Urinary Tract Infections Flashcards by Misty-Kay Casabianca

What is an UTI

Most common bacterial infection in women

At least 20% of women will develop a UTI during their lifetime

How well did you know this?

Not at all

Perfectly

What pathogen causes UTI’s

Escherichia coli most common pathogen

Fungal and parasitic infections can cause UTIs

How well did you know this?

Not at all

Perfectly

Who is t risk?

Immunosuppressed

Diabetic

Having undergone multiple antibiotic courses

Have traveled to developing countries

How well did you know this?

Not at all

Perfectly

What are the classifications of an UTI

Upper versus lower

Complicated versus uncomplicated

How well did you know this?

Not at all

Perfectly

Where are upper UTI’s located and the S/S

Renal parenchyma, pelvis, and ureters

Typically causes fever, chills, flank pain

Example:

Pyelonephritis: inflammation of renal parenchyma and collecting system.

How well did you know this?

Not at all

Perfectly

Lower UTI

Usually no systemic manifestations

Examples:

Cystitis: inflammation of bladder

Urethritis: inflammation of the urethra

How well did you know this?

Not at all

Perfectly

Upper vs Lower Picture

How well did you know this?

Not at all

Perfectly

What is an uncomplicated UTI

Occurs in otherwise normal urinary tract

Usually involves only the bladder

How well did you know this?

Not at all

Perfectly

What is a complicated UTI

Coexists with presence of:

Obstruction

Stones

Catheters

Diabetes/neurologic disease

Pregnancy-induced changes

Recurrent infection

How well did you know this?

Not at all

Perfectly

Alteration of defense mechanisms increases risk of contracting UTI Predisposing factors

Factors increasing urinary stasis

Foreign bodies

How well did you know this?

Not at all

Perfectly

Examples of Factors increasing urinary stasis

BPH

tumor

neurogenic bladder

How well did you know this?

Not at all

Perfectly

Examples of foreign bodies

catheters

calculi

instrumentation

How well did you know this?

Not at all

Perfectly

Predisposing factors Anatomic factors examples

obesity

congenital defects

fistula

How well did you know this?

Not at all

Perfectly

Predisposing factors Compromising immune response factors

examples

age

HIV

diabetes

How well did you know this?

Not at all

Perfectly

Predisposing factors Functional disorders

examples

constipation- Due to make it harder for bladder to empty completely

How well did you know this?

Not at all

Perfectly

Other causes examples

pregnancy

multiple sex partners

Hospital-acquired UTI

accounts for 31% of all nosocomial infections

Causes:

Often: E. coli

Seldom: Pseudomonas species

Catheter-acquired UTIs

Bacteria biofilms develop on inner surface of catheter

Symptoms

Urinary frequency

Abnormally frequent (more often than every 2 hours)

Urgency

Sudden strong desire to void immediately

Incontinence

Loss or leakage of urine

Bladder storage:

Nocturia

Waking up two or more times at night to void

Nocturnal enuresis

Loss of urine during sleep

Bladder emptying

Weak stream

Hesitancy

Difficulty starting the urine stream

Intermittency
Interruption of urinary stream during voiding
Postvoid dribbling
Urine loss after completion of voiding
Urinary retention
Inability to empty urine from bladder
Dysuria
Difficulty voiding

Clinical manifestations in the older adult

Symptoms often absent

Nonlocalized abdominal discomfort rather than dysuria

Cognitive impairment possible

Fever less likely

Diagnostic Studies

History and physical examination

Dipstick urinalysis

Identify presence of nitrites, WBCs,
and leukocyte esterase

Urine for culture and sensitivity
(if indicated)

Imaging studies

CT urography or ultrasonography when obstruction suspected

Drug therapy

Antibiotics

Selected on empiric therapy or results of sensitivity testing

Uncomplicated cystitis

Short-term course (1 to 3 days)

Complicated UTIs

Long-term treatment (7 to 14 days)

Antibiotics

Trimethoprim/sulfamethoxazole (TMP/SMX)- Bactrim

Nitrofurantoin (Macrodantin)

Ampicillin

amoxicillin

cephalosporins

Fluoroquinolones

Trimethoprim/sulfamethoxazole (TMP/SMX)- Bactrim

Used to treat uncomplicated or initial UTI

Inexpensive

Taken twice a day- 3 days

Nitrofurantoin (Macrodantin)

Given three or four times a day

Long-acting preparation (Macrobid) is taken twice daily

amoxicillin

***interferes wih oral birth control***

Fluoroquinolones

Treat complicated UTIs Example: ciprofloxacin (Cipro)

Antifungals

Amphotericin or fluconazole UTIs secondary to fungi

Urinary analgesic

Phenazopyridine (Pyridium) Used in combination with antibiotics Provides soothing effect on urinary tract mucosa Avoid long-term use ***Stains urine reddish orange*** Can be mistaken for blood and may stain underclothing

Other Urinary analgesic

Methenamine/phenyl salicylate (Urised) Used in combination with antibiotics Used to relieve UTI symptoms Preparations with methylene blue tint urine blue or green

Nursing Assessment

History Objective data Fever Hematuria, foul-smelling urine, tender, enlarged kidney Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP

Planning

Patient will have: Relief from lower urinary tract symptoms Prevention of upper urinary tract involvement Prevention of recurrence

Nursing Implementation

Health promotion Recognize individuals at risk Debilitated persons Older adults Underlying diseases (HIV, diabetes) Taking immunosuppressive drug or corticosteroids

Health promotion

Emptying bladder regularly and completely Evacuating bowel regularly Wiping perineal area front to back Drinking adequate fluids (person’s weight in pounds/2) Twenty percent of fluid comes from food Cranberry juice or cranberry tablets may reduce the number of UTIs Avoid unnecessary catheterization and early removal of indwelling catheters Aseptic technique must be followed during instrumentation procedures Wash hands before and after contact Wear gloves for care of urinary system Routine and thorough perineal care for all hospitalized patients Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals

Acute intervention

Adequate fluid intake Patient may think condition will worsen because of discomfort Dilutes urine, making bladder less irritable Flushes out bacteria before they can colonize Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods Potential bladder irritants Application of local heat to suprapubic or lower back may relieve discomfort Emphasize taking full course of antibiotics despite disappearance of symptoms Second or reduced dosage of a drug may be ordered after initial course in susceptible patients Instruct patient to monitor for signs of improvement and decrease in or cessation of symptoms Counsel on persistence of lower tract symptoms beyond treatment or onset of flank pain or fever: should be reported immediately

Ambulatory and home care

``` Emphasize importance of compliance with drug regimen Take as ordered Maintain adequate fluids Regular voiding (every 3 to 4 hours) Void after intercourse ``` Temporarily discontinue use of contraceptive diaphragm Instruct on follow-up care Recurrence of symptoms: typically 1 to 2 weeks after therapy