Urinary tract infections, obstructions 3a Flashcards
Urinary Tract Infections
Infection and inflammation of the urinary tract caused by pathogenic
microorganisms.
• Urinary tract is normally sterile above the urethra.
• Upper UTI:
kidneys (interstitial nephritis), ureters (acute and chronic pyelonephritis), renal abscesses
Lower UTI
: bladder (cystitis) and urethra (urethritis), prostate gland (bacterial prostatitis)
Uncomplicated infection
confined to bladder
Complicated infection
presence of obstruction, stones, catheters, recurrent infections, co-morbidities of diabetes or neurological issues. Patient at risk of pyelonephritis, urosepsis, and renal damage
UTI - Aetiology and
Pathophysiology
Sterility of the bladder is usually maintained
by: urethra, urine flow, uretero-vesical
junction, antibacterial enzymes and antibodies,
and mucosal cells of bladder.
• Infection only develops when bacterial
virulence overcomes normal host defences
mechanisms.
• Lower UTI’s caused by dysfunction or
abnormalities to these mechanisms.
• Most UTI’s stem from faecal organisms that
ascend from the perineum to the urethra and
the bladder to adhere to the mucosal surfaces.
• Can be transferred via bloodstream or
lymphatic system
Clinical Manifestations: Lower UTI
Uncomplicated: • Pain and burning upon urination. • Frequency. • Urgency. • Nocturia. • Haematuria, cloudy, smelly urine. • Suprapubic or pelvic pain. • Children – low fever, irritability, new day or night wetting, feeding problems in babies. Complicated: • Symptoms range from asymptomatic to septic shock.
UTI Diagnostic Studies
Urine cultures: MSU or CSU • Cellular studies: haematuria and pyuria • Evaluation for sexually transmitted infections (SIT’s) or vaginitis infections (can have similar symptoms to UTI’s) • Other diagnostic tests: intravenous pyelogram (IVP), cystoscopy, ultrasound
Uncomplicated UTI medical management
Antibiotics o Trimethoprim/sulfamethoxazole (Bactrim, Septrin) o Nitrofurantoin •Urinary analgesic o Phenazopyridine •Patient teaching •Adequate fluid intake (1.5 L/day)
Complicated UTI medical management
Repeat U/A • Urine culture & sensitivity • May need imaging of urinary tract • Antibiotics – may include sensitivity guided AB’s or 3-6 month AB regime • Prophylactic or suppressive antibiotics • Patient teaching • Adequate fluid intake (1.5 L/day)
UTI Prevention Alternative Therapies
- Cranberry Juice
- Probiotics
- Non-steroidal Anti-inflammatory Drugs
- Oestrogen
- Vitamin C
- Immunotherapy
Nursing Management UTI
Nursing Diagnosis:
Impaired urinary elimination related to effects of urinary tract
infection as evidenced by pain and burning on urination
Nursing interventions: Management UTI
Relieving pain
• Administer antibiotics and antispasmodic medications as needed and prescribed
• Apply heat to perineum
• Urinary alkaliser (ural) sachets
• Adequate hydration
• Frequent voiding to empty bladder
• Teach patient to avoid urinary tract irritants
• Monitoring and managing potential complications
Nursing Diagnosis: Deficient knowledge related to factors predisposing patient to
infection and sepsis
Nursing interventions
Education
• Administration of medications
• Appropriate hygiene, i.e.. wiping from front to back for women
• Encourage the patient to void regularly
• Voiding before and after sexual intercourse
• Recognise symptoms of recurrent UTI or sepsis (fever, warm flushed skin,
hyperventilation)
• Cranberry juice – what is the evidence?
Catheter Associated Urinary Tract Infections (CAUTI)
- Common in surgical patients
- Inappropriate use
- Kept in for too long
- Poor hygiene
- Insertion method
