual activity, sexual abuse, prolonged baths, or bubble baths)
- difficulty with toilet training
- neurogenic bladder
- history of abnormal voiding patterns
Signs and Symptoms In the Neonate/ Newborn
- failure to thrive
- jaundice
- hypothermia
- vomiting or diarrhea
- cyanosis
- abdominal distention
- lethargy
- sepsis
Signs and Symptoms in the Infant
- poor feeding
- fever (especially r/t pyelonephritis)
- vomiting or diarrhea
- malodor (unpleasant smell)
- dribbling urine
- abdominal pain/ colic irritability
- malaise
- poor weight gain
Signs and Symptoms in Toddler and Preschooler
- abdominal pain
- vomiting or diarrhea
- flank pain
- fever (r/t pyelonephritis)
- malodor
- altered voiding pattern
- diaper rash
- enuresis (inability to control frequent urination)
- malaise
Signs and Symptoms in School-aged and Adolescent Children
- enuresis (inability to control frequent urination)
- malodor
- classic dysuria with frequency, urgency, and discomfort
- fever/chills
- abdominal pain
- flank pain
- malaise
- vomiting or diarrhea
Normal Urinalysis Values
>Appearance: -clear >Color: -amber yellow >Odor: -aromatic >pH: -4.6-8.0 (average 6.0)
> Osmolarity:
-50 to 1400 mOsm/L
> Protein:
- none or up to 8 mg/dL
- 50 to 80 mg/24 hr (at rest)
- <250 mg/24 hr (exercise)
> Specific Gravity
- Adult: 1.005-1.030 (usually 1.010-1.025)
- Elderly: decrease with age
- Newborn: 1.001-1.020
>Leukocyte esterase: negative >Nitrites: negative >Ketones: negative >Crystals: Negative >Casts: none present
> Glucose:
- Brand new specimen: negative
- 24-hour: 50-300 mg/day or 0.3-1.7 mmol/day
WBC: <5/hpf
WBC casts: negative
RBC: <5/hpf
RBC casts: none
Diagnosis
-based on urine cultures and sensitivities
-obtaining a urinary culture that confirms the pathogen and the exact type of bacteria present in the urine
-suprapubic aspiration (SPA) or catheterization with 50,000/mL bacterial growth
>when a child is intensely ill, a catheterization or a SPA is choice in all age groups to detect a UTI
Prevention
- void frequently
- wash hands after elimination
- wear loose-fitting clothes
- wipe from front to back
- cotton underwear for both genders b/c it decreases moisture
- constipation, if an issue, needs to be prevented
- drink plenty of water for his/her age to prevent dehydration and enhance immune system’s infection fighting abilities
Nursing Care
- provides developmentally appropriate education to entire family
- obtain a hx that identifies risk factors, signs and symptoms, medications, and nutritional and fluid intake and output parameters
- nursing assessment of external genitalia; noting irritation, pinworms, sexual abuse or trauma
- for girls, inspect perineal area for redness, edema, discharge, labial adhesions, and vaginitis
- in males that are not circumcised, “dribbling, thread-like stream, and urethral ballooning” is assessed
- note any dimpling in sacral area
- vital signs
- assess growth and development
- pain, tenderness, a mass in the flank area, or fecal impaction
- notice odors
- record intake and output
Who is typically admitted to the hospital
- patients who require IV fluids or IV antibiotics
- neonates and infants identified as high-risk
- infants younger than 1 month with suspected UTI, even if not febrile
Medical Care
- parenteral and oral antibiotics; urine culture must be obtained before starting
- parenteral antibiotics for children with toxic symptoms, dehydration, vomiting, or non-compliance
- IV antibiotics usually given for 14 days to toxic children or with pyelonephritis
- oral antibiotics for 2 to 4 days for uncomplicated cases
