Infection: Urinary Tract Infection - Antibacterials Flashcards
What is infection?
Infection is defined as the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response.
4 Pathogens and examples
- Parasite: glardia, toxoplasmosis, malaria, lice
- Bacterial: Salmonella, E. coli, tuberculosis, staph, strep, listeria, chlamydia, gonorrhea
- Fungal: candidiasis - yeast, coccidiomycosis (Vally Fever), pneumocystis pneumonia, tinea (ringworm)
- Viral: COVID-19, Hep A & B, influenza, MMR, polio, rabies, common cold
How to break the chain of infection
- Masks
- Gloves
- Washing hands
- Immunizations
- Patient Education
- Cleaning, sanitizing
- Waste disposal
- Food safety
- Isolation
Define UTI
- 2nd most common bacterial disease
- most common in women because of a shorter urethra
- E. coli most common pathogen: the immunocompromised may have a UTI develop due to fungi or parasitic pathogens
- Normally urine is more acidic and actual flow with peristaltic activity help to rid the body of bacteria.
- Urinary tract above the urethra is usually sterile but many common issues halt this normal (kidney stones, pregnancy, congenital defects, aging, chronic health issues)
- Upper UTI: occur in the renal pelvis and ureters and are often showcased through systemic manifestations: flank pain, fever, chills and malaise
- Lower UTI’s: occur in urethra and bladder; general complaint of burning (also need to rule out yeast infection)
- E. coli coming from rectum as most don’t know how to wipe, wipe front to back when doing diaper change
- Empty bladder after intercourse
Differentiate the 4 locations of UTIs
- Pyelonephritis: infection in kidney
- Urethritis: infection in urethra
- Cystitis: infection in bladder
- Urosepsis: sepsis arising from infection in urinary tract
Complicated vs. Uncomplicated
- Uncomplicated: occurs in otherwise normal urinary tract, usually involves only the bladder
- Complicated: those with coexisting presence of: obstruction, stones, catheters, existing diabetes/neurologic disease, or recurrent infection
UTI Risk Factors
Factors that increase urinary-stasis:
- Benign Prostatic Hyperplasia (BPH) (prostate enlarges, ask about urine flow, comes with aging)
- Tumor
- Neurogenic bladder
- Urethral stricture (narrowing, sometimes need to go in and open up urethra)
- Foreign bodies: catheters, calculi, instrumentation
Compromising immune response factors:
- Age: older = weaker immune systems
- HIV: compromised immune system
- Diabetes: compromised immune system
Anatomic factors:
- Obesity
- Congenital defects
Functional disorders:
- Constipation: When someone is really constipated, pressure of bowels can put pressure on urethra and block the flow of urine
- Neurogenic bladder
Etiology and Pathophysiology
- Hospital-acquired UTI accounts for 31% of all hospital acquired infections
- Causes: Often E. coli
- Catheter-acquired UTIs (CAUTI)
UTI Symptoms
- Urinary frequency
- Urgency
- Incontinence
- Nocturia
- Nocturnal enuresis
- Weak stream
- Hematuria
- Hesitancy
- Intermittency
- Post-void dribbling
- Urinary retention
- Dysuria: Painful or difficult urination
- Confusion in older adults
- High WBC count
- Fever
UTI Symptoms in Elderly
- Symptoms are often absent
- Experience non-localized abdominal discomfort rather than dysuria
- May have cognitive impairment-confusion
- Are less likely to have a fever
- Weakened immune ststem
- May not have immediate reaction
Assessment
- Health hx
- Physical assessment
- Medications: inquire about recent antibiotics and immunosuppressants
- Personal hygiene habits
- Recent foley within the last 30 days
Diagnostic Studies for UTI
- Dipstick urinalysis/UA : Nitrates, WBCs, leukocyte esterase; UA will show nitrates if E.Coli. For UTI dx- colony count 100,000 (10 to 5th power)
- UA C&S (clean catch or from catheter): Urine for culture and sensitivity; Bacteria, WBC, RBC; Growing whatever the bacteria is (culture) and seeing which abx they are sensitive to
- IVP for higher urinary issues:
- calculi
- Prostate Specific Antigen (PSA) for Benign
- Prostatic Hyperplasia (BPH)
Nursing Diagnoses
- impaired urinary elimination
- ineffective self-health management
- acute pain
- altered sensory perception
- acute confusion
Patient outcomes and goals
- Relief from lower urinary tract symptoms
- Prevention of upper urinary tract involvement
- Prevention of recurrence
- Adoption of adequate hygiene measures
- No evidence of UTI or other secondary infection
Nursing Interventions - Pharmaceutical
Pain Management:
- Phenazopyridine (Uristat, Pyridium)-turns urine orange/red
- Acetaminophen (Tylenol)
- other OTC
Antibiotics:
- Selected on empiric therapy or results of sensitivity testing
- Nitrofurantoin (Macrodantin) turns urine brown
- Trimethoprim/sulfamethoxazole (Bactrim, Septra)
- Uncomplicated: short-term course (1 to 3 days)
- Complicated UTIs: require long-term treatment (7 to 14 days)
- Recurrent UTI’s: prophylactic antibiotic therapy is considered
