UTI/Pyelonephritis (Exam 3) Flashcards
UTI Patho
cystitis is an inflammation or infection of urinary bladder; with infection is UTI
interstitial cystitis is a chronic inflammation of the lower urinary tract (bladder, urethra, adjacent pelvic muscles)
cystitis may sometimes occur as a complication of other disorders like gynecological cancers, PID, endometriosis, Crohns, diverticulitis, lupus, TB
Uncomplicated UTI
infection (typically E.Coli in 90% of cases) in a healthy, non pregnant, pre-menopausal female pt with anatomically and functionally normal urinary tract
Noninfectious Inflammation Causes (UTI)
chemical exposure
radiation therapy
immunologic responses in chronic inflammatory diseases
UTI Causes
bacteria
viruses
fungi
parasites
UTI S/S
increased frequency or urgency in voiding
urgency and pain/discomfort on urination
change in COC; presence of (pus) WBCs or RBCs
abdominal or back pain
bladder distention
feelings of incomplete bladder emptying
voiding in small amounts or inability to urinate
difficulty in initiating urination
urinary meatus inflammation
prostate gland changes or tenderness
UTI S/S Older Adults
the symptoms of UTI may be as vague as increasing mental confusion or unexplained falls
sudden onset or worsening of incontinence may be an early symptom
fever, tachycardia, tachypnea, hypotension even w/o urinary symptoms may be sign of urosepsis
loss of appetite, nocturia and dysuria are common symptoms
UTI Risk Factors
female (short urethra)
older adults (decreased estrogen promotes atrophy of urethral opening)
sex
frequent use of feminine hygiene products
poorly fitted diaphragm
synthetic underwear and pantyhose
wet bathing suits
frequent baths/hot tubs
catheters
diabetes
UTI Labs and Diagnostics
elevated plasma WBCs
clean catch urine sample*
urinalysis (leukocyte esterase and nitrates; positive for UTI)
urine C&S (bacteria in urine)
review C&S reports to identify what antibiotic the organism is susceptible to and ensure pt is on correct antibiotic
Clean Catch Urine Sample
self clean before voiding
initiate voiding after cleaning; pt then stood and resumed voiding into container
pt anatomy should never touch lip or inner aspect of container
only 1 oz (30 mL) is needed
UTI Meds
antibiotics (in uncomplicated UTIs, a 3-day course of oral antibiotic treatment is recommended; TMP-SMX, nitrofurantoin, fosfomycin)
analgesics (phenazopyridine) or antipyretics may be used to promote comfort (urine may turn orange)
antispasmodics may be used to decrease bladder spasm and promote complete bladder emptying in certain chronic conditions or with recurrent UTI
antifungal agents (amphotericin B) in daily bladder instillations and ketoconazole in oral form may be used if infecting microbe is fungal
UTI Nursing Care
diet therapy*
warm sitz baths to relieve perineal discomfort
teach about antibiotic use (take full course even if feeling better, may take probiotic, manage SE like nausea)
expect changes in color/texture of urine with some treatments or UTI progression
use appropriate techniques to prevent discomfort with sex and how to prevent postcoital infections; empty bladder and wash before and after sex
adequate fluids to maintain urine color as clear or light yellow
clean the perineum after peeing
empty bladder as soon as urge is felt
avoid irritants such as caffeine, carbonated bevs, tomato products, chemicals in bath water, vaginal washes or scented toilet tissue
seek prompt medical care if symptoms recur
pregnant women with cystitis require prompt and aggressive antibiotic treatment because infection can lead to preterm labor/birth
UTI Diet Therapy
ensure sufficient fluid intake to maintain clear or light yellow urine (2-3 L/day) unless CI in chronic condition
cranberry juice or tabs (reduce bacteria adherence to urinary tract) taken daily may reduce frequency or recurrent UTIs but should be avoided with interstitial cystitis (bladder pain); tabs may be more effective than juice
