Urinary Tract Infections Flashcards
What is an UTI
Most common bacterial infection in women
At least 20% of women will develop a UTI during their lifetime
What pathogen causes UTI’s
Escherichia coli most common pathogen
Fungal and parasitic infections can cause UTIs
Who is t risk?
Immunosuppressed
Diabetic
Having undergone multiple antibiotic courses
Have traveled to developing countries
What are the classifications of an UTI
Upper versus lower
Complicated versus uncomplicated
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.
Lower UTI
Usually no systemic manifestations
Examples:
Cystitis: inflammation of bladder
Urethritis: inflammation of the urethra
Upper vs Lower Picture
What is an uncomplicated UTI
Occurs in otherwise normal urinary tract
Usually involves only the bladder
What is a complicated UTI
Coexists with presence of:
Obstruction
Stones
Catheters
Diabetes/neurologic disease
Pregnancy-induced changes
Recurrent infection
Alteration of defense mechanisms increases risk of contracting UTI Predisposing factors
Factors increasing urinary stasis
Foreign bodies
Examples of Factors increasing urinary stasis
BPH
tumor
neurogenic bladder
Examples of foreign bodies
catheters
calculi
instrumentation
Predisposing factors Anatomic factors examples
obesity
congenital defects
fistula
Predisposing factors Compromising immune response factors
examples
age
HIV
diabetes
Predisposing factors Functional disorders
examples
constipation- Due to make it harder for bladder to empty completely
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
